Depression afflicts one in every 20 children. The effects range in severity and can interfere with functioning and enjoyment in all aspects of life including school, friendships, and self esteem. Many children living with depression benefit from antidepressant drugs; however, concern about an uncommon, but serious side effect surfaced years ago and persists today—an increase in suicidal thoughts and behaviors.

To investigate this link, the Food and Drug Administration (FDA) analyzed 24 trials of nine commonly used antidepressants. Their findings, published in the March issue of the Archives of General Psychiatry , indicate that children taking antidepressants have a modestly increased risk of suicidal thoughts and behaviors, compared with children taking a placebo. These findings prompted the FDA to require a warning on product labeling and the distribution of patient and caregiver guides explaining the risk.

About the Study

FDA researchers analyzed 24 placebo-controlled trials of antidepressant drugs in children with depression and anxiety disorders. One study was conducted by the National Institute of Mental Health (NIMH); the rest were done by drug companies. The 24 studies included 4,582 children and ranged in duration from 4-16 weeks. The FDA scrutinized each study to determine the number of cases of suicidal thoughts or behaviors, called suicide-related adverse events (SREs). The number of SREs was compared among the antidepressant and placebo (sugar pill) groups.

None of the children committed suicide. However, the NIMH study reported a significant increase in SREs in those taking antidepressants. No other single study found such an increase, but all 24 studies analyzed together showed a moderate rise in SREs with antidepressant use. This moderate rise was quantified as follows: for every 100 children treated with an antidepressant, an increase in SREs (beyond the increase attributed to the depression itself) can be expected in one to three children.

These findings are limited by the duration of the studies; the drug effects after 16 weeks are unclear. Studies published elsewhere suggest antidepressants protect against suicide when taken for longer periods of time. In addition, the increase in SREs could have resulted from more reports rather than actual increases in such thoughts and behaviors.

How Does This Affect You?

It would appear that childhood depression is a kind of catch-22—both untreated depression and antidepressant drugs may increase the risk of suicidal thoughts and behaviors. This dilemma, however, can be managed with careful assessment and continuous monitoring. The decision to use antidepressants must consider the child’s symptoms, quality of life, and medical and family history. Drugs are not and should not be the only option. Talk therapy is a crucial component of successful treatment. Many psychiatrists, including those from McLean Hospital in Boston who authored an accompanying editorial, believe that close follow-up and talk therapy can detect any escalations of suicidal feelings and allow for prompt treatment. If you suspect your child has depression, contact your pediatrician. The signs of depression in children include:

  • Sadness, crying, extreme sensitivity, or hostility
  • Hopelessness, low self-esteem, low energy
  • Decreased interest in activities
  • Social isolation
  • Frequent complaints of physical illness
  • Major change in eating, sleeping, and/or school performance
  • Talk of or efforts to run away from home
  • Thoughts or expressions of suicide or other self destructive behavior