Thursday, 09 February 2012 19:20

In 2004, concerns about antidepressant drugs increasing suicidal thoughts and behaviors in young patients prompted the FDA to issue a rare "black box warning." Now, eight years later, a new analysis of clinical trial data finds that treatment with the antidepressant fluoxetine (Prozac) did not increase — or decrease — suicidality in children compared to treatment with a placebo. An analysis of data involving 9,000 patients also found that antidepressant drugs were effective at reducing suicidal behavior and depressive symptoms in adult and geriatric patients. These findings were published online Monday, February 7, in the journal Archives of General Psychiatry.

The primary author of the study, Robert Gibbons, PhD, said that the failure to replicate the link between antidepressants and suicide in young patients 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.

As for adult and geriatric patients, the study demonstrated that antidepressants were effective in reducing suicide risk and depression symptoms, suggesting that the drugs reduced suicidality by alleviating depression. In analyzing the effects of antidepressants in children, the researchers found that no significant change in suicide risk was detected between the two patient groups (fluoxetine or placebo). "I think that this paper supports the general idea that the effects of antidepressants in kids and adults are not really the same, since we don't see anything but beneficial effects of antidepressants in adults and geriatrics."

Nevertheless, the finding that use of antidepressants does not increase the risk of suicide in children is very significant. At least since 2004, parents considering antidepressants for their children have had to balance the potential beneficial effects against the supposed increased risk of suicidality. Now that it has been demonstrated that use of antidepressants does not increase the risk of suicide among children, hopefully parents and clinicians can make an informed decision regarding use of antidepressants without having to add another (now unfounded) worry that use of the drugs would increase the potential for suicide.  The decision to incorporate antidepressants in a treatment plan is difficult enough.  With these new study findings, this decision need not be made more difficult for parents.