Antidepressants & Suicide Risk in Tweens and Teens
When it comes to prescribing antidepressants to children, is one regimen safer than another? According to a new Pediatrics study, the answer appears to be no; the (relatively low) risk of suicidal acts among children using selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications is roughly the same.
For the study, researchers examined medical data on nearly 21,000 Canadian children ages 10 to 18 with a depression diagnosis (and, in some cases, co-occurring psychiatric disorders), who started taking an antidepressant between 1997 and 2005. During the first year of use of a single antidepressant, 266 children attempted suicide and three died as a result of suicide.
Using fluoxetine—the most widely prescribed antidepressant—as a benchmark, the researchers found no meaningful differences in the rate of suicide attempts for other SSRIs (including citalopram, fluvoxamine, paroxetine and sertraline). And tricyclics showed similar risks. Too few children used monoamine oxidase inhibitors (MAOIs), so these drugs could not be studied. For various reasons, bupropion, escitalopram and duloxetine were not studied.
The researchers conclude that their analysis "supports the decision of the Food and Drug Administration [FDA] to include all antidepressants in the black box warning regarding suicidality risk for children and adolescents initiating use of antidepressants." The Black Box Warning highlights an increased risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders.
It's important to note that depression itself raises the risk of suicide. In fact, experts point out that untreated depression is the bigger worry. Many believe that antidepressant therapy reduces suicidal attempts.
Suicide Prevention
If your son or daughter is starting an antidepressant, switching antidepressants or changing doses, it's important to monitor your child and to work closely with the health care provider. After starting an antidepressant, the FDA recommends that your child see his or her doctor
Once a week for the first 4 weeks
Every 2 weeks for the next 4 weeks
After taking the antidepressant for 12 weeks
After 12 weeks, follow your health care provider's advice about how often to come back
If problems or questions arise, see your child's health care provider more often. Contact the doctor right away, if your child exhibits any of the following signs for the first time, or if they seem worse: thoughts about suicide or dying, suicide attempts, new or worse depression, agitation, irritability or restlessness, panic attacks, insomnia, aggressive behavior, anger, violence or other unusual changes in behavior.
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