Do antidepressants make children and adolescents suicidal?

Gordon, Michael S.; Melvin, Glenn

doi:10.1111/jpc.12655

Cited by 11 publications

(10 citation statements)

References 54 publications

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“…On the other hand, there is a debate about whether antidepressants are efficacious treatment alternatives in this age group, and whether they have acceptable trade-offs between benefits and harms [35]. In particular, studies suggest an increased risk of suicidality and aggression in antidepressant users under age 25 years [13, 36–38], meaning that the rise of antidepressant dispensation in this age group should be monitored closely. Consistent with findings that the onset of most major mood and anxiety disorders occurs in adolescence or early adulthood [39], there was a higher prevalence of having dispensed one or more antidepressant prescriptions with increasing age over the study period.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study from the USA has found an increase in the prevalence of CNS polypharmacy among 6- to 17-year-old antidepressant users during the period 1996–2007 [21], although more recent studies of this kind are lacking. A trend of increasing CNS polypharmacy warrants attention, as there is a lack of evidence regarding the risk and efficacy of combining CNS drugs in this age group [36]. However, polypharmacy is challenging to address.…”

Section: Discussionmentioning

confidence: 99%

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Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

Lagerberg

Molero

D’Onofrio

et al. 2019

Eur Child Adolesc Psychiatry

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This study examines trends in antidepressant drug dispensations among young people aged 0–24 years in Sweden during the period 2006–2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0–24 years that collected at least one antidepressant prescription (here defined as antidepressant users) between 1 January 2006 and 31 December 2013 ( n = 174,237), and categorized them as children (0–11 years), adolescents (12–17 years), and young adults (18–24 years). Prevalence of antidepressant dispensation rose from 1.4 to 2.1% between 2006 and 2013, with the greatest relative increase in adolescents [by 97.8% in males (from 0.6 to 1.3%) and by 86.3% in females (from 1.1 to 2.1%)]. Most individuals across age categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4–10.1%). Anxiolytics, hypnotics, and sedatives comprised the most common additional CNS drug class among persons who were prescribed antidepressants. These findings show that the dispensation of antidepressants among the young is prevalent and growing in Sweden. The substantial degree of CNS polypharmacy in young patients receiving antidepressants requires careful monitoring and further research into potential benefits and harms. Electronic supplementary material The online version of this article (10.1007/s00787-018-01269-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

Lagerberg

Molero

D’Onofrio

et al. 2019

Eur Child Adolesc Psychiatry

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“…The increased risk of suicidal ideation and behavior in children/adolescents receiving antidepressant medications compared with placebo, in pooled data from clinical trials evaluating the efficacy of antidepressants (Hammad, Laughren, & Racoosin, 2006), has been particularly worrisome. However, the nature and extent of these suicidal adverse events is still not well understood with greater antidepressant prescription rates also being associated with declining suicide rates (Gordon & Melvin, 2014).…”

Section: Introductionmentioning

confidence: 99%

Adverse events reported by anxious school refusing adolescents receiving cognitive behavioral therapy with and without fluoxetine

Melvin

Finnin

Taffe

et al. 2019

Clin Child Psychol Psychiatry

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Background: Investigating adverse events associated with antidepressant treatments in adolescents is important given the concerns about increased risk of suicidal ideation and behavior in this age group. The aim of this study is to investigate adverse and serious adverse events associated with the treatment of anxiety (cognitive behavioral therapy (CBT)-only, CBT-plus-placebo, and CBT-plus-fluoxetine) in anxious school-refusing adolescents. Methods: A side-effect symptom checklist was completed by participants prior to commencing treatment and during treatment (weekly/fortnightly). Results: CBT-plus-fluoxetine was well tolerated and not associated with higher levels of adverse events than the other treatments. Adverse events in all groups decreased over time, and the only adverse event distinct to fluoxetine was nausea. Baseline anxiety predicted higher levels of adverse events. There was one suicide attempt in the CBT-plus-placebo group but no statistically significant difference in suicide attempts between groups. Participants with a comorbid depressive disorder were more likely to report self-injury ideation but not suicidal ideation compared with those who did not have comorbid depressive disorder. Frequency of suicidal ideation and non-suicidal self-injury was significantly lower in the CBT-plus-fluoxetine group compared with the CBT-only group. Frequency of self-injury ideation was significantly lower in the CBT-plus-fluoxetine group compared with both other groups. Conclusions: Overall, the treatments were well tolerated and fluoxetine plus CBT appeared to be protective against suicidal ideation, non-suicidal self-injury, and self-injury ideation in this sample.

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“…In recent years, the use of antidepressant drugs among children and adolescents has increased in western countries [1,2]. Several meta-analyses of data from randomizedcontrolled trials (RCT's) have found an increased risk of suicidality for children and adolescents treated with antidepressants [3][4][5][6][7]. In 2004, The American Food and Drug Administration (FDA) directed that the labelling of all antidepressants should include a boxed warning of an increased risk of suicidality for children and adolescents [8], and in 2007, this was expanded to include young adults (ages 18-24 years) [9].…”

Section: Introductionmentioning

confidence: 99%

Clinician compliance to recommendations regarding the risk of suicidality with selective serotonin reuptake inhibitors in the treatment of children and adolescents

Sørensen

Rasmussen

Roesbjerg

et al. 2019

Eur Child Adolesc Psychiatry

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Meta-analyses of randomized-controlled trials have established a heightened risk of suicidality for children and adolescents treated with selective serotonin reuptake inhibitors (SSRIs). The present study examined to what extent daily clinical practice complied with specific recommendations regarding the risk of suicidality when treating children and adolescents with SSRIs. All in-and outpatients aged 0-17 years at the Child and Adolescent Mental Health Services, Capital Region of Denmark with a prescription for SSRI on January 1st, 2016 were identified. Data were obtained for n = 365 patients regarding the level of clinician compliance to deliver pre-consent information about adverse effects, monitor for suicidality, and provide nonpharmacological interventions. 81.7% (n = 298) of patients received pre-consent information about adverse effects. 67.7% (n = 247) were monitored for suicidality within 6 weeks after SSRI initiation. Children (0-13 years) were less likely to be monitored for suicidality compared to adolescents (14-17 years) (49.6% vs. 77.5%, p < 0.001). Patients with depression as indication for SSRI treatment were more likely to be monitored for suicidality than patients with other indications (OR = 3.4, p = 0,002) and more likely to receive information specifically about suicidality (34.7% vs. 19.7%, p = 0.002). Respectively, 89.3% (n = 326) and 93.4% (n = 341) of all SSRI-treated patients were treated with non-pharmacological interventions prior to and in parallel with SSRI treatment. For the majority of cases, treatment of children and adolescents with SSRI complied with recommendations from clinical guidelines. However, patients of younger age and/or with indications for SSRIs other than depression were less likely to be managed according to recommendations.

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Do antidepressants make children and adolescents suicidal?

Cited by 11 publications

References 54 publications

Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

Adverse events reported by anxious school refusing adolescents receiving cognitive behavioral therapy with and without fluoxetine

Clinician compliance to recommendations regarding the risk of suicidality with selective serotonin reuptake inhibitors in the treatment of children and adolescents

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