What is the role of antidepressant medications in the etiology of suicide?

Updated: Sep 02, 2020
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. In September 2004, the results of an FDA analysis suggested that the risk of emergent suicidality in children and adolescents taking selective serotonin-reuptake inhibitors (SSRIs) was real. The FDA advisors—the Psychopharmacologic Drugs and Pediatric Advisory Committees—recommended the following:

  • A "black-box" warning label be placed on all antidepressants, indicating that they increase the risk of suicidal thinking and behavior (suicidality)

  • A patient information sheet (Medication Guide) be provided to the patient and their caregiver with every prescription

  • The results of controlled pediatric trials of depression be included in the labeling for antidepressant drugs

The committees recommended, however, that the products not be contraindicated in the United States, saying that access to the drugs is important for patients who can benefit from them. For more information, see the FDA Statement on Recommendations of the Psychopharmacologic Drugs and Pediatric Advisory Committees.

Some studies have shown that the FDA warnings regarding suicide in children on antidepressants may have had the unintended result of a decrease in the rates of diagnosis and treatment of depression, as well as dosing adjustments by physicians. It has also been noted that monitoring of these patients did not increase following the warnings. [14, 15, 16, 17]


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