Antidepressants and suicide are an odd combination. On the one hand, antidepressants reduce depression, which is a major cause of suicide. But – and this is an important “but” – there is also consistent evidence that, in a very small proportion of adolescents and young adults, antidepressants can trigger suicidal thoughts and suicide itself.
Before I continue, I must note that even with the dangers of antidepressants to adolescents and young adults, antidepressants appear to do more good than harm when it comes to suicide prevention. As a result, for most adolescents and young adults it can be more dangerous to not take antidepressants.
And it is also important to note that there is not consistent evidence that antidepressants increase suicide risk at all for adults older than 25. In fact, one study found that depressed adults, especially those older than 65, who took antidepressants called serotonin reuptake inhibitors (drugs like Prozac and Paxil) were less likely to die by suicide than those who did not take antidepressants.
Increased Risk in Young People
For adolescents and young adults, the story is quite different. Adolescents who took antidepressants in one review of studies were twice as likely to attempt or die by suicide than those who did not. There is also evidence that antidepressants may increase the risk of suicidal thoughts and behaviors in young adults under 25.
As a result of the increased danger for suicidality in adolescents and young adults, the U.S. Food and Drug Administration issued a “black box” warning for antidepressants in these age groups. This warning to physicians is one step short of removing the drugs from the market for adolescents and young adults.
Do Antidepressants Do Less Harm than Good?
Interestingly, the year that the FDA’s warning took effect, rates of antidepressant prescriptions to adolescents dropped by 20%, and the suicide rate for adolescents increased by 20%. It’s impossible to know whether the timing of these events was a coincidence or a cause-effect relationship.
Another study of antidepressant use in children and adolescents found that the benefits outweigh the risks. Adolescents effectively helped children and adolescents to recover from depression, anxiety, and obsessive compulsive disorder.
Also important to note is the tiny fraction of adolescents and young adults who experience increases in suicidal thoughts or behaviors (seemingly) due to antidepressants. According to one study, the increased occurred in 1 in 1,000 when it came to suicide attempts and 1 in 3,000 for suicide.
It has been hard to determine definitively the increased risk of suicide, suicide attempts and suicidal thoughts caused by antidepressants. Depression itself causes suicidal thoughts, so an increase in suicidal thoughts would be expected in depressed people, especially those for whom antidepressants simply are not effective. Studies of suicide risk with antidepressants, though, include comparison groups of depressed people who take a placebo (a pill that has no medicine in it). This enables researchers to take into account in their statistical analyses how much suicidal thoughts progress naturally.
The Mystery of Antidepressants’ Effects
Why would antidepressants, which have been shown to decrease depression, actually increase the danger of suicide and suicide attempts? Various reasons have been proposed. The medications might, paradoxically, worsen depression. Alternatively, they might energize people who previously were too paralyzed by depression to act on their suicidal thoughts. It also is known that antidepressants can cause, in some people, intense feelings of agitation and restlessness. These sensations may prompt a person to feel desperate for escape.
The takeaway message from all of this is that physicians, clients, and parents need to be especially mindful of any increases in suicidal thoughts or behaviors in adolescents or young adults that occur after starting the medication. For the small percentage of adolescents and young adults who worsen with antidepressants, another medication or therapy will need to be tried.
Still, chances are far better that adolescents and young adults will feel better with antidepressants than that antidepressants will do them harm.
© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide
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