Effects of antidepressants on suicidal thoughts and behavior differ by age group
Research Activities, August 2012, No. 384
The U.S. Food and Drug Administration has issued black box warnings on the use of antidepressants by children, adolescents, and young adults. These warnings were based on the occurrence of suicidal thoughts and attempts, not on actual suicides. A re-analysis of data from 41 previous studies that included 9,185 patients has found no evidence of increased suicide risk in children and adolescents ages 7-18 receiving active medication. Relative to placebo, depression symptoms lessened among treated patients in this group. However, unlike the older population, there was no greater decrease of suicidal thoughts and behavior in treated versus control subjects.
It's unclear why some youths whose depressive symptoms are reduced continue to have suicidal ideation and behavior. The authors suggest that perhaps other psychopathology, such as aggressive impulsive traits in youths, plays a more important role in this. Nevertheless, the overall rate of suicidal thoughts and attempts was not significantly greater than that of youths randomized to placebo in the study.
The findings were based on a synthesis of 41 adult, geriatric, and youth trials of the antidepressant drugs, fluoxetine and venlafaxine. Only fluoxetine was administered to youth. Despite a strong association between depression severity and suicide risk in youths, treatment with fluoxetine did not decrease suicide risk beyond that observed with placebo. By contrast, with older patients receiving either fluoxetine or venlafaxine treatment, there was a greater reduction in suicide risk relative to control patients receiving placebo. The effect of treatment on depression severity appears to be the mechanism whereby antidepressants lower suicide risk in adult and geriatric patients. This study was supported, in part, by the Agency for Healthcare Research and Quality (HS16973).
See "Suicidal thoughts and behavior with antidepressant treatment. Reanalyis of the randomized placebo-controlled studies of fluoxetine and venlafaxine," by Robert Gibbons, Ph.D., Hendricks Brown, Ph.D., Kwan Hur, Ph.D., and others in the Archives of General Psychiatry published online February 6, 2012.