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Antidepressants and Suicide: Do Medicines Increase Your Risk? A Look at the Studies
by Matthew S. Koval, M.D.

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Experts have long known that the rare person may have an increased risk for attempting suicide after starting antidepressants. Psychiatric textbooks dating from the 1960s warned about suicide during the “convalescent period.” Doctors thought that as patients started to improve, they could then develop the energy, motivation and drive to carry out a plan.

But in 2003, scientists in Great Britain made an announcement that sent a ripple through the world. In the United States, it resulted in a black-box warning and calls for further research.


SURPRISING FINDINGS ABOUT ANTIDEPRESSANTS AND SUICIDE

The researchers were studying the SSRI paroxetine (Paxil) and its effect on children and adolescents. They looked at safety data from five studies involving children. When they examined each study individually, the data was fine. But when they pooled the data from all five, a pattern emerged that suggested increased suicidal thinking and behavior in the drug-treated group compared to the placebo group.

After the researchers made this data public, the FDA embarked on their own review. They examined 24 studies involving 4,400 children and adolescents who were taking antidepressants or placebo (fake pill). There was a 2-percent rate of “suicidal thinking or behavior” in the placebo-treated group versus a 4-percent rate in the antidepressant-treated group. (No participants died by suicide.)

Although the studies didn’t prove the medicines caused the so-called suicidality, the higher risk prompted the FDA to act. In 2004, it ordered drug companies to include black-box warnings about antidepressants and the risk of suicidal thinking or behavior in youth, and later in young adults.


WHAT TO DO

If taking antidepressants leads to an increase in harmful ideas or behavior, this usually happens close to when treatment begins or when the medication dose is changed. In addition, a change in the person’s demeanor and behavior usually heralds the harm-related thinking. (This causes some to speculate that antidepressants activate these patients in a negative way.) People taking antidepressants should be monitored closely for negative or harmful changes in mood or behavior, especially early in treatment.

newsletter-graphicAt the same time, studies indicate that antidepressants are indeed helpful for depression and result in overall decreased rates of suicide. Reports suggest that the FDA-mandated warnings resulted in fewer young people being prescribed antidepressants. Unfortunately, suicide rates increased, suggesting that withholding antidepressants may cause more harm than good.

You could compare antidepressant therapy to the use of safety restraints in our cars. We’ve all heard stories in which the use of a seatbelt or airbag caused harm during an accident. However, most people would agree more lives are saved with restraints than without.


MATTHEW S. KOVAL, M.D.
, is a practicing psychiatrist and associate professor at the Medical University of South Carolina. Disclosure: He was formerly on the speakers bureau for GlaxoSmithKline, a pharmaceutical company that makes antidepressants (Wellbutrin and Paxil).

Last updated and/or approved: April 2010. Original article appeared in September/October 2007 former print magazine. Bio current as of September 2007. This article is not meant as individual advice. Please see our disclaimer.

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