Antidepressants and the Risk of Youth Suicide, July 2007
Overview
Do teenagers who take antidepressant drugs run a higher risk of attempting or committing suicide? The U.S. Food and Drug Administration (FDA) thought so, and in 2005 they ordered warnings to be placed on all packages. Since then, teen suicide rates in the U.S. have jumped by more than 10%, leading some experts to worry that more young people are committing suicide because they are not receiving antidepressants to calm their suicidal thoughts. The FDA remains unconvinced, and recently expanded its label warnings to include adults up to the age of 25. Who’s right?
What problem is being addressed?
Suicide is a leading cause of death in adolescence, and depressed teens are at high risk of suicide. A newer class of antidepressant drugs called SSRIs (selective serotonin reuptake inhibitors) is now being widely used to treat more severe cases of major depression. These drugs, which include Prozac™, Zoloft™ and Paxil™, work by allowing the body to make more efficient use of serotonin, a chemical in the brain that can affect mood and behaviour.
Some studies have suggested a link between antidepressant use and suicide. One said people using antidepressants are twice as likely to attempt suicide. Other studies have found antidepressants reduce the risk of suicide, including a 2006 study that found suicide rates in the U.S. to be lowest in counties where antidepressant use was highest.
What is the real scientific evidence?
When researchers assessed the results of multiple studies of antidepressant use in children and teenagers, they found that there were many problems with the studies that made it difficult to interpret their individual results.
Most of the results were based on reports by young people who said they felt like killing themselves, talked about killing themselves, or engaged in acts of self-harm that may or may not have been suicide attempts.
What the media did not report is that not one teen taking part in a clinical trial of antidepressant drugs ever committed suicide.
The researchers who reviewed the studies concluded that, from the evidence available, there may be a short-term risk of suicidal thinking or planning in children and adolescents with major depression.
It is important to note that many of the drug trials specifically excluded participants who expressed a desire to kill themselves or who had made a serious attempt to do so. Thus, it is not clear whether or not the antidepressant drugs may have a role in increasing the likelihood that a child or teen will attempt or actually commit suicide, or if the depression itself causes the behaviour.
It is known, however, that depressed children and especially teenagers, are at high risk of killing themselves. Treating them with antidepressants will alleviate their symptoms of depression, but careful monitoring and questioning of the child or teen about suicidal thinking by their parents and the professionals treating them is essential to guard against the remote possibility that the treatment could trigger suicidal thinking.
Further studies that don’t exclude participants who voice suicidal thoughts, and that use strict definitions of what constitutes suicidal thoughts or acts, are needed, so that better assessments can be made of genuine risks of suicide.
Reference:
Dubicka B, Hadley S, Roberts C. Suicidal behavior in youths with depression treated with new-generation antidepressants. A meta-analysis. British Journal of Psychiatry 2006, 189: 393-398.
