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Singulair increases risk of Suicide? Don't just poo-poo the possibility

This analysis is solely the work of the author. It has not been edited or endorsed by GLG
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Analysis By:David Engler, MD
Physician, The Allergy Clinic

Implications: It is difficult to imagine why taking Singulair would increase the risk that someone would complete suicide. After all, what does a leukotriene receptor antagonist have to do with mental health? I don't know. But doctors, ask yourself, have you ever had a Singulair patient stop taking it because it caused headaches? I have had dozens of them stop taking it because of headaches. When they attempt to try it again, the headache comes back. But the package insert says that the risk of headache is no greater than it is in people who took placebo. Try explaining that to the patient who got the headache--it's very real to them.

Analysis: The story about Singulair and suicide may be based on some cause-effect relationship. I don't know what that is, but I will tell you story of a patient I saw last week. She is a 19 year old college student, with the usual stresses of college. I have been treating her for asthma and allergies since she was 10 years old, and she had been on Singulair for about 5 years.

She was treated in the town's ER for an intentional Tylenol overdose; she took 15 of them for a headache that wouldn't go away. The usual charcoal to the stomach, with Mucomyst to protect the liver from the Tylenol went fine. While under evaluation, the ER doc also noticed she had been "cutting" her wrists and arms. She said that it relieved stress.

They asked her about the Singulair and she said it gave her bad dreams. Astutely, they stopped it. All this happened a week or so before the recent news headlines.

Is that cause and effect? No way....but remember that MRK is the same company that still denies that Vioxx can increase the risk of heart attack. Oh yeah, Vioxx. That drug would have been great as a niche drug if given to treat pain in those already at risk of a GI bleed. But, no, MRK was encouraging dentists to give it out for toothaches, and most patients in my practice who were on it had no history of GI bleed. MRK wanted Vioxx to be a billion-dollar blockbuster; had it been marketed appropriately, it may still be on the market.

So how will I change my prescribing habits? For patients who have a psychiatric history, including those who take antidepressants, I'll mention the story of this patient to those on Singulair and start asking questions to try to determine if they are brittle or fragile from a psychiatric standpoint.

This may be much ado about nothing, but what if it's not? I've learned to stop drinking the drug company Kool Aid without a few grains of salt.

Trying to figure out if my back pain is like others. The pain is in the lower left side and groin area of both hips. I have trouble reaching my feet to put on shoes and socks. Ive been on Lipitor 20 for about 5 years and have never had a problem before. This started about 6 months ago and even with heat and stretching it seems to get worse. It hurts when I stand for any length of time. It hurts to walk or run. It hurts very badly if I try to straddle something like an ATV or a horse. When I sleep (if I can) I sometimes have to put a pillow between my legs and lay on my side because it hurts a lot to bring my legs together. Feel free to email me at ******

I am disheartened but not surprised that so many doctors are dismissing these reports of symptoms that patients have had after taking Singulair. The only reports that I have found to share with you are from Europe and Canada. All of these reports pre-date the recent news stories regarding Singulair and suicide.

In addition to those reports, the most important thing that I have posted is the reference to the fact that Merck itself recognizes that there are genetics differences among patients that are directly linked to the potential efficacy of Singulair (montelukast). I posted a British reports on that subject and a reference to Merck's clinical trial where they studied genetical differences and montelukast.

The best thing that we can do is to try to convince our doctors that this is not politics -- the major does not have to rule. Why do European countries publish frequent reports on all adverse drugs reactions not just those of the majority of the people? One size does not fit all.

The actual incident of headache in all users according to European reports is 18-19%. So when I read that headache, adverse drug reaction to a leukotriene receptor antagonist (Singulair) is then treated by ibuprofen (a Cox-2 inhibitor), which of course gets treated for stomach inflammation or GERD by Nexium or another drug-histamine receptor antagonist, then I wonder what the hell is left to inhibit? So if a patient does not fit the profile of the 80%, do we have to make that patient catatonic (meant figuratively)? I realize that this leaves out all of the receptors that aren't affected by any of these drugs but I am just trying to make a point.

So why does Merck list headache as just one of the side effects in a category of side effects just listed as greater than 1%? And why do so many people believe that there is no scientific proof of any of the complaints that we see here at this site?

Follow up to my post earlier today...

I took the my son to the doctor this morning and he was somewhat dismissive of the recent reports on Singulair...says he's had a lot of kids on the drug and never heard a peep about side effects until last week when the report on suicidal tendencies showed up. He did advise that when these kinds of behavior changes happen after a new drug is started he would recommend that we stop taking the drug no matter what it was, but I still felt uncomfortable with his response to us.

I felt like he was accusing me of making it up or only coming up with it because of recent news and message board posts. In fact, I made the appointment BEFORE I saw the posts. I was worried about his behavior BEFORE I saw the posts. It's just that seeing the stories from everyone else basically confirmed my suspicions that it might be the drug causing the problems.

I feel like I definitely wasted OVER AN HOUR waiting for a doctor to spend five minutes making me feel small.

Last night was the last time my son will take the drug, and I don't care what the doctors think of me.

