No Causal Relationship Between Antidepressants and Suicide in Adolescents, Young Adults

young adult, teen sad, clasped hands
No evidence was found to support the concerns of international drug safety authorities regarding an increased risk for suicidality in young people treated with antidepressants.

The following article is part of conference coverage from the 2019 American Psychiatric Association Annual Meeting (APA 2019) in San Francisco, CA. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry. Check back for the latest news from APA 2019.

SAN FRANCISCO —Contrary to concerns of international drug safety authorities, no statistically significant causal relationship between antidepressants and suicide in adolescents or young adults was found in a data review presented at the American Psychiatric Association’s Annual Meeting, held May 18-22, 2019, in San Francisco, California.

An FDA analysis leading to black box warnings in 2004 showed a relative risk of suicidal behavior or ideation of 1.95 for young people treated with antidepressants. In May 2007, the FDA extended the warnings to include young adults from 18 to 24 years old; European regulators issues similar warnings. Subsequently, the rate of prescribing SSRIs for adolescents was reduced by approximately 22% in the United States and such countries as the Netherlands.

A current systematic review of literature on the MEDLINE database was designed to describe the relationship between antidepressant use and suicide in adolescents. Only articles in English, Spanish, or Portuguese that described a direct relationship between the use of antidepressants and suicide in young people age 13 to 24 were included. Of the 15 articles included for review, 4 articles proposed antidepressants as a protective factor against suicide, 1 article proposed it as a risk factor, and 10 found no relationship between antidepressants and suicide. The single article that found an increased rate of suicide and antidepressant use clarified that a causal relationship could not be established. Among the 4 articles that proposed antidepressants as a protective factor, 1 evaluated suicide risk and 3 evaluated suicide rates. Comparisons between the articles were made impossible due to differences in the classes of antidepressants used, age intervals, methodologies, and outcomes.

Researchers concluded, “The use of [antidepressants] in adolescence are of particular concern, because there is a higher risk of attempts at young age, however, it is not necessarily caused by antidepressants and most likely is accompanied by a similar risk of suicide.”

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Santos L, Silva A, Moura W, et al. Antidepressants, suicide, and adolescence: a systematic review. Poster presented at: American Psychiatric Association Annual Meeting; May 18-22, 2019; San Francisco, CA. Abstract 100.