Reopening the Debate on Antidepressants for Children and Teens

In 2004, the US Food and Drug Administration issued a “black box warning,” the sternest of its kind, on nearly the entire antidepressant category of psychotropic medications. Specifically, the warning communicated the possibility of a heightened suicide risk in children and teens who take antidepressants. Doctors were advised to strongly consider whether a pharmaceutical intervention was the best choice in cases of pediatric depression or anxiety. Even though research seemed to indicate that the potential risks outweighed the benefits, there was controversy around the decision. Some medical professionals worried that such a blanket statement might do more harm than good, and others questioned the research methodology, claiming the results of certain studies were not conclusive or were open to interpretation.

Recently, a team of researchers led by Dr. Robert Gibbons conducted a statistical analysis of antidepressant clinical trials. Specifically, they wanted to quantify the actual suicide and suicidal thought risk in youth, adult, and geriatric patients. They limited the drugs under consideration to Prozac (fluoxetine) and Effexor (venalafaxine). Some of the analyzed studies were sponsored by drug manufacturers, but the study authors claim no conflict of interest in the present research. Several outcomes were quantified: reduction in suicidal thoughts and behavior, reduction in depression symptoms, and relationship between severity of depression and risk of suicide. Results were further segregated into their respective age groups.

Gibbons’ team found, not surprisingly, that symptoms of depression subside with antidepressant treatment compared to placebo. Even in the youth category, both Prozac and Effexor were shown to be effective in managing the depression. Careful analysis demonstrated no compelling link between antidepressants and suicidal thoughts or behaviors. On the other hand, neither of the drugs under consideration was as effective in reducing suicidal thoughts in youth as compared with adult or geriatric patients. Even when depressive symptoms abated, a higher proportion of youth maintained suicidal thoughts. The study authors propose that the link between mood and thoughts of self-harm are weaker than in adults. They also point out that the correlation between suicidal thinking and suicidal behavior is weaker in youth patients. In other words, such thoughts very rarely lead to dangerous behavior—though that is not to say that thoughts of harming oneself should ever be taken lightly.

Ultimately, the results of this statistical analysis argue for a new assessment of antidepressant safety and efficacy in children and teens. If the fear of suicide is unwarranted, then potentially a large population of depressed young people is receiving less than ideal treatment. Further investigation is necessary.

Gibbons, R., Brown, C. H., Hur, K., Davis, J., & Mann, J. (2012). Suicidal Thoughts and Behavior With Antidepressant Treatment. Archives of General Psychiatry, 69(6), 580-587. Retrieved June 29, 2012, from

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