Child/Adolescent Health

Study provides new evidence linking antidepressants and risk of suicide in depressed children and adolescents

Recent studies have raised concerns that antidepressants paradoxically boost the risk of suicidal behavior among depressed children and adolescents (but not adults). A new study of Medicaid-insured adults and children from all 50 States provides additional evidence of these risks. It found a twofold increased risk of suicide attempts among children treated with any antidepressant medications.

The researchers, affiliated with the Center for Education and Research on Therapeutics at Rutgers University, compared the risk of suicide attempts resulting in injury during the early stages of antidepressant treatment in children and adults. They wanted to find out whether children and adults beginning treatment with antidepressants had different risks of attempting suicide by matching cases (patients who attempted suicide) with controls (patients who did not) similar in age, sex, and race/ethnicity (white or nonwhite, Hispanic or non-Hispanic).

Most of the injuries from suicide attempts for both children and adults (73 percent and 79 percent, respectively) resulted from drug ingestion. The researchers found no significant relationship for adults between use of any antidepressant and more specifically use of any SSRIs (selective serotonin reuptake inhibitors and an increased risk of a suicide attempt. In contrast, for children and adolescents, treatment with any antidepressant was associated with a significant twofold increase in the risk of a suicide attempt.

Also, treatment with any antidepressant significantly was linked to a reduction of two-thirds in suicide risk for adult males, but not for adult females. Although the case-control study found no significant effect of psychotherapy on reducing suicide risk for adults or children, the researchers warn against ignoring therapy on this basis. They note that other controlled studies have shown the effectiveness of psychotherapy in preventing repeat suicide attempts in adults.

The study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS16097) to the Center for Education and Research on Therapeutics (CERT) at Rutgers University. For more information on the CERT program, please visit http://www.ahrq.gov/clinic/certsovr.htm.

More details are in "A case-control study of antidepressants and attempted suicide during early phase treatment of major depressive episodes," by Mark Olfson, M.D., M.P.H., and Steven C. Marcus, Ph.D., in the March 2008 Journal of Clinical Psychiatry 69(3), pp. 425-432.

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