In November 2007, the US Food and Drug Administration required that black box warnings be placed on all antidepressant medications warning they may result in increased risk of suicidal tendencies in children and adolescents. It is now considered good practice that patients of all ages who initiate antidepressants should be monitored for clinical worsening or suicidality.
However, since the introduction of this black box warning, some epidemiological studies have reported rises in suicide rates in Norway and the USA (Gibbons et al).
This observational study conducted by a research team from Weill Cornell Medical College in New York, examined the association of antidepressants with suicide attempts and with suicide deaths.
The researchers analysed a large prospective cohort of 757 depressed patients who were followed up for up to 27 years.
Here’s what they found:
- The risk for any suicidal action with antidepressant treatment was 20% lower than without
- Patients with severe depression were more likely to receive treatment with antidepressants
- This suggests that antidepressants, overall, may reduce suicidality in a treatment-seeking population and that associated risks can be safely managed
The authors concluded:
This longitudinal study of a broadly generalizable cohort found that, although those with more severe affective syndromes were more likely to initiate treatment, antidepressants were associated with a significant reduction in the risk of suicidal behavior. Nonetheless, we believe that clinicians must closely monitor patients when an antidepressant is initiated.
Leon AC, Solomon DA, Li C, Fiedorowicz JG, Coryell WH, Endicott J, Keller MB. Antidepressants and risks of suicide and suicide attempts: a 27-year observational study. J Clin Psychiatry. 2011 May;72(5):580-6. [PubMed abstract]
Gibbons RD, Brown CH, Hur K, et al. Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 2007;164:1356–63. [PubMed abstract]