Data on Antidepressants and Suicide3
August 5, 2015
Prior to the 1990’s, Youth Suicides in the United States had been increasing for decades.
Between 1955-1985, the Suicide Rate TRIPLED for those with Depression, between the ages of 5-19.
Since 1990, these same rates have been DECLINING STEADILY.
One of the main reasons for this, according to the data, was the widespread use of Antidepressant Medications.
When the FDA learned of possible Suicidal Ideation, related to Antidepressants and Teenagers, they warned Doctors.
In 2004, the FDA placed a Black Box warning on Antidepressants, prescribed to Children and Teenagers.
In 2006, the FDA extended the warning to include all Americans, up to the age of 24 years old (perhaps also reflecting our societal shift, toward delayed Adulthood).
The FDA did not provide crucial information, such as describing the spectrum of Suicidality.
Suicidal Ideation was essentially lumped together with Suicide Attempts, and Completions.
There was no attempt to clarify terms, such as Passive Suicidal Ideation from Active.
There was no clarification, allowing one to appreciate the difference, between Self Harm, and a Suicide Attempt, as well.
These are all very important distinctions, as you will soon see.
In 2006, a Meta Analysis completed by the NIMH, collected all of the data, from all of the Placebo Controlled Studies, involving SSRI’s prescribed to Children and Adolescents.
I never Meta Analysis, that wasn’t comprehensive.
This review looked at an N = 2,200 Children and Adolescents taking SSRI’s, between the years 1988-2006.
The results indicated that SSRI’s were safe and effective, in the majority of the people taking them.
There was a significant association, where 4% of Teenagers on SSRI’s, DID IN FACT, show more Suicidal Ideation and Suicide Attempts.
And this effect was seen for all the Antidepressants studied, including the SNRI, mentioned earlier.
The most important point, amongst the data?
THERE WAS NOT A SINGLE COMPLETED SUICIDE, WHILE A CHILD OR ADOLESCENT WAS TAKING AN SSRI, or any other Antidepressant Medication.
After the Black Box warnings, prescription rates for Antidepressant medications for Teenagers and Young Adults, fell by 25-30%.
During that same period of time, the rates of SUICIDE ATTEMPTS INCREASED BY 22% in Teenagers.
Data indicates that during 2003-2004, there was a 14% increase in COMPLETED SUICIDES for those aged 5-19 years old.
This was the single largest yearly increase in the Suicide Rate, seen in the past 36 years.
Suicide Attempts also increased, by 34% in Young Adults, between 2003-2004.
If there was a causal connection, between SSRI’s and Suicides, shouldn’t the rate of Suicides decrease, with less SSRI prescriptions?
And actually, there was 1 Antidepressant that was not associated with Suicidality.
Only FLUOXETINE (PROZAC), showed NO ASSOCIATION WITH INCREASED SUICIDAL IDEATION OR ATTEMPTS.
It was equal to the ‘Placebo’ sugar pill.
For this reason, Child and Adolescent Treatment Guidelines, at least in Canada, indicate that Fluoxetine (Prozac) should almost always be the first medication used to treat Child and Adolescent Depression.
There are special cases, such as a Family History of poor response, or sensitivity to Prozac, which may preclude its use.
One final thought, for today.
Perhaps it would have been more helpful, if in 2004, the FDA had highlighted the risk of Suicidal Ideation, and Suicide Attempts, due to Adolescent Depression first.
Then added that no teens have ever committed suicide, according to the data, while taking these medications.
The FDA could have gone on to say that the risk of a Teenager attempting Suicide, would be much higher, if you decided not to have your Depression treated with an Antidepressant, or stopped one you were already taking.
At that point, they could have mentioned the 4 % risk, of possible increased Suicidal Ideation and Behaviors.
It would have been nice, if there was more of a partnership, between institutions like the FDA and Mental Health.
They could have collaborated, and worked out the best way to get this important message out.
I’m struck by the notion, of how things might have been, if the FDA had chosen to think outside of this Black Box, and included the people and families suffering, with this awful illness.
Tune in for the final chapter.
Simon Trepel, MD
Note– There are some side effects due to SSRI’s, that have been seen more often, in Suicidality. One of these Receptor Effects, causes Akithisia, which occurs in all SSRI’s, including Fluoxetine (Prozac).
Note– The most effective treatment for Child and Adolescent Depression, is the Combination of Antidepressant Medication, and Cognitive Behavior Therapy, supported by evidence from the TADS study.
Note- This phenomenon is not specific to the United States. In the Netherlands, in 2003-2005, a decrease in the rate of SSRI prescriptions by 22% resulted in a 49% rise in Youth Suicides.
Note- Here is another great reference.
Simon Trepel, MD FRCPC, is a practicing Child and Adolescent Psychiatrist, in Winnipeg, Canada. He is an Assistant Professor, at the University Of Manitoba, in the Faculty of Medicine, and the Co-founder of the GDAAY Clinic. He is, more importantly, the proud Father of 2 beautiful Daughters. He writes in his spare time about things he knows something about, and occasionally about things he doesn’t; like Yoga, and Italian flavored coffees. He was not referring to coffee that tastes like an Italian person.
Check out his Blog, called Simon Says Psych Stuff, at