Antidepressant drugs increase risk of suicide in teens.
Only one clinical study has shown a statistically significant increase in suicide risk in teenagers on antidepressants. All other studies show a non- statistically significant doubling of suicide risk in this patient population.
In 2006, the US FDA published the results of a meta-analysis evaluating the relationship between antidepressant drugs and suicidality in pediatric patients (2). Data from 24 placebo controlled antidepressant clinical trials submitted to the FDA which included a total 4,582 patients were analyzed.
Fortunately, there were no completed suicides. Only one of these 24 studies showed a statistically significant excessive suicide risk (1). All other studies had a doubling of the risk of suicide but not at the level needed to meet statistical significance. The FDA concluded that antidepressants are associated with a ‘modest’ increased risk of suicidality.
The study that did show a statistically significant difference in suicide risk was called the Treatment for Adolescents with Depression Study (TADS). The study compared the rates of physical, psychiatric, and suicide-related events in adolescents treated with fluoxetine alone, cognitive-behavioral therapy, combination treatment or placebo. Suicidal ideation improved overall, with greatest improvement in the adolescents taking fluoxetine and doing cognitive-beahvioral therapy. However the the fluoxetine treated group had a statistically significantly higher risk of suicide related events.
Possible mechanisms linking antidepressant to suicidal behavior have been proposed, including an energizing effect of antidepressants that allows patients with depression to act on suicidal impulses, side-effects of the medication and a paradoxical worsening of depression.
The challenge with this meta-analysis is that it was a post-hoc analysis that only involved 16 weeks of follow up. The overall interpretation of the findings and the implications for clinical practice are thought to be unclear as the scientific community is divided about the strength of the signal for antidepressant-induced suicidality. In view of this the FDA has not contraindicated antidepressant drugs for pediatric use. The FDA has introduced new labelling that warns of the risk of suicidality and encourages prescribers to balance this risk with clinical need.
In summary, the scientific community is divided about the clinical interpretation of the risk of suicide in teenagers on anti-depressants. The FDA recommends caution but does not contraindicate use of antidepressants in teenage patients.
- Emslie G, Kratochvil C, Vitiello B, Silva S, Mayes T, McNulty S, Weller E, Waslick B, Casat C, Walkup J, Pathak S, Rohde P, Posner K, March J; Columbia Suicidality Classification Group.; TADS Team Treatment for Adolescents with Depression Study (TADS): safety results. J Am Acad Child Adolesc Psychiatry. 2006 Dec;45(12):1440-55.
- HammadTA,LaughrenT,RacoosinJ. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63(3):332-339.