Adults suffering severe depression are two-and-a-half times more likely to attempt suicide if they are taking antidepressants compared with a placebo drug.
That's according to new research published in international medical journal Psychotherapy and Psychosomatics.
This comes as the number of New Zealanders being prescribed antidepressants has increased dramatically in the past three years - despite little evidence the drugs are helping curb the country's alarming suicide rates.
An expert says these findings only confirm what we already know - that antidepressants are not a "silver bullet" and should only be given as a second line of treatment after therapy and with caution.
Psychotherapist Kyle MacDonald stressed it was really important people prescribed antidepressants didn't panic because they still work for some people.
"This is a population-based study looking at trend. It doesn't reflect every individual case - if antidepressants are working for you, keep taking them," MacDonald said.
The study, led by Zurich University of Applied Sciences and Paracelsus Medical University of Salzburg, showed about one in 200 people who started taking one of 14 antidepressant drugs approved by the US Food and Drug Administration (FDA) had attempted to take their own life due to side effects of the drug.
One particular drug that researchers looked at was called Mirtazapine, which was FDA approved in 1996 and is prescribed in New Zealand. Of the 2425 people who were prescribed the drug, 29 had attempted suicide and eight had died by taking their own life.
Researchers compared that with the 494 people suffering severe depression who were taking a placebo drug - a "fake" treatment like a sugar pill. Of those, three attempted suicide and none took their own life.
For Stephen Ferguson these findings are not surprising.
The 63-year-old Timaru man was taking venlafaxine, another antidepressant included in the study, for a year after finding a homicide victim and separating from his wife of 13 years.
'Seven years of medicated hell': One in eight Kiwis prescribed antidepressants
He described his experience of taking the drug as "the most horrific time" of his life.
"It took me away from who I am and I was miserable," Ferguson said.
He said his GP prescribed the antidepressant without any offer of counselling and no additional support.
"I wasn't told of any of the possible side effects, like I used to get these awful brain zaps and whenever I forgot to take the drugs, even just for a day, I'd have major withdrawals."
Ferguson said he didn't have any suicidal thoughts on the drug but he could see how people could.
"For me suicide was just not an option I believed in. But for someone who wasn't equipped to deal with it or who was in a worse state than I was, I could see how easy it would be to give up."
MacDonald said for a long time now New Zealand had taken the wrong approach to treating mental health.
"The first line of treatment should be talk therapy and then antidepressants should be added in if the health professional thinks they need it but not without support."
He added: "I think they have become so culturally accepted that I think it is possible to get a bit blase about them."
MacDonald said he hoped this issue would be addressed with the new measures outlined in the Wellbeing Budget providing better access to mental health support at a community level.
Mental Health advocate Mike King spoke briefly to the Herald about his battle with depression.
"I went off my meds in October last year because I didn't think I needed them any more. Over the ensuing months I went from being stable to slowly travelling downhill until three-and-a-half weeks ago when I had a massive breakdown."
King said he went back to seeing his psychiatrist and then back on medication and has seen improvement.
"Does that mean meds are good for everyone? No, of course not. Does that mean I endorse their use? No, of course not.
"What works for some people doesn't work for others and vice versa."
Mental Health Foundation chief executive Shaun Robinson said antidepressants could be helpful to many people but they do not work for everyone and should never be seen as the total response for those living with mental distress.
"The focus needs to be on a holistic response to the person's circumstances. That could include talk therapies, peer support, practical life assistance, wellbeing practices and medications to help aid recovery."
There was no single issue that creates suicidal behaviour, Robinson said, and people prescribing antidepressants need better training and support to recognise the full range of risks.
"This includes clear communication when initially prescribing medication and also when it comes to reducing or stopping antidepressants.
"People with lived experience have long been calling for greater support for people when they choose to come off meds."
The Herald approached the Ministry of Health for comment but has not received a response.
• The number of New Zealanders aged 15 and over-prescribed antidepressants has surged by 21 per cent in seven years, from 10.4 per cent in 2008 to 12.6 per cent in 2015.
• Pākehā women aged 65 and older were the highest users with 22.8 per cent nationwide prescribed antidepressants in 2015.
• Mental health experts say these figures have increased dramatically in the past three years.
• Researchers say there's no evidence the increased use of the drugs has curbed New Zealand's alarming suicide rates.
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Samaritans 0800 726 666
• If it is an emergency and you feel like you or someone else is at risk, call 111.