Literature Review

Can Antidepressant Use in Adolescence Increase Suicide rates/thoughts?

A Review of the Literature

Over the past recent years, there have been growing concerns about the use of antidepressants in adolescents (10-17 years of age). All over the world there has been an increase in adolescent depression. Many parents and clinical psychiatrists are beginning to wonder if it is really beneficial for adolescents to be prescribed antidepressants. For parents, if their child is acting differently than he/she normally does, they will take them to a psychiatrist to see if they can do anything about it. Depending on the severity of the situation, the psychiatrist may prescribe an antidepressant. Unfortunately, prescribing an antidepressant to an adolescent may increase suicidal thoughts and/or suicidal completions. This literature review considers whether or not antidepressants are appropriate for use by adolescents and if they do contribute to the increased suicidal thoughts and actions. This review will respond to the following questions:

1. Are antidepressants safe for adolescents?

2. Are the risks of suicide increased as a result of taking antidepressant medication?

3. What is the FDA doing to warn of the risks of suicide with use of antidepressant medication?

Before a child is prescribed an antidepressant, both the parents and the psychiatrist need to understand the risks of suicide associated with the specific antidepressant. Being prescribed an antidepressant at such a young age, the medication may actually make the child worse by increasing suicidal thoughts as well as increasing the chances that the child may actually carry out a suicidal attempt.

Are antidepressants safe for adolescents?

Depression in adolescents can be a very devastating problem for both the child and the parent. Many times, both want to get back to the “normal” life that the child had lead before. In many instances, the parent wants to have the child put on an antidepressant medication to try and “re-balance” the brain. Unfortunately, there are many instances where that doesn’t necessarily occur. Psychiatric drugs can cause a feeling known as akathisia to occur in the person that is taking the drug. Akathisia is “a condition that can make a person commit violent acts-against self or others” (“Alarming Suicide Statistics”). Akathisia causes the patient to have extreme inner restlessness which may cause him/her to want to do anything to get rid of that unbearable feeling. The people that experience this feeling become anxious, agitated, terrified, restless, and sometimes are unable to sleep at night. Mark Olson states that studies have shown that children and adolescents who were “treated with an antidepressant medication were significantly more likely to attempt suicide than those who were not treated with an antidepressant drug” (Olfson, MPH et al.).

Are the risks of suicide increased as a result of taking antidepressant medication?

When it comes to increased suicide rates and antidepressant medication, Robert Gibbons et al. as well as other sources agrees that there may be some sort of correlation. “Suicide is the third leading cause of death in younger adolescents in the United States (10-14 years) and the leading cause of death in this age group in other countries such as China, Sweden, Ireland, Australia, and New Zealand” (Gibbons, Robert D. et al.). Robert Gibbons says that in the United States, about 90% of suicides occurring in youth are associated with psychiatric illness, most commonly a mood disorder (Gibbons). Each antidepressant medication is supposed to contain a warning label that warns about the increase of suicide and suicidal thoughts. The Food and Drug Administration (FDA) “asked manufacturers to change the labels of ten drugs to include stronger cautions and warnings about the need to monitor patients for worsening of depression and the emergence of suicidalityвЂ¦Ð²Ð‚Ñœ (Schimelpfening, Nancy). In children and adolescents, “the risk of suicide attempts was 1.52 times higher after antidepressant drug treatment compared with no antidepressant drug treatment” (Olfson).

Table 1 Risk of suicidal behavior associated with use of SSRIs to treat depression in children and adolescents

________________________________________

Drug

________________________________________ Duration of trial(s) (weeks)

________________________________________ Adverse outcomes (drug v placebo)*

________________________________________ Odds ratio (95% CI)

________________________________________

Fluoxetine

________________________________________ 8

________________________________________ Suicide attempts: 2.4% (6/249) v 1.9% (4/209)

________________________________________ 1.3 (0.4 to 4.4)

________________________________________

Sertraline

________________________________________ 10

________________________________________ Suicide related events (includes suicidal thoughts): 2.7% (5/189) v placebo: 1.1% (2/184)

________________________________________ 2.4 (0.5 to 12.4)

________________________________________

Citalopram