Talking Points About Antidepressants and Suicide

Thomas A. M. Kramer, MD

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In This Article

Why Is This an Issue Now?

Why did this happen? What started this whole process of questioning whether these drugs are safe, and as such what should be the thresholds for prescribing them? It appears that this all started in Great Britain, when the UK equivalent of the FDA began to look at data from clinical trials in children. The concern that the researchers expressed has been greatly misunderstood. They did not say that these drugs routinely caused suicide; what they said was that there seemed to be very little evidence that these drugs were particularly effective in children. When compared with placebo, the children taking medication did not seem to be doing all that much better. Thus, there appeared to be little benefit to the medication, and since there were a few more episodes of suicidal behavior (there were virtually no completed suicides on these clinical trials), the risks vs benefits may not justify prescribing these medications for children.

There are a number of reasons why placebo-controlled trials of antidepressants for children often have trouble separating the responses of the drug group from the placebo group. Subjects participating in clinical drug trials get a lot of attention. They come in for frequent visits and talk about depression often. This talking about depression can get them thinking about depression and can be, in effect, de facto cognitive therapy. When you consider the fact that children are considerably more impressionable than adults, it may explain why medications that are in common clinical use in the treatment of depression in children may not look so great in a clinical study. If you have concerns about the efficacy of newer-generation antidepressants in the treatment of depression in children, talk to child psychiatrists who use them. The enthusiasm for these medications among the practitioners who pharmacologically treat depression in children is quite strong. If they didn't work that well, these are the people who would know.

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