New evidence suggests that antidepressants do not influence suicidal thinking in young people

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In 2004 the US Food and Drug Administration published a “black box” warning that highlighted an increased risk of suicide and suicidal thoughts in young people who were taking antidepressants. This warning was updated in 2007.

A new analysis of 41 randomised controlled trials has been published in the Archives of General Psychiatry, which suggests that antidepressants do not influence suicidal thinking in young people.

The authors set out to determine the short-term safety of antidepressants by standard assessments of suicidal thoughts and behaviour in children, adults, and geriatric populations and the mediating effect of changes in depressive symptoms.

They conducted an intention-to-treat analysis of longitudinal data of depression from 12 adult, 4 geriatric, and 4 youth randomised controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride.

This study draws on a larger data set than the research from 2004, although the data for young people is limited to just fluoxetine (Prozac).

Here’s what they found:

  • Adults had a decreased risk of suicidal thoughts and behaviours while taking an antidepressant
  • Antidepressants neither increased nor decreased suicidal thoughts or behaviour in children
  • In all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behaviour

Professor Robert Gibbons, lead author of the study and Professor of Medicine, Health Studies and Psychiatry at the University of Chicago said:

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.

I hope that the warnings will not prevent depressed children and adults from getting treatment for depression. The greatest cause of suicide is untreated or undiagnosed depression. It’s very important that this condition be recognised and appropriately treated and not discarded because doctors are afraid to be sued.

Gibbons RD, Brown CH, Hur K, Davis JM, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. Published online February 6, 2012. doi:10.1001/archgenpsychiatry.2011.2048