How Asthma Medication Can Cause Suicidal Thoughts

What is depression?

You may "feel down" at times; everybody does. But the feelings of sadness, hopelessness, and worthlessness persist for long periods when you have depression. Consequently, you may have a reduced quality of life. You may also get suicidal thoughts when you have depression. Typically, the condition may be caused by factors such as major events in personal and professional life. 

You may witness the following signs:

• Fatigue and loss of energy 

• Difficulty concentrating and making decisions

• Feelings of guilt and worthlessness 

• Recurrent thoughts of death and suicide 

• Slowed movement and speech

• Loss of appetite

• Loss of sexual desire

• Unintentional weight loss or gain 

• Reduced pleasure and interest in activities that may have fascinated you previously

• Sleeping too little or too much 

Causes of depression

Numerous factors could cause depression. These include:

• Changes in the brain's chemical properties: Emotions are regulated by chemical changes in the brain. Abrupt changes in the chemical composition of the brain may lead to mood disorders such as depression.

• Abuse: You may be vulnerable to depression following physical, sexual, and emotional abuse when you were younger. 

• Age: Older adults may be at a higher risk of developing depression. Issues with old age, such as isolation, may bring on depression. 

• Certain medications: Some medications may make you depressed as a side effect. Before taking any medication, it is important to consult your doctor. 

• Genes: Depression may run in the family. 

• Gender: Women are nearly twice as likely as men to be diagnosed with depression.  

• Substance misuse: Drug abuse is also a risk factor for developing depression. For instance, abusing alcohol may only aggravate depression symptoms.

• Specific illnesses: In some cases, depression may be triggered by particular illnesses, such as chronic heart disease and diabetes. It may also occur as a side effect of specific medications. Sometimes, adjusting to major life changes due to disease may also trigger depression.

• Major events: Life changes may also cause the condition — whether they are good or bad. You may develop depression if you have trouble adjusting to a new reality. 

• Death or a loss: Typically, death and major losses are accompanied by grief. The grieving process should end with the acceptance of the new status. Failure to adjust to the new reality could lead to depression. 

Depression is one of the main causes of reduced quality of life worldwide. The World Health Organization reports that the condition affects teenagers, children, and adults. 

Can depression make your asthma worse?

Research on depression and asthma has demonstrated that individuals with asthma demonstrate lower quality of life. While no studies have directly linked asthma to depression, studies have found that depression occurs in up to 45% of individuals with asthma. Additionally, a 2010 study demonstrated suicide rates in individuals with asthma at more than double that of individuals without asthma. These rates, while alarming, underscore the need for increased mental health services, through the lens of physical health difficulties.¹ ²

Strong emotions such as stress may trigger an asthma attack. Mood disorders such as anxiety and depression may also accompany strong emotions like guilt. Therefore, depression and asthma may occur together when you are faced with highly emotional circumstances.

Notably, strong emotions during conditions such as depression may trigger asthma — but only if you already have asthma. Changes in breathing often occur even in individuals who do not have asthma.

The following emotions and actions may trigger asthma:

• Crying

• Yelling

• Laughter

• Excitement

• Fear

• Anger

It is important to note that no emotion causes asthma. However, breathing changes when you are emotional could trigger specific asthma symptoms — for instance, the tightening of smooth muscles along the breathing tract could lead to blockage of airflow.

Developing self-awareness is necessary when you have asthma. It is best to consult your doctor to identify key triggers and develop an effective asthma management plan.

Stress reduction is, therefore, a good strategy in asthma management. You can use the following strategies to reduce stress:

Mindful breathing: The technique involves meditation by focusing on breathing. You can use the strategy by following the steps below:

• First, breathe in and out slowly.

• Let your breath flow in easily through your nose and mouth.

• Inhale for a fixed period (for example, 7 seconds), and hold your breath for the same duration. It is best to exhale for the same period.

• Focus on breathing until you stop obsessing over particular ideas.

• Repeat the process a few times.

Observation: Observation is also a meditation technique that may enable you to reduce stress-related asthma attacks. Follow the steps below to use the technique:

• Select an object present in your environment.

• Focus on the selected object by watching it for a few minutes.

• Suitable objects for the exercise may include a tree, the sky, or an insect.

• It is best to avoid doing other things besides observing the selected object.

• It will help to look at the object as if it is your first time seeing it.

• Focus on the observation for as long as possible.

Is your asthma making you depressed?

Asthma attacks may be frightening. They may also be exhausting, especially if you are new to the condition. Severe attacks may also make you anxious.

Your quality of life may also be reduced. It may be difficult to undertake particular social and professional duties, especially if the attacks are severe. Sometimes, you may need to take some time off from commitments such as school and work.

Therefore, having asthma is a risk factor for being depressed — it may be difficult to adjust to radical life changes that may come along with the condition. Mood disorders such as anxiety and depression are more common in people with asthma compared to the general population, with up to 45% of asthmatics having depression or depressive symptoms. Moreover, having both asthma and the presence of depression and anxiety results in poorer controlled asthma and increased healthcare use. 

Asthma — depression cycle

Depression may make it difficult to manage your asthma. This condition comes with disorganization and the inability to fulfill particular duties in your life. As a result, your asthma symptoms may get worse. Consequently, your depression may intensify due to the discomfort and risk you are exposed to with increased asthma attacks.

Tips to break the asthma-depression cycle

The asthma-depression cycle may make it difficult to manage either condition.

Fortunately, you can apply the strategies below to break the cycle:

1. Consult with your doctor about your feelings: It will help to consult your doctor on the best strategies to manage depression — medications, therapy, or a mixed approach.

2. Consult with your doctor about your asthma symptoms: It is best to talk to your doctor about the asthma action plan. It may also be helpful to review whether you are good at using the inhaler. Testing your understanding is necessary for making the action plan effective.

