Antidepressants do raise kids' suicide risk: study

[Guest guest]

inding supports recent FDA moves to highlight the drugs' dangers By

Gardner

HealthDay Reporter

(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 ,

chief of child and adolescent medicine at Montefiore Medical Center/Albert

Einstein College of Medicine, 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. "

, who is also an associate professor of psychiatry and behavioral at

Albert Einstein College of Medicine, 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. "

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 , Psy.D., associate professor of psychiatry and behavioral sciences,

and chief, child and adolescent medicine, Montefiore Medical Center/Albert

Einstein College of Medicine, New York City; August 2006, Archives of General

Psychiatry

Remember, news summaries provide general information only. They are not

meant to endorse the findings or recommendations of any group, nor are they

meant to replace professional advice or imply coverage of specific clinical

services or products.

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