Antidepressants and suicide attempts among youth

New research suggests that all antidepressants are created more or less equal when it comes to their association with suicide attempts in children.

At least that’s the finding of a new population-based study from Vanderbilt University Medical Center in Nashville, Tennessee.

William Cooper, MD, and colleagues studied almost 37,000 kids and adolescents aged between 6 and 18 years who were new users of one of the following selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor antidepressants: fluoxetine, sertraline, paroxetine, citalopram, excitalopram, venlafaxine.

Almost half (47.4%) of the participants were being treated for major depressive disorder; one-fourth of the participants were diagnosed with attention-deficit/hyperactivity disorder; and the remainder had other conditions including conduct disorder and anxiety.

Four hundred nineteen participants attempted suicide, including 4 who completed the act. However, the researchers found no evidence that use of paroxetine, sertraline, citalopram, excitalopram, or venlafaxine was associated with a greater risk of medically treated suicide attempts than fluoxetine. The rate of confirmed suicide attempts for current users of the study drugs ranged from 24.0 per 1,000 person-years (paroxetine) to 29.1 per 1,000 person-years (citalopram and venlafaxine).

To further test the reliability of their findings, the investigators performed additional analyses stratified by gender, older age, absence of suicide attempt before initiating antidepressants, and data from the most recent years of the study period. Still they found no evidence of increased risk for any of the study drugs relative to fluoxetine. They did, however, find increased risk of attempted suicide among participants taking multiple antidepressants concomitantly.

The US Food and Drug Administration began requiring that a "black box" warning be added to package inserts for antidepressants back in 2004.

According to the American Academy of Child and Adolescent Psychiatry, suicide is the third leading cause of death for 15- to 24-year-olds and the sixth leading cause of death for 5- to 14-year-olds.

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