Antidepressants and suicide risk

Source: Wikipedia, the free encyclopedia.

The relationship between antidepressant use and suicide risk is a subject of medical research and has faced varying levels of debate. This problem was thought to be serious enough to warrant intervention by the U.S. Food and Drug Administration to label greater likelihood of suicide as a risk of using antidepressants.

antidepressants correlate with an increased risk of suicide in some patients relative to other antidepressants.[2] However, these conclusions have faced considerable scrutiny and disagreement: A multinational European study indicated that antidepressants decrease risk of suicide at the population level,[3] and other reviews of antidepressant use claim that there is not enough data to indicate antidepressant use increases risk of suicide.[4][5][6]

Youth

Antidepressants could increase the risk of suicidal thoughts and behavior in people with depression under the age of 25. In 2004, the U.S. Food and Drug Administration along with the Neuro-Psychopharmacologic Advisory Committee and the Anti-Infective Drugs Advisory Committee, concluded that there was a causal link between newer antidepressants and pediatric suicidality.[7] Federal health officials unveiled proposed changes to the labels on antidepressant drugs in December 2006 to warn people of this danger.[citation needed]

A 2016 review of

serotonin-norepinephrine reuptake inhibitors (SNRIs) which looked at four outcomes—death, suicidality, aggressive behaviour, and agitation—found that while the data was insufficient to draw strong conclusions, adults taking these drugs did not appear to be at increased risk for any of the four outcomes, but that for people under the age of 18, the risks of suicidality and for aggression doubled. The authors expressed frustration with incomplete reporting and lack of access to data, and with some aspects of the clinical trial designs, which may have resulted in significant under-reporting of harms.[8]

Boxed warning for desvenlafaxine, an SNRI

Warnings

The

paradoxical effect) or part of the depression itself (i.e. the antidepressant enables those who are severely depressed—who ordinarily would be paralyzed by their depression—to become more alert and act out suicidal urges before being fully recovered from their depressive episode).[10] The increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents.[11]
Young patients should be closely monitored for signs of suicidal ideation or behaviors, especially in the first eight weeks of therapy. Sertraline, tricyclic agents and venlafaxine were found to increase the risk of attempted suicide in severely depressed adolescents on Medicaid.[12]

Increased risk for quitting medication

A 2009 study showed increased risk of suicide after initiation,

dothiepin found that the risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first 1 to 9 days.[14]

Prevalence

On September 6, 2007, the

epidemiological data, the suicide rate in 2005 in children and adolescents actually declined despite the continuing decrease of SSRI prescriptions. "It is risky to draw conclusions from limited ecologic analyses of isolated year-to-year fluctuations in antidepressant prescriptions and suicides.[17]

One promising epidemiological approach involves examining the associations between trends in

psychotropic medication use and suicide over time across a large number of small geographic regions. Until the results of more detailed analyses are known, prudence dictates deferring judgment concerning the public health effects of the FDA warnings."[18][19] Subsequent follow-up studies have supported the hypothesis that antidepressant drugs reduce suicide risk.[20][21]

Suicide risk

In those under the age of 25 antidepressants appear to increase the risk of suicidal thoughts and behaviors.

black box warning regarding this concern.[22]

A 2016 review found a decreased suicidal events in older adults.[23]

See also

References

  1. ^ Research, Center for Drug Evaluation and (2018-11-03). "Suicidality in Children and Adolescents Being Treated With Antidepressant Medications". FDA.
  2. PMID 25693810
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  3. PMID 23840475
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  4. S2CID 904085
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  5. PMID 27354459
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  6. S2CID 23771296
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  7. PMID 15995053
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  8. PMID 26819231
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  9. PMID 16543316
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  10. ^ "SSRI Antidepressants". Patient.info. 2010-10-27. Retrieved 2012-11-30.
  11. PMID 19671933
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  12. PMID 16894062
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  13. S2CID 24870988
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  14. PMID 15265848
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  15. ^ Carey, Benedict (September 7, 2007). "Suicide Rises in Youth; Antidepressant Debate Looms". New York Times.
  16. S2CID 27774152
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  17. ^ "Adverse Effects of Anti-depressants". Archived from the original on 2 April 2015. Retrieved 23 March 2015.
  18. PMID 18056247
    .
  19. ^ Kung HC, Hoyert DL, Xu J, Murphy SL. "N C H S - Health E Stats - Deaths: Preliminary Data for 2005". National Center for Health Statistics. Archived from the original on 12 December 2007. Retrieved 2007-12-12.
  20. PMID 17440145
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  21. S2CID 32153323
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  22. ^ a b "Fluoxetine Hydrochloride Monograph for Professionals". Drugs.com. Retrieved 15 October 2019.
  23. ^
    PMID 27514302
    .

Further reading

External links
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