Some reports link certain asthma medications to a risk of suicidal ideation, which is when a person thinks about or wants to end their life. Specifically, there are concerns that montelukast (Singulair) could cause this side effect.

In 2020, the Food and Drug Administration (FDA) issued a boxed warning advising doctors to avoid prescribing montelukast to individuals with only mild symptoms or who could take other medications.

Some studies also link theophylline (Elixophyllin) and corticosteroids to suicidal ideation, but research notes that more studies are necessary to determine their safety.

This article discusses the link between asthma medications and suicidal ideation, drugs that may carry this risk, and whether the effects go away. It also explains the risk factors for suicidal ideation, signs a person may be thinking about suicide, and when to seek help.

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Yes, some asthma medications may cause significant mood changes, including suicidal ideation.

The FDA has warned the public that one particular asthma medication may cause suicidal ideation as a side effect. There are some associations between suicidal ideation and other asthma drugs, too. However, research on these medications has had mixed results.

More research is necessary to determine whether other asthma treatments can cause depression or suicidal thoughts.

Below are some asthma drugs that may carry a risk of causing suicidal ideation.


Montelukast is an asthma medication that blocks inflammation. In 2020, the FDA issued a boxed warning for the generic medication as well as the brand name Singulair.

The FDA has recommended that doctors avoid prescribing montelukast unless their patient cannot tolerate other drugs. The warning also advises doctors to refrain from prescribing the drug to people with mild asthma symptoms.

The most recent warning strengthens an earlier FDA warning from 2008, which stated that there is a connection between mental health conditions, including suicidal ideation, and montelukast. This was a response to continued reports of suicidal thoughts or actions and other adverse events in people taking montelukast.


Theophylline (Elixophyllin) is an asthma medication that widens the airways. An older 2012 study that involved 664 people with asthma explored the association between theophylline and suicidal ideation.

Within 2 weeks of taking theophylline, 11.5% of those participating in the study reported suicidal ideation. The results suggest that those who take the medication have an increased risk.


Corticosteroids are anti-inflammatory medications with a wide range of uses, including asthma treatment. An older 2000 review linked corticosteroids to depression and other adverse psychiatric effects.

Suicidal thoughts can affect a person’s emotions, behavior, and speech. A person who is experiencing suicidal ideation may feel:

  • extreme sadness, agitation, anxiety, or rage
  • trapped, hopeless, or that they have no reason to live
  • empty or numb
  • unbearable emotion or physical pain

These moods may change dramatically, causing extreme mood changes.

In conversation, a person thinking about suicide may express:

  • intense shame or guilt
  • being a burden to others
  • wanting to die

They may also exhibit changes in their behavior, such as:

  • taking dangerous risks
  • using alcohol or drugs more frequently
  • eating or sleeping more or less than usual
  • withdrawing from friends, making a will, giving away important items, and saying goodbye
  • researching or planning ways to die

Some specific mood and behavior changes that montelukast can cause in adults or children include:

  • irritability or agitation
  • aggression or hostility
  • vivid bad dreams
  • disorientation or confusion
  • hallucinations
  • insomnia
  • sleepwalking
  • difficulty with memory or focus
  • stuttering
  • tremors or shaking
  • involuntary muscle movements

Medical News Today asked Dr. Zeeshan Afzal of Welzo, an online pharmacy and home healthcare platform, for his perspective.

“When a person experiences suicidal ideation as a side effect of asthma medications, it is important to speak with their healthcare professional immediately,” he said.

“The duration of the side effect may vary depending on the individual and the medication, but they should stop the medication at once and seek medical attention as soon as possible.”

If a person has any of the above signs, they could be experiencing significant medication side effects and may be thinking about suicide.

Even if they are not considering suicide, these signs still indicate that the person needs immediate medical treatment. Speak with a doctor right away if these symptoms develop. If they are affecting someone else, help them get medical attention.

If a person is at immediate risk of a suicide attempt, follow the directions below, and tell emergency responders which medications they are taking.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Learn more about supporting someone with suicidal thoughts.

The FDA states that experts do not yet know what factors increase the risk of a person experiencing suicidal thoughts as a result of taking montelukast.

However, it is important to note that doctors can prescribe montelukast for long-term asthma treatment in people ages 1 year and above. This means many people who take the drug are children or teenagers.

This is important to note, as people may overlook signs of suicidal ideation in young children. In adolescents, they may mistake symptoms of depression as part of puberty.

However, extreme mood changes, severe anxiety, rage, guilt, or numbness are not typical at any age — they indicate that a person may need help.

Other risk factors for suicidal ideation more generally include having:

  • depression or other mental health conditions
  • substance use disorder
  • a history of suicide attempts
  • a family history of suicide or mental health conditions
  • exposure to others’ suicidal behavior
  • exposure to family violence, including sexual abuse
  • long-term physical pain
  • recently left prison
  • guns or other weapons in the home

There are alternatives to medications that carry a risk of mood changes or suicidal ideation. These include inhaled bronchodilators and biologics.

“Bronchodilators are a class of asthma medications that can help relieve bronchospasms and improve breathing through relaxing and opening air passages,” said Afzal. “An example of a bronchodilator is the beta-2 adrenergic antagonist albuterol (ProAir).”

“Biologics are a newer type of asthma medication that can help individuals with moderate to severe asthma symptoms that other medications do not control well,” added Afzal. “They target specific immune system proteins that can contribute to airway inflammation. An example of a biologic for asthma is omalizumab (Xolair).”

It is important to work with a doctor to determine the most appropriate treatment plan based on someone’s asthma symptoms, medical history, and other factors.

A link exists between certain asthma medications and suicidal ideation. Because of sufficient reports of the problem from people taking montelukast (Singulair), the FDA has issued a boxed warning that advises doctors not to prescribe it for mild asthma.

Other drugs that may increase the risk of mood changes or suicidal thoughts include theophylline (Elixophyllin) and corticosteroids. More studies are necessary to verify this, as not all studies have had the same results.

Alternative asthma medications are available. A doctor can determine which one may be appropriate for someone’s needs.

Anyone who is experiencing significant mood or behavioral changes after starting or stopping a medication should get immediate help.