RxISK says doxycycline causes suicide

March 12, 2013 • 12 comments

There have been several reports to RxISK of young men committing suicide on doxycycline. This led us to investigate further. The evidence seems clear – doxycycline can cause someone to commit suicide. We have no idea how often this happens but that it happens is certain.

Given for a skin rash

The first report came from a mother in Australia who reported the death of her teenage son, who had been put on doxycycline for a minor dermatitis affecting his face. RxISK.org takes people through a causality algorithm to establish whether there is a link between their treatment and the adverse event. This algorithm expands on standard causality algorithms in the field such as the Naranjo algorithm. It gives a RxISK score. In this case the algorithm generated a score of 6 which points to a likely link between the treatment and the adverse event.

One of the goals behind  RxISK is to get the person involved or a concerned family member to take a RxISK report to a doctor,  pharmacist or someone else to get a conversation going and to intervene early. In this case, it is too late to prevent an injury but there are important conversations that families still need to have with their doctor or others. If there is agreement between doctor and the family member or the healthcare team that the drug has caused a problem in this case, this is the best evidence there is that the drug likely did cause the problem.

In this case the doctor had been consulted before the RxISK report had been written. The doctor had already written to the Australian drugs regulator, the Therapeutic Goods Administration (TGA). Although her letter did not blame the drug, it offered no other explanation for this death other than the effect of the drug. Her question was ‘did the TGA have any evidence doxycycline could cause suicide?’

In fact the true RxISK score in this case should probably have been a great deal higher than the 6 reported here that pointed to a likely link. It should have been 9 or greater, which points strongly to a link. The reason it should have been higher is that several years beforehand, this young man’s elder brother had also been prescribed doxycycline as an anti-malarial pill. He stopped the drug after experiencing a lot of anxiety, insomnia and feeling ‘not right’.

The family did not make the connection between an anti-malarial drug one son had and the treatment for dermatitis another was put on some years later. If we take this earlier reaction into account, we have evidence for a challenge, de-challenge and re-challenge which would make for compelling evidence for a link between the treatment and the adverse event.

Challenge, de-challenge and re-challenge offers the kind of conclusive evidence for causality that many of us once applied to Christmas tree lightbulbs. Attempts to start the Christmas tree lights after they have been put away for a year often failed. Until the recent replacement of bulbs by LEDs, the next step was to unscrew each bulb in turn and if the lights came on when a particular bulb was unscrewed and went off again when that bulb was screwed back in this was taken as conclusive evidence that this bulb was the cause of the problem.

Challenge, de-challenge and re-challenge operates the same way and it appears very clear in the case of this family.

TGA response

In response to the letter from the family doctor, Dr Hammett of the TGA noted that there had been no reports of completed suicides in Australia, other than this young man’s case. He conceded that there had been 15 or so reports of anxiety reactions. He also noted that there was nothing in the academic literature worldwide suggesting that this drug causes suicide.

This is a standard regulatory response to any questions like this from a doctor, or journalist, or family member. The first point is that regulators will never say a drug has caused a problem. They are still prepared to say that in the case of a limbless baby that the thalidomide its mother was on might have prevented a miscarriage rather than caused limblessness. When a young person hangs themselves on an SSRI,  it is commonly because they are troubled by thoughts of self-harm and test their feelings out by putting their head in a noose which unfortunately can press on the carotid bodies on either side of their neck, cause them to slip out of consciousness and hang themselves in a manner that leaves them almost kneeling. In these cases regulators might raise the possibility that this is auto-erotic asphyxiation gone wrong.

The second thing a regulator will do is contain their search within national boundaries. Had the regulators in this case broadened the search out beyond Australia they would have found compelling evidence from the FDA database on RxISK.org. FDA have 16 reports of completed suicides on doxycycline since 2004, 18 reports of suicidal ideation and 17 reports of suicide attempts. Of the 16 suicides, 3 come from Australia.

Other resources

Had the TGA gone further they might have found a petition on Change.org Doxycycline Causes Suicide in Teens that was put in place by Tara McCarthy after the death of her son Damien. Over 3,800 people have signed up to this requesting that the drug be more appropriately labelled.

On another information site making FDA data on adverse events available, eHealthMe.com, under the heading of suicide attempt there are 111 reports of suicide attempts from the FDA database. The difference in the number of reports between here and RxISK stems primarily from the fact that eHealthMe somewhat confusingly also includes data on doxycycline where doxycycline is not the only drug in the mix. In the case of someone given doxycycline for acne, and also given Roaccutane which is well known to cause suicide, eHealthMe files the event under doxycycline making it difficult to get a clear picture.

