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Antidepressants may increase children's and adolescents' risk of suicide attempts after hospitalization for depression

Children and adolescents who have been hospitalized for depression are 52 percent more likely to attempt suicide if they take antidepressants after hospitalization for depression than if they do not take antidepressants, according to a new study. This finding supports careful clinical monitoring during antidepressant drug treatment of severely depressed young people. The results also tend to agree with the black box warning on antidepressants required by the U.S. Food and Drug Administration (FDA) that states these drugs may increase suicidal ideation and behavior in children and adolescents. The study authors nevertheless note that this risk must be balanced against evidence that depression itself is a key risk factor for suicide and that antidepressants are effective for adult and adolescent depression. Fluoxetine, the only antidepressant drug approved by the FDA for the treatment of pediatric depression, was not associated with suicide attempts or deaths in any analyses.

The researchers analyzed suicide attempts and suicide deaths among Medicaid-insured children, adolescents, and adults from 50 States who received antidepressant drug treatment following a hospitalization for severe depression over a 2-year period. When compared with similar patients who did not receive antidepressants after hospitalization, antidepressant drug treatment was not significantly associated with suicide attempts or suicide deaths among adults. However, it was linked to more suicide attempts and suicide deaths among children and adolescents ages 6 to 18 years. Certain antidepressants appeared to elevate the risk more than others. For example, the serotonin/ norepinephrine reuptake inhibitor venlafaxine was associated with 2.3 times the risk of suicide attempts compared with no antidepressant drug treatment. Older tricyclic antidepressants were also significantly associated with suicide attempts in young people. The study was supported in part by the Agency for Healthcare Research and Quality (HS16097).

More details are in "Antidepressant drug therapy and suicide in severely depressed children and adults," by Mark Olfson, M.D., M.P.H., Steven C. Marcus, Ph.D., and David Shaffer, M.D., in the August 2006 Archives of General Psychiatry 63, pp. 865-872.

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