Antidepressants in the U.S. carry a FDA “black box” warning that children taking depression medication may become suicidal when taking depression medication. Exactly how antidepressants impact teenage suicide risk is a matter of some debate. Certainly such warnings should be taken seriously, but does the suicide risk outweigh the benefits of depression medication?
The FDA Antidepressant Warning
The U.S. Food and Drug Administration initially ordered the black box warning for ten antidepressants in March of 2004. The ten depression medications in question were:
- bupropion (Wellbutrin / Zyban)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- fluvoxamine (Luvox)
- mirtazapine (Remeron)
- nefazodoe (Serzone)
- paroxetine (Paxil)
- Sertraline (Zoloft)
- venlafaxine (Effexor).
Almost a year later, in February 2005, the FDA updated the warning, requiring black box warnings on all antidepressants. Some critics of the decision claim that politics were behind the decision more than medical science, as political pressure had been placed on the FDA to take some type of action regarding antidepressants, children and suicide risks.
Study Results for Depression, Suicide and Antidepressants
Evidence for a relationship between suicide and depression medication often conflicts. On the one hand, the FDA examined the results of multiple antidepressant trials that reported suicidal behavior in children (including suicidal attempts, suicidal thoughts and similar behaviors). None of the suicide events reported succeeded.
The FDA concluded that suicidal behavior amongst children taking second generation antidepressants was approximately four percent, compared to the rate of suicidal depression seen in children taking placebos, which was only two percent.
These results are at odds with other reports, which claim that communities with higher than normal antidepressant use have lower suicide rates, and that suicidal behavior drops when people take depression medication. Further research is required to determine if these seemingly contradictory results can be reconciled.
Teenage and Childhood Suicide Statistics
Teens have a high suicide risk, with suicide the second leading cause of death amongst U.S. adolescents. 500,000 teens attempt suicide in the U.S. every year, and 5,000 succeed. Depression and suicide are closely linked: depression is a factor in two thirds of all suicides.
Antidepressants: Suicide Risk or Prevention
The link between antidepressants, suicide and depression is a complex one. It’s possible for depression medication to worsen depression symptoms and trigger suicidal thoughts and behavior. Untreated depression, however, is also a serious suicide risk. When severe depression causes suicidal behavior antidepressants often provide faster relief than psychotherapy. The risk of suicidal behavior in people taking antidepressants appears to decrease as people age.
Further complicating the matter is the fact that the FDA warning is not a warning against prescribing children depression medication. Instead, the warning recommends that children and teens taking depression medication be watched for signs of suicide.
Sadly, there are no easy answers to this dilemma. Parents and health providers need to balance the potential risk against the potential benefits of antidepressants. The risk of suicidal behavior in depressed children is highest in the first few weeks of treatment, or when dosage is increased. Parents should learn to recognize suicidal behavior and signs of teenage depression.
Resources
MedicineNet. (Retrieved 19 September, 2009). Antidepressants and Suicide, FDA Warns
Simon, G. (Retrieved 19 September, 2009). The Antidepressant Quandary: Considering Suicide Risk when Treating Adolescent Depression
Disclaimer: The information contained within this article is for informational purposes only, and is not intended to be a substitute in any way for care and treatment by a qualified health professional.
Michael McGrath - Michael McGrath began providing web content shortly after finishing his graduate degree in English at the University of Alberta. His broad ...
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