As many of you may already know, there has been a controversy around antidepressants and suicide for the last several years, especially for patients under the age of 18. As a matter of fact, in October of 2004, the FDA (Food and Drug Administration) released a “black box warning” on antidepressant for that age group. Basically a black box warning means that the person prescribing the medication must discuss a certain side effect with a patient before giving it to the patient. In the case of antidepressants the discussion is that there is a 2% chance that the person taking the medication may have suicidal thoughts or self harming behaviors (see “parentsmedguide.org” for more information on this).
The controversy is that studies have not actually made a direct association with antidepressants causing suicidality and that this has been a very hard issue to study. This is partly because suicide is such a rare event and the best studies usually require thousands of patients.
Interestingly, it has been shown in a recent observational study that counties in the United States with higher prescribing rates of antidepressants actually have lower rates of youth suicide. The problem with large observational studies is that they don’t take into account extra variables that may influence outcomes of suicide or no suicide so these kinds of studies cannot establish cause/effect relationships, they can just give trends.
As it stands, the FDA and several other groups continue to review this issue. There is a large study on antidepressants and adults that is looking at suicidal behavior that is under way.
In my practice and in most studies we see that peoples’ responses to antidepressants are unique and unpredictable. Some people respond very well to certain medications while others do not. The reason for this is probably in the genetic make up of each individual and some day we will be able to look at that and know which medications are best suited for which people. In the meantime, the best approach to take when deciding whether or not to use medications to treat depression and which medication to use is to have a detailed and thorough conversation with your provider regarding risks and benefits of the medications and what to watch for in terms of risk factors for suicide. Again, much of this is covered in the FDA sponsored website “parentsmedguide.org”.
Overall, the use of antidepressants to treat major depression is still encouraged and many people gain great benefits from treatment. The key to successful treatment is good rapport and communication with your provider. I would urge you to write down your questions and concerns and be as open as possible in your treatment.