After reading the recent news reports and reading other parents opinions on Singulair I thought I should be fair to the company, and to other parents seeking advice on this drug, to write about our POSITIVE experience with Singulair. Our 7 year old son was diagnosed with seasonal Asthma when he was 3. We have him on the Ventilator and Advair. During spring time allergy season he would begin wheezing and coughing on a regular basis. We would then give him his puffers. While it would relieve him of the wheezing he would be quite hyper and out of control. Therefore, our goal was to wean him off the puffers. We added Claritin to his diet each day. When he was 5 he struggled through his spring soccer season. As the months went by he looked tired, very sickly, and worn out. His coach recommended that we investigate Singulair. It really turned his child's life around! We talked to our doctor about it. She wasn't familiar with children using Singulair but she prescribed the 5mg chewable but recommended that he use both puffers before his soccer games. We followed her advice. He took his Singulair before bed and the puffers before the game. Sadly, we noticed that he was completely "out of it" during his games. He had no focus (not shocking for a 6 year old boy), no real interest in the game, and no energy. We just assumed it was because he was tired after a full day of school. One day we forgot his puffers but decided to let him play anyway. He had a great game. During a daytime tournament he was back to having his head in the clouds, so for the second game we decided to "forget" his puffers again. He played a great game. But best of all..no breathing problems. We decided to omit the puffers for the rest of the season and just use Singulair. It worked wonderful for him. None of the side effects that the other parents have described. We use it when spring begins and for the the first part of the fall season. He doesn't use it during the winter months. We are experiencing a real dry March so I started the Singulair on Tuesday. Then all of the negative comments came out. I certainly will not dismiss the concerns of the product. We are watching him closely to make sure there are no negative side effects. So far, so good. And no need for the puffers!

I have posted before but wanted to update. Singulair ruined my life for nearly 2 years, but I did not realize it was the reason until about 2 months ago. About 4 months after being on singulair, I sought treatment for severe depression and anxiety. My docs/psychs thought that it was a delayed reaction to the death of my father a couple of years earlier, so we did lots of therapy and 3 different psych meds trying to help me adjust. After all this (and one suicide attempt), I was finally just starting to accept that I was a miserable excuse for a human being, and I should get used to the fact that my life was going to suck from here on out. Then, I developed GERD and could not see my regular doc. The new doc told me to research all my meds (I was taking FOUR a day at that point, including the singulair...I am 27...) to find out if any could be the cause. That was when I found out what singulair can do, and that it could be the cost of my problems. My doc checked my charts, and sure enough, I started taking it shortly before I developed all of these "psychological problems". I've been off singulair for 2 months and my psych meds for a month (had to wean off). I finally feel like myself again after two years of hell!!!! I still have a slightly foggy head and problems concentrating sometimes, but what can I expect? I've been on mind-altering drugs for a couple of years. I hope things continue to improve. Never again will I take any drugs without doing *thorough* research (not just reading the hand out that comes with it..when I started singulair, there was no information about all these problems on the leaflet).

I just took my daughter to the doctor for her 8 year check up. As her pediatrician was looking through the chart, she noticed she takes singulair and said that 1 of her patients had just informed her about the recent news story about the suicide connection, she said to have my daughter stop taking it and she would look up some info and call me. My daughter had been diagnosed with "possible asthma" when she was 2 and I gave her singulair during allergy seasons, but when she wasn't taking it I noticed the night time coughing would happen occasionally and she would have times where she was short of breath. I believe at about 6 we started to give her singulair all the time. The coughing and shortness of breath did stop. Now that I've been informed of these side effects, (I had previously asked pharmacists & doctors several times and all assured me it was completely safe to take) I wonder if some of her attitude/moodiness could be related to this drug. Then I remembered a time a couple months ago when she was frantic about my husband leaving for the weekend...she was staying with her grandparents, whom she loves and has stayed w/ her whole life. For a week before she was absolutely hysterical, crying and saying she didn't want us to leave, she had a bad feeling she couldn't explain. We tried to understand her feelings, but could find no reasonable explanation. She came to me the day before we left and said" if you go, I'll kill myself." This bothered me coming from my 7 year old daughter, but I spoke to her about what she said, what it actually meant etc. Now months later I can only wonder, but am taking her off the drug and we'll see if anything changes.

I'm a 47 year old male and have been on 20Mg Daily Lipitor for about 4 years. Everything was mostly fine until about 1 year ago when I started experiencing severe hip and groin pain. I played hockey regularly up until that time and assumed the problem was a hockey related injury, though never remember any specific incident that may have been directly responsible. I told my doctor I thought it was a sports hernia because the symptoms and suspected cause held a close resemblance. X-Rays, MRI and Bone Scans were all negative. Physical Therapy was a useless waste of money. I was in agony for over a year and barely able to walk some days. Could no longer participate in hockey or other sports. Even coaching youth sports was a challenge due to the pain that greatly limited my mobility. The maddening part of it all was the doctor's had no explanation and just wanted me to continue with Physical Therapy. My wife casually suggested to me that maybe it was the Lipitor as she had heard some recent news on TV related to Lipitor and muscle pain. I told her she was being ridiculous and that's when I started to do some internet research and came across this site. It's all starting to add up. I've been off Lipitor for a week and the pain on my left hip is almost completely gone while the pain on the right side has shown significant improvement. While I am seriously happy that I think I have found the cause of my pain, I am incredibly angry that not a single doctor (I saw a total of 3) even suggested the possibility that the problem might be the Lipitor. They all new I was taking it. I know the drug has had highly positive affect on most people and saves lives but I feel that I've lost a year of my life to it.

I can't believe what I am reading. My son, who is 10 now has been on this med for 5 years now. The same amount of time that he has been dx with ad/hd. He started a new med for adhd this past summer and was doing wonderful, at the same time I had run out of Zyrtec for a couple of months and was giving him Claritin instead. Well we got a Zyrtec prescription on Oct. 1 and since then his behavior has went down hill. I thought that the adhd med had just stopped working, now I am wondering if it is the Zyrtec. The time the med seemed to stop being effective is the same time we had the Zyrtec filled. I am taking him off of it immediately. He has been angry, smart mouthed, disrespectful. Doesn't listen to anything I say. This summer and even until last month was wonderful. He did what I asked the first time, I didn't have to repeat myself, and he was calmer and nicer. I can't wait to see if this is the cause of a lot of his problems.