Two compelling cases

But aside from the figures, there is more compelling evidence that turns up on Google. Here are two narrative reports that appear uncomplicated by secondary drug intake.

A Mr Davies reported:

“I am a 42 year old male father of two. I started taking Doryx pills for a ruptured cyst several months ago and it did reduce the size and swelling. I have never thought about suicide before but within a few weeks of starting this medicine I have had the idea just pop into my head. I am not sure why – I am healthy and well-off and have a great relationship with my children and friends. I stopped taking the medicine for several months and have not had any ‘thoughts’ since.

Recently I began taking it again after checking the side effects and not finding depression or suicidal tendencies among them. After a couple of days back on it I again started having these thoughts. This prompted me to query Doryx plus suicide on Google and I found this page and a few others that mention others having similar experiences”.

RxISK aims at being the natural home for narratives like this and putting a megaphone in the hands of people who have experiences like this by giving them data on other cases but also engaging them with their doctor, pharmacist or local healthcare community.

A woman called Carrie also reports that:

“My 14 year old daughter just attempted suicide after several months on doxycycline for acne. She now says she has had suicidal ideation since shortly after starting the medication several months ago. Her dose of doxycycline was doubled a few weeks before her suicide attempt. She herself says she was not sad, she had no other signs of depression and does not understand why she felt compelled to kill herself. She gets good grades, is involved with clubs and friends and demonstrates appropriate affection. The timing with doxycycline is just too coincidental to not be connected.”

And more

My personal interest in the issue of doxycycline and suicide was stimulated in the first instance by a colleague who reported very similar reactions. He took doxycycline for malaria prophylaxis when visiting South America some years ago. He noticed that he became anxious and irritable and had a change in personality. He did not connect this change to the drug at the time. He began to suspect the drug when he returned to the UK and stopped taking it.

A year later he visited China and again took doxycycline for malaria prophylaxis. When the same reaction happened a second time he was very clear that the doxycycline was causing the problem. Again the problem cleared up once he was in a position to stop the treatment.

Another report was filed with RxISK on yet another young man, who in this instance was put on doxycycline for mild acne. He took a first course in a low dose for over a year. He later reported to his parents that he had not liked its effects and felt better off it. This looks far more clear retrospectively than it looked at the time to his family. Six months later he went back on doxycycline but this time round was accidentally placed on double the dose and some weeks later committed suicide. His mother compiled a RxISK report but ended up with a much lower score than she should have for two reasons. One was because she was unaware of comparable reactions elsewhere.

The second was she filed the report to indicate her son had not increased the dose when in fact he had. She was right that the package was still labelled doxycycline 50 mg but in fact the pharmacist has accidentally dispensed 100 mg tablets. The aggravation of a problem with an increase in dose is almost as conclusive as the Christmas tree light bulb effect.

Doxycycline & suicide

There is a compelling case that doxycycline can cause people to commit suicide.

At RxISK we are interested in any ideas anyone has as to the mechanism through which it causes suicides. In addition to any other problems doxycylcine may cause, we welcome other reports of suicidal or violent reactions or other strange behaviors linked to it. We are particularly interested in what your experience is like from the inside if anything like this has happened to you.

We are equally interested in any comments about why doxycycline cannot cause suicide and how someone might be mistaken into thinking that it could.

Reporting to RxISK

This story makes clear why report to RxISK.

Reporting to companies alone is pointless. They will bin, distort or degrade even compelling reports to the status of anecdotes.

Reporting to regulators alone, or companies and regulators alone, is also pointless. Regulators will never attempt to establish whether the drug did cause a problem in your case. There is nothing any regulator will ever do to help explain anything to a family or an affected individual. Their job is to regulate the wording of advertisements not to look after the public health in general or get involved in your case in particular.

(We would welcome any reports from anyone who has had anything useful back from a regulator).

The ideal is to report to RxISK and use a RxISK report to engage your doctor in the issue. If both you and your doctor think the drug has caused the problem, regardless of what companies or regulators might say, there is a chance of a successful intervention in a developing problem or getting closure after an injury has happened but there is also the possibility of mobilizing people to make treatment safer. Your doctor can give you more support than anyone. But equally, do not underestimate how much you can do for your doctor – your case may take her back to kind of ideals that brought her into medicine in the first place.

Make Your Voice Heard

Make your voice heard!
Report your experience with prescription drug side effects

Although drug side effects are known to be a leading cause of death and disability, less than 5% of serious drug side effects are reported. Our mission is to capture this missing data directly from patients to help make medicines safer for all of us.

