Depression Drugs and Suicide

Antidepressant link with suicide in adolescents not seen in new research

(RxWiki News) For the last few years, a possible link between suicide and antidepressant drugs in young people has been debated in the medical community.

After a 2004 study suggested that antidepressants increased suicidal thoughts and behaviors in those 25 years old and younger, the Federal Drug Administration issued a rare "black box" warning.

But new clinical analysis has failed to replicate any such link, and is reassuring doctors about medically treating seriously depressed youth.

"Ask your doctor about the risks of antidepressants in children."

Robert Gibbons, PhD, of the University of Chicago Medicine, led a recent analysis of 41 different clinical trials and more than 9,000 patients. Results showed that treatment of depression in children with the antidepressant fluoxetine did not increase, or decrease, suicidality compared to a placebo.

Fluoxetine is a serotonin reuptake inhibitor marketed as Prozac or Sarafem, and was the only antidepressant approved for pediatric use until recently. To analyze its effects on children, the researchers used four trials of the drug. 

Once again, a reduction in depressive symptoms was observed in the drug-treated population compared to placebo. However, no significant change in suicide risk was detected between the two patient groups.

The analysis also found that two different popular antidepressant drugs were effective at reducing both depressive and suicidal symptoms, in adult and geriatric patients. Gibbons says that these results should reassure doctors about prescribing these drugs to depressed patients.

"The key finding here, when we re-analyze all the patient-level longitudinal records in these studies, is that antidepressants neither increase nor decrease suicidal thoughts or behavior in children," Gibbons said.

The UCM analysis used individual-level, longitudinal data from the previous clinical trials, some of it unpublished. The data included weekly screenings of each trial participant for depression and suicidal thoughts, which allowed researchers to compare the effect of the drug versus a placebo over a length of time.

While a reduction in depressive symptoms was seen in those who took the drug rather than placebo, no significant change in suicide risk was observed between the two groups. 

"Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants," Gibbons said.

"Basically, the results say that the mechanism by which the antidepressants affect suicide rates is by decreasing depression," Gibbons said. "It follows that if a treatment is not working for an individual, the risk for suicidal behavior and perhaps worse remains high."

He added that the paper supports the general idea that antidepressant results in kids and adults are not the same. In adults and geriatrics only beneficial results are seen; with kids, the researchers did not see a harmful effect but did see a disassociation between the beneficial effects on depression, and those on suicide.

Gibbons was on the FDA panel that considered placing black box warnings on antidepressants, and hopes this new research will reassure clinicians about the safety of these drugs.

Findings were published in the February 2012 issue of the Archives of General Psychiatry.

Review Date: 
February 9, 2012