Antidepressants: Youth Suicide Warnings Increasingly Questioned

[HuckleB]

http://www.psychiatrictimes.com/showArticle.jhtml?articleId=185303201

"FDA advisories warning of increased suicide risk among children and adolescents beginning antidepressant therapy have alarmed the health care community. But emerging evidence suggests that this may not be the case—and that it may actually be a disservice to withhold these medications from persons who need them.

Recent observational evidence of reduced suicide risk in persons beginning antidepressant therapy stands in direct opposition to FDA advisories associating these agents with suicidality. This finding also raises the question of whether more patients will be at risk if FDA advisories and the “black box” warning serve to discourage antidepressant use, rather than—as intended—to encourage their careful monitoring.

Simon and colleagues1 evaluated health plan data (1992 to 2002) for more than 65,000 patients receiving their first antidepressant for a depressive episode. For both adults and adolescents, the risk of suicide was highest in the month before starting the antidepressant, and decreased progressively with continued treatment. “The patterns . . . appear more consistent with a decline in suicide risk after initiation of treatment, than they are with a medication-induced increase,” the investigators observed. “The decline in suicide attempts . . . closely parallels the trend in depressive symptoms seen in patients who receive new antidepressant prescriptions.”

The month before this study appeared in the literature, Donald Klein, MD, of the New York State Psychiatric Institute, Columbia University, published his concern about an “uncertain public health impact” from the sharp decrease in antidepressant prescriptions that followed issuance of a blackbox warning in October 2004 advising physicians of possible increased suicide risk in children.2,3 “There is no convincing evidence that antidepressants specifically increase suicide attempts,” Klein declared. “The committee's decision was probably influenced by the paucity of data, except for fluoxetine, demonstrating a specific benefit. In terms of a risk-benefit ratio, the lack of specific benefit became misleadingly translated into a high specific risk.”2

..."

[Warpy]

1. Back in the good old days

when we actually had a mental health system (bad as it was), most people who were suffering from a major depression with risk of suicide were hospitalized while the antidepressants were starting to kick in. It's been well known for decades that there is a suicide "window" with these drugs when the patient starts to feel a little more energized but is still deeply depressed. They use the energy to do what they have wanted to do for a long time but were simply unable to manage, end the pain the only way they know.

Now of course, they're all on their own. Suicide is still rare, but it is a well known risk for anyone beginning drug therapy. Close monitoring is essential.

You can't just give any depressed person, adult or child, a handful of pills and turn them loose like overworked docs are doing now.

[Master Mahon]

2. Excellent response

your post sums up the situation perfectly!
I believe you are absolutely correct and you point out the failures of our current health care system in this regard.

[Sgent]

3. Excellent description of the problem

Suicide risk has also been found to increase at the beginning of psychotherapy -- for the same reason that you expressed.