by Dr. Barbara Geller, The Balanced Mind Foundation Scientific Advisory Committee member

The controversy continues: Does antidepressant use affect suicidality in depressed children and adolescents, and if so, in which direction? In 2003, researchers reported an association between increased use of antidepressants and decreased suicide in adolescents (Journal Watch Psychiatry Dec 2004, p. 93, and Archives of General Psychiatry 2003; 60:978). To learn more, the same research group examined data among all Medicaid patients, ages 6 to 64, hospitalized for depression during a 2-year period (1999-2000).

 In this case-control study, cases had attempted or completed suicide, and controls had not. Controls were matched for demographics, substance-use disorders, other psychotropic-medication use, and date of discharge. Depression levels were hypothesized to be comparably severe in these inpatients. There were 263 child cases (age range, 6-18), 1241 child controls, 521 adults cases, and 2394 adult controls. Among the cases, 64% evidenced suicide phenomena within the first 4 months after discahrge, and 74% within the first 6 months.

Among adults, there were no significant associations between antidepressant use and suicide attempts or completions. Among children and adolescents, however, suicide attempts increased significantly with use of any antidepressant, sertraline, tricyclic agents, or venlafaxine; suicide completion was associated with use of any antidepressant or any SSRI. Increased risk for attempts was seen in white but not minority children and adolescents.

Comment: Why these findings differ from some others is not clear but may be related to the study limitations, as noted by the authors. For example, children may have been hospitalized for suicidality, medication adherence was not monitored, and only Medicaid recipients were included. Still, clinicians need to take into account these provocative findings when discussing antidepressant use with children's families. —Barbara Geller, MD

Olfson M et al. Antidepressant drug therapy and suicide in severely depressed children and adults: A case-control study. Archives of General Psychiatry 2006 Aug; 63:865-72.

This article appears courtesy of Journal Watch Psychiatry.
©Journal Watch Psychiatry, October 2006