Antidepressants Increase Risk of Suicidal Behavior

* Untreated depression is the biggest risk factor for suicide. However it is important to know that there is an increased risk of suicidal behavior and thinking with any antidepressant medication, particularly when starting a medication, in children, adolescents, and (to a lesser extent) young adults between the ages of 18 and 24.

There is a 'black box' warning on all antidepressant medications to make sure people are aware of this potential problem.

Note: Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions.

Many clinical studies on the effects of antidepressants on children and adolescents have shown that that four percent of the youngsters taking medication reported suicidal thinking and behavior, compared to two percent of those taking a placebo. (There were no suicides during any of these studies)

Scientific data has also shown an increased risk of suicidal thinking and behavior in young adults between 18 and 24 years of age in the first month or two of treatment. No increase in suicidal thinking and behavior was seen in people between the ages of 24 and 65, and people over 65 had a decreased risk. See FDA's Revisions to Product Labeling and pooled analyses of placebo-controlled trials.

People of any age should be aware of the increased risk of suicidal thoughts and behavior when beginning treatment with an antidepressant.

Though the majority of people take antidepressants with no such problems, any drug powerful enough to produce a response may sometimes produce undesired responses in some people.

*Anyone who has a worsening of their depression after starting medication should call their physician immediately. It is important to be aware that discontinuing certain antidepressant medications abruptly can cause Antidepressant Discontinuation Syndrome (withdrawal). As antidepressants are not considered addictive (they do not cause drug-seeking behavior), the term withdrawal is not often used.

Antidepressant Discontinuation Syndrome is unlikely to occur if the antidepressant has been taken for less than six weeks. Withdrawal symptoms may come on gradually - with SSRIs they may begin after a couple of days of not taking the medication.

Increased Stigma and Fear of Taking Antidepressants due to fear of Suicidal Behavior:

Any time an illness can be controlled by non-pharmacological measures it is preferable. But sometimes medication is needed, especially in cases of severe depression. There is already a stigma attached to mental illness. A person with depression doesn't need the added stigma of being on antidepressant medication. Some people with clinical depression fare much better while taking antidepressants though they would choose anything else over medication if it were as effective.

Whether or not to give antidepressants a trial depends largely on the severity of depression - basically do the benefits outweigh the risks. Some people with mild depression may be just as well treated with psychotherapy.

There has actually been a decrease in suicides in recent years, correlating to an increase in the number of antidepressant prescriptions written. Whether this is due to antidepressant medication alone or increased depression awareness and communication is unknown.

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