Effect of antidepressants on suicide risk in children and adolescents
- C Scott Moreland, DO
C Scott Moreland, DO
- Clinical Assistant Professor
- Baylor College of Medicine
- Liza Bonin, PhD
Liza Bonin, PhD
- Associate Professor of Pediatrics and Psychiatry
- Baylor College of Medicine
There is concern that selective serotonin reuptake inhibitors (SSRIs) and other antidepressants may increase the risk of suicidal ideation and behavior in children, adolescents, and adults younger than 25 years [1-3]. In early 2004, the US Food and Drug Administration (FDA) in the United States asked manufacturers of a number of antidepressants to make labeling changes to include a warning about a possible increased risk of suicidal ideation or behavior, particularly at the initiation of therapy or at the time of dose changes . After further analysis, in October 2004, the FDA directed manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors) to include a warning stating that antidepressants may increase the risk of suicidal ideation and behavior in children and adolescents .
Establishing the causal association is difficult because of the clear associations between severe depression and suicide and between severe depression and the need for antidepressant therapy. Because suicide is uncommon, it also is difficult to demonstrate the negative, which is that antidepressants do not cause suicide. Risk factors for suicidal behavior in children and adolescents are discussed separately. (See "Suicidal behavior in children and adolescents: Epidemiology and risk factors", section on 'Psychiatric disorder'.)
This topic discusses the evidence regarding antidepressants and the risk of suicide in children and adolescents. The use of antidepressants in adolescent depression is discussed separately, as is the association between antidepressants and suicide risk in adults. (See "Pediatric unipolar depression and pharmacotherapy: Choosing a medication" and "Effect of antidepressants on suicide risk in adults".)
EVIDENCE OF ASSOCIATION
Overview — Evidence for and against an association between antidepressant therapy and suicidal thoughts and/or behaviors in children, adolescents, and young adults comes from randomized trials [6-10], observational studies [11-13], and population-based studies comparing the rates of suicide and antidepressant use over time [14-18]. Each of these study designs has limitations in demonstrating a causal association [19,20]:
●Suicide is rare in randomized, controlled trials of antidepressants. Thus, individual trials typically lack the power to detect a relationship between antidepressants and suicidal ideation or behavior.
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