3. Consider small steps that will help you improve your mood: It may be helpful to take small steps to increase activity and socialization. You can therefore engage in actions such as calling a friend, taking a walk, or participating in community events such as sports.

4. Share your feelings with others with asthma: Depression may worsen when people around you fail to understand you. Meeting other people with asthma and depression may have numerous benefits, such as the ones listed below:

• Using platforms such as support groups where you can share your thoughts and experiences will reassure you that you are not alone. It is necessary to have an understanding community available for you at all times.

• Meeting other people will also allow you to express your feelings freely. It will help you reflect on issues you have overlooked before and in a safe environment.

• You may also gather new information by sharing. Platforms such as a support group will enable you to learn more about issues you may witness and effective ways of managing particular challenges.

• The strategy will also protect you from isolation. Being withdrawn may escalate problems such as depression.

• You may also regain hope by sharing your experiences with others. You may derive motivation from the progress made by others in depression management.

• Sharing may also enable you to develop self-awareness through reflection. You could then leverage your strengths to manage both asthma and depression better.

Is depression a side effect of asthma medicines?

You may experience depression symptoms once you start taking asthma medications. It is best to report issues such as anxiety and loss of motivation to your doctor. Your doctor will help you identify the root causes of depression and manage it well. The doctor may also apply strategies such as changing the dosage of a specific medication to make you feel better.

Specific interventions in asthma management may have the side effects discussed below:

Asthma reliever inhalers: Your doctor may prescribe the use of salbutamol medications to relieve asthma attacks. Ideally, you should not have to rely on your asthma reliever regularly, as the aim would be to have your asthma well controlled with preventative medications. Salbutamol works by relaxing muscles in the breathing system — whose intense contractions lead to blockage. While there are no mental health risks associated with salbutamol use, research has shown that those who use their salbutamol inhalers more frequently have higher rates of depression. However, this is more likely due to the underlying cause of having more poorly controlled asthma.

The medication may be given as tablets, an inhaler, or a nebulizer. The side effects of using asthma preventers include:

• Shaking

• Headache

• Increased heartbeat

Asthma preventers: Asthma preventers are usually inhalers that contain long-acting beta blockers similar to salbutamol and corticosteroids. 

Steroid inhalers or tablets: Corticosteroids are another type of medication used to treat asthma. They can be inhaled, injected, or given in tablet form. Their action in the body is to reduce swelling and inflammation. Due to their side effects, they are only used for moderate to severe asthma, in small amounts and for as short a duration as possible. 

The medications may come with specific side effects — including anxiety, depression, insomnia, and, rarely, psychosis. It has been found that long-term use of corticosteroids, both tablet and inhaled forms, is associated with increased rates of anxiety and depression.  

Montelukast: The medication may be used for asthma management and specific allergies that affect the breathing system. In the last decade, there have been concerns about whether the use of montelukast results in higher neuropsychiatric events such as increased depression, aggression, or suicide. Given this, there is an FDA warning, cautioning the use in patients at risk of mental health conditions and for the medication to be immediately ceased if mental health side effects occur. Later studies now seem to suggest that the association with neuropsychiatric events may be overstated, but more research is needed.³

The long-term effects you may witness after using the medication are discussed below.

What are the long-term effects of montelukast?

Montelukast is a medication used for asthma treatment. It is often sold under the brand name Singulair, among others. 

The medication may be used to control and prevent asthma symptoms. For instance, it may be used before exercise to prevent symptoms such as wheezing. It may also be used for general conditions that affect the breathing system, such as hay fever and allergic rhinitis. Your doctor may require you to use the medication regularly to get the best results. 

Specifically, the medication works by blocking specific natural substances — leukotrienes. Leukotrienes may worsen allergies in the breathing system. Therefore, montelukast works by reducing inflammation along the airways.

Montelukast comes along with side effects such as the ones listed below:

• Cough

• Trouble swallowing

• Stuffy or runny nose

• Loss of voice

• Difficulty breathing

• Tenderness or pain around the eyes and cheekbones

• Pain, redness, or swelling in the ear

• Stomach pain

• Tender, swollen glands in the neck

• Body aches or pain

• Unusual tiredness or weakness

• Voice changes

• Headache

• Dryness or soreness of the throat

• Fever

It is best to consult your doctor if you experience any of the side effects listed above.

Overall, the medication is accompanied by several side effects. Your doctor may only recommend it when the benefits outweigh the involved risks. Only use the medication with your doctor's approval. In case of anxiety and other mood problems, it is best to consult your doctor immediately.  

What you can do if you suffer from asthma and depression

The consequences of asthma and depression can be serious and can lead to increased suicide risk. Because of this, it is important to take care of your mental health as well as your physical health symptoms. If you have symptoms of depression or are experiencing suicidal thoughts,  many treatment options are available. 

One method of treating depression is through medications such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and even antipsychotic medications or ketamine treatments in more severe cases. Medications can help you to feel more stable and in control of your symptoms, and they are often a great complement to other treatments, such as psychotherapy and lifestyle changes.

The lowdown

Depression is a mood disorder that comes along with strong emotions such as sadness and hopelessness. It may make asthma symptoms worse.

Both asthma and depression are affected by emotions. Strong emotions may cause troubled breathing. Consequently, you witness increased frequency and severity of asthma attacks when you are depressed.

An asthma-depression cycle is then created. Depression makes asthma attacks more severe. The frustration and fear that may come along with asthma attacks could increase depression.

Fortunately, depression is treatable using various methods, such as medication, relaxation and breathing techniques, and psychotherapy. Your doctor may also wish to review your asthma medications, as sometimes side effects of these medications, such as inhaled corticosteroids and montelukast, can increase anxiety and depressive symptoms.