When you report your drug side effect, you also receive a free RxISK Report to take to your doctor or pharmacist. This report serves as a means to initiate a more detailed discussion of your treatment.

At the end of the reporting process, we also provide you with the option to take the information you have reported on RxISK and automatically create a form to send to your country’s health authority — for example, the FDA in the United States, Health Canada in Canada, and Yellow Card in the United Kingdom (more countries will be added soon).


Filed Under: RxISK Stories | 12 comments

Comments (12)

  1. If this really checks out (and it sure looks solid) someone needs to warn the young men and women of the United States military. And fast. Up until 2009, U.S. troops were routinely given mefloquine (Lariam) to prevent malaria. That drug has a terrible reputation, well-deserved, for inducing violence, suicide and psychotic symptoms which in some people may persist for months or years after stopping. As of 2009, the Defense Department, finally giving in to the avalanche of evidence, switched their drug of choice for malaria prevention. To doxycycline.

    Elspeth Ritchie, former lieutenant colonel and DoD’s leading psychiatrist in the field, presided over the mass dosing of soldiers with Lariam for most of the 2000’s. Now, however, she is endeavoring to present the drug as somewhat of a scapegoat. She’s due to lecture at the upcoming American Psychiatric Association convention in May on the psychiatric side effects of two drugs she’s prepared to admit could play a role in military suicides: mefloquine, which is seldom used anymore, and steroids, whose use by active-duty troops is often illicit.

    Ritchie has speculated in Time magazine’s Battlefield blog that the massacre of Afghan civilians carried out by Sgt. Robert Bales in 2012 was due to mefloquine intoxication. But it’s far more likely Robert Bales would have been given doxycycline, not mefloquine in Afghanistan in 2011-2012. In 2011, the Army gave doxycycline to 151,802 soldiers, compared to only 1,780 soldiers who received mefloquine. Meanwhile, the role of multiple antidepressants, antipsychotics, sleep aids and painkillers continues unexamined. Add doxycycline to the list of medications that soldiers and their families need to watch out for.

    Much of my information here comes from the progressive online magazine Truthout – which seems well-sourced on this:

    http://truth-out.org/news/item/8624-former-guantanamo-psychiatrist-promotes-dubious-drug-theory-on-afghan-killings

  2. My son is one of the you g men mentioned above. I also questioned and mentioned the use of Doxy in US Military and the rise of active duty suicides.
    Please read Damein’s story and sign and share our petition.
    http://www.change.org/petitions/doxycycline-causes-suicide-in-teens

  3. I think the Rxisk score will vary from person to person simply because some people are likely to ‘play’down certain effects they have experienced-which is why the score may need to be higher than how it first appears on a report.
    I speak from experience – the report I submitted didnot sound as serious as in fact it was – Only now several months after the event am I actually determining the ‘damage’ my side effect had or potentially could have had- if I hadn’t caught it in time and delivered myself for help. I feel the Rxisk score could well have been alot higher- but I suppose the main thing is I reported it.

  4. I am very interested in this, and the wider purpose of RxISK. However, it is important to capture the reason the drug is given, alongside the drug itself. For instance, doxycycline is prescribed both as an antibiotic and for malaria prophylaxis in the military. The risk associated with use in military personnel who may be exposed to traumatic situations is fundamentally different from antibiotic use, and the potential for suicidality will also vary. Incidentally, doxycycline is also used for acne, and here again there is an enhanced risk of suicide among such patients. I am not dismissing the evidence at all, merely pointing out how the information can be better gathered and used. I am sure that there are many side effects which are under-reported and we should encourage more thorough feedback; but do tie it in with the drug’s use.

    • Perhaps if there is a gap of say one month in between reports – and there could be a follow up report – it would be interesting to see the difference between the reports

  5. I personally have been taking this pill day to day and I have been noticing the effects I have been receiving from this medication. I fell as though I am less anxious and depressed when I do not take it which I got from being off and on the pill many times throughout the past four years. I took the pill today and I have decided to stop.

  6. I was prescribed Doxycline for a respiratory infection. Almost immediately I had serious depression evidenced by weeping, a feeling of sadness, general anxiety as well as nausea.
    I will not take this drug again.

