Antidepressants Do Raise Kids' Suicide Risk: Study

Finding supports recent FDA moves to highlight the drugs' dangers

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By Amanda Gardner
HealthDay Reporter

MONDAY, Aug. 7, 2006 (HealthDay News) -- There's new evidence that the use of common antidepressants boosts suicide risk for children and adolescents.

A study involving nearly 5,500 adults and children found that children aged 6 to 18 who were treated with antidepressants were 1.5 times more likely to attempt suicide, and 15 times more likely to die of the attempt, than individuals not treated with an antidepressant. No such trend was seen among adults who used the drugs.

"This reinforces what the [U.S.] Food and Drug Administration has been warning about for the last couple of years," said Dr. Mark Olfson, lead author of the study and professor of clinical psychiatry at the New York State Psychiatric Institute at Columbia University Medical Center in New York City.

"Parents and teachers and health care professionals should pay close attention to changes in mood and actions of depressed children and take them seriously if they do report that they feel more anxious or restless or develop thoughts of wanting to harm themselves," he added.

In particular, children and adolescents who used antidepressants seemed to be at heightened risk for suicide in the period after a hospitalization, especially if they were just starting on antidepressants, Olfson said. The risk appeared to be linked to certain types of antidepressants and not others.

Another expert agreed that the findings support a link between antidepressants and pediatric suicide.

"It appears that there are still reasons to be concerned about the antidepressant treatment of child and adolescent depression," said Alec Miller, chief of child and adolescent psychology at Montefiore Medical Center in New York City.

Pediatric use of antidepressant medications -- especially a newer class of drugs called selective serotonin reuptake inhibitors (SSRIs) -- has been the subject of extended controversy.

In October 2004, the FDA directed manufacturers of SSRIs, which include Celexa, Paxil, Prozac and Zoloft, to put a special "black box" warning on the drugs' labeling. The warning would alert health care providers to an increased risk of suicidality in children and teens using the medications.

In July 2005, the FDA issued a public health advisory that raised the possibility that the risk of suicidality also applied to adults taking SSRIs, after several studies pointed to that possibility.

Much of the previous research had focused on users' suicidal thoughts and actions. This study, published in the August issue of Archives of General Psychiatry, takes the analysis a step further.

"Here, we're focusing on things that are at the far more severe end of the spectrum," Olfson said. "Kids coming into the emergency room following suicide attempts and those who actually die. These are things that are many, many times less common, thankfully, than the sorts of things that have been studied."

Olfson and his colleagues looked at nearly 5,500 Medicaid beneficiaries across the country who had received inpatient treatment for depression. They then divided the group into those who had received antidepressants and those who had not.

They found higher risks for suicide attempts and completed suicides among children taking certain antidepressants, including a 15-fold higher likelihood of death in young people who attempt suicide while taking the drugs.

The authors warned that the statistics on suicide deaths were based on only eight people. These eight may have been among the sickest, which may have skewed the results.

There were some differences between type of antidepressant. Venlafaxine (Effexor) -- a serotonin-norepinephrine reuptake inhibitor (SNRI) -- was associated with 2.3 times the risk of suicide attempts compared with no drug treatment at all. Tricyclic antidepressants were also significantly linked with suicide attempts.

With the exception of Zoloft, selective serotonin reuptake inhibitors (SSRIs), were not significantly associated with suicide attempts, the study found.

It's likely that the differences in suicidality among children were, in fact, due to the drugs they were taking, Olfson said.

"In order to be due to the depression, there would have to be differences in depression between groups," Olfson said. "I can't completely exclude that possibility, and those that are more severely ill get more medications, but I think if depression were responsible, we would expect to find the same kind of relationships in adults. The fact that we see it with kids should raise our concern about this risk."

Miller, who is also an associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in New York City, said children battling depression need more and better treatment options.

The Columbia study "makes the argument for really establishing more effective psychosocial interventions so that we don't need to rely on medication treatment," he said, adding that "there are more and more data suggesting that dialectical behavior psychotherapy is an effective treatment for suicidal patients."

More information

The U.S. National Institute of Mental Health has more on treating mental disorders in children.

SOURCES: Mark Olfson, M.D., M.P.H., professor of clinical psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York City; Alec Miller, Psy.D., chief, child and adolescent psychology, Montefiore Medical Center, and associate professor of psychiatry and behavioral sciences, Albert Einstein College of Medicine, both New York City; August 2006, Archives of General Psychiatry

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