Antidepressant drugs increase suicide risk in children

Journal of Family Practice, June, 2006

* Clinical Question

Are antidepressant medications associated with an increased risk of suicidal behavior in children?

* Bottom Line

The use of antidepressant medications in children is associated with an increased risk of suicidal ideation and suicide-related behaviors, It is uncertain what overall effect antidepressant medications have on the morbidity and mortality of treated children, Close monitoring of patients using these medications regarding the risk of suicidality is recommended. (LOE=1a-)

Study Design

Meta-analysis (randomized controlled trials)

Funding

Government

Setting

Various (meta-analysis)

Synopsis

Concern exists about the potential for antidepressant medications to raise the risk of suicide in children and adolescents. The investigators pooled data from all 24 placebo-controlled trials comprising 4582 patients submitted to the Food and Drug Administration by various drug manufacturers. It is likely that this search method found most, if not all, clinical trials reporting safety information.

Studied drugs included fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), bupropion (Wellbutrin), venlafaxine (Effexor), nefazodone, and mirtazapine (Remeron). Sixteen trials studied patients with major depressive disorder, and the remaining 8 studied obsessive-compulsive disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and social anxiety disorder.

Events included either increased suicidal ideation or suicidal behavior. None of the trials reported a completed suicide. Trial durations ranged from 4 weeks to 16 weeks, so long-term risk is not included in this analysis. Individuals blinded to treatment group assignment evaluated adverse events potentially representing suicidal-related events.

The selection process resulted in 130 unique patients with a suicidal-related event. The overall relative risk increase for suicidality for selective serotonin reuptake inhibitors in depression trials was 1.66 (95% confidence interval [CI], 1.02-2.68; number needed to harm [NNH]=54, 95% CI, 21-1786) and for all drugs across all indications was 1.95 (95% CI, 1.28-2.98; NNH=38, 95% CI, 18-128). Venlafaxine (Effexor) was the only individual drug with a statistically significant increased risk of suicidality. There were no suicidal-related events reported for nefazodone and bupropion.

FAST TRACK

Monitor closely for suicidality any child taking an antidepressant

Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006; 63:332-339.