In October 2004, the US Food and Drug Administration (FDA) began requiring manufacturers to issue warning labels stating that the use of antidepressants may increase the risk of suicidal thinking and suicidal behavior in children and adolescents. Studies that look at suicidal behaviors tend to include suicidal actions that are unlikely to be fatal. As a result, the risk of serious suicide attempts or deaths in children and adolescents taking antidepressants is not clear. In addition, researchers do not know exactly how antidepressants affect the risk of suicide attempts or death in adults.

In a study published in the August 2006 Archives of General Psychiatry , researchers report that severely depressed children and adolescents taking antidepressant drugs are at a significantly increased risks for suicide attempts and suicide death compared to children and adolescents not taking antidepressants. Antidepressant use did not increase the risk for suicide attempts or death in severely depressed adults.

About the Study

The researchers identified 784 case patients—children and adolescents (ages 6-18 years) and adults (ages 19-64 years) who had been hospitalized at least once for depression and had attempted suicide during a particular two-year period. They matched each case patient to up to five control patients of similar age, gender, and race or ethnicity, but who had not attempted suicide during that period. The control patients had also been hospitalized at least once for depression and had a similar date of hospital discharge as the case patients. The control patients were assigned an “event date” that was the same number of days after hospital discharge as the date that their matched case patient attempted suicide. The researchers determined whether each patient had been taking an antidepressant drug on the date of suicide attempt or event date. They then compared the risk of suicide attempt and suicide death in patients taking and not taking antidepressants.

Children and adolescents treated with an antidepressant were 1.52 times as likely to attempt suicide and 15.62 times more likely to actually die of suicide than children and adolescents not taking an antidepressant. These were significant differences. In adults, antidepressants increased the risk of suicide attempts and decreased the risk of suicide death, but not to a significant degree in either case.

This study is limited by the fact that antidepressant drugs are likely to be prescribed to more severely depressed children and adolescents, who also tend to be at greater risk for suicidal behaviors.

How Does This Affect You?

This study found that antidepressant-use was associated with an increased risk of suicide attempts and suicide deaths in severely depressed children and adolescents. Antidepressants did not increase the risk of these suicidal events in adults.

Physicians now face the difficult job of weighing the benefits of antidepressant use for the treatment of depression in children and adolescents against the potential risks of attempted suicide and death, which is one of the main reasons to prescribe these medications in the first place. We should not lose sight of the fact that many moderately and severely depressed children and adolescents are successfully participating in their lives because of these medications.

So, should children and adolescents continue to be treated with antidepressants despite their known risks? Careful observation may be the answer. According to the researchers, two-thirds of the attempted suicides in this study occurred in the first four months after hospital discharge, and three-quarters occurred in the first six months after discharge. This might serve as a guideline for physicians and other caregivers to scrupulously monitor children and adolescent behavior for at least six months, if not a full year, after hospitalization to minimize the risk of suicide attempts and death.