March 9, 2006

According to data amassed from 24 clinical trials, the use of antidepressants may increase the risk of suicidal thoughts and behaviors in children, suggests an article in the Archives of General Psychiatry, one of the offshoot publications of the Journal of the American Medical Association.

The 24 studies profiled included 23 short-term clinical trials and one more comprehensive study funded by the National Institute of Mental Health. The trials included 4,582 pediatric study subjects, each taking one of nine antidepressant medications -- fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, bupropion, venlafaxine, nefazodone and mirtazapine -- for depression, anxiety or other psychiatric disorders. While none of the children involved actually committed suicide, the trial results showed a heightened rate of suicidal ideation --209 suicide-related adverse events were reported, 89 of which were classified as the primary outcome of suicidal behavior or ideation, and 120 classified as possible suicidal behavior or ideation. The overall risk ratio for suicidality for all drugs across all indications was 1.95

"When considering 100 treated patients," states the article, "we might expect one to three patients to have an increase in suicidality beyond the risk that occurs with depression itself owing to short-term treatment with an antidepressant."

Certain physicians and policymakers profiled in the article, however, do not view this correlation as significant or worrisome, pointing to the largely positive psychiatric effects of antidepressant medication. "Only a small fraction of patients with suicidal thoughts attempt suicide," write Ross Baldessarini, of McLean Hospital in Belmont, Mass., and his colleagues, in an attached editorial. "When adverse responses do occur, they are often detectable with close clinical follow-up and psychological support, especially early in treatment."