  7. I’ve been in healthcare for 25 years and have cared for a number of people over that time who have been prescribed doxycycline for infection control. Just as there is no scientific evidence presented in any of the above articles and comments, I too will give anecdotal evidence. NONE of the people I cared for developed depression or attempted suicide that I can recall. In the instances listed above I note many are incomplete personal testimonials from parents. What parent is going to admit their child was not perfect? How many times do we hear of someone committing or attempting suicide and their family and friends are perplexed because everything appeared to be fine? We just have seen L’ren Scott commit suicide by hanging herself. Mick Jagger and all her aquaintances were shocked even though it was well known she was having serious Relationship,financial and business problems. I understand the pain and guilt associated with the death of a loved one, especially a child. But in an effort to place blame for the actions of the deceased on anyone BUT the deceased, are these allegations that doxycycline “caused” their suicides legitimate? I have never known a thought to actually kill someone. I’m unsure how a medication is physically capable of loading a gun and firing it. Or hold a knife and slit a wrist. Or tie a noose and force it over a persons head. Or cram other pills down a persons throat. In other words, each individual who attempted or committed suicide had to take a series physical actions to perform the act. No where have I heard in the anecdotal evidence that the individuals were otherwise mentally impaired by using the medication. Since their mental status did not appear to be affected adversely, their actions should still have been able to be controlled by themselves. Why then no call for assistance to those nearby? Why no questions to Doctors, family members or others about these strange new thoughts? In fact, I have heard no anecdotal evidence AT ALL that explains why there has been made a definitive link between taking doxy and suicide much less establishing causality. In no case of suicide EVER has the culprit been the item used to commit it. Inanimate objects are incapable of jumping up and performing an action which would lead to the death of a person. It is ALWAYS the person who performs the action and thus it is the person who is responsible for their own death. This is sad and unfortunate. But it is NOT a reason for people to blame anyone but the individual for their actions. Individual accountability for ones actions has been downplayed in this country for decades. The willingness for people to blame every bad event in their lives on anything but themselves has come into vogue currently. The desire to have rights without responsibilities is seductive because accepting personal accountability is difficult and opens oneself up to recriminations and consequences. Who wants to accept consequences that are negative? However that is exactly what needs to be done here.

    • I’m a mental health nurse in New Zealand near to having prescribing rights. I have no idea of the pharmacodynamics & how it may impact the central nervous system however our national medicines authority notes depression & anxiety as uncommon side effects of doxycycline. I found this out after seeking this info out due to increasing flat affect, consistent low mood and loss of appetite. I will be stopping the medication as I suspect I am experiencing these as side effects. Doxycycline will not ’cause’ suicide however if it precipitates a major depressive episode then it can be linked to a suicide.

  8. *discussion of suicidal thoughts/mental illness below*

    I was on Doxy for about 2 months. I became increasingly paranoid, felt intense anxiety and developed severe symptoms of OCD. The feelings I experienced were horrific. I felt like I was having some kind of nervous breakdown.

    My brain became compulsive. I had music constantly playing in my head (an earworm) and my thoughts would race. I became terrified that I would never have peace in my brain again, and for the first time in my life seriously contemplated shooting myself in the head to get some ‘quiet’. I honestly felt like I would never have a quiet moment again.

    I also suffered from morbid intrusive thoughts and images. I became afraid of hurting myself and others, even though I’ve never self harmed or seriously harmed anyone in my life before.

    I am now off the Doxy and my symptoms are settling down. I am now able to sleep in my own room alone, and am not having nightly panic attacks. The whole experience was terrifying and because of it I have now developed triggers. Seeing or hearing discussion of things such as schizophrenia, bipolar disorder, psychosis etc make me feel ill, as these were the mental illnesses I was convinced I had developed.

    I wish I had been warned by my Dr that there was a possibility for these symptoms. I suffered depression as a teenager and feel that I was possibly more susceptible due to this. I wish my history had been taken into account before I was prescribed such a terrible drug for me.

    I suffered through all of this because I have hormone related pimple breakouts. A nightmare, over achieving clear skin.

  9. My 15 year old daughter started taking 100 mg doxycycline twice daily for acne last summer. After about two months of taking the drug I noticed that my normally type A perfectionist child was becoming even more obsessive and fatalistic. She kept talking about how hopeless everything was and how she was a big disappointment to everyone around her. She obsessed over being a failure and despaired over every decision. This kid with a great sense of humor stopped laughing and seemed unable to experience any joy in her life. The only change in her life/routine I could identify was the doxy (which didn’t seem to be working anyway). I took her off the doxy and within two weeks she began to act like her old self. She laughed more, slept better, started to look forward to things, and began to have friends over again. Incidentally my younger daughter was also on doxy for acne and she never seemed to experience any difficulties from the drug. She is a more laid back kid and not as intense as her older sister. Neither one of them have taken the drug since last fall and I have no intentions of putting them back on it ever again. I hope this is helpful.

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