Antidepressants – including selective serotonin reuptake inhibitors (SSRIs) – can be an effective means of treating symptoms associated with obsessive compulsive disorder, anxiety and depression – which affects an estimated five percent of teenagers. Depression in children and adolescents, when left untreated for prolonged periods of time, can result in severe behavioral issues and problems at home and in school.
While some antidepressants and psychological therapies have shown positive results, there has been mounting concern about the side effects of SSRIs among children and adolescents. The most serious concern is that of suicidal thoughts and tendencies among young adults who take antidepressants – specifically those who are age 25 and younger.
FDA warns about antidepressants and suicide risk in children
In the beginning of 2004, the Food and Drug Administration (FDA) asked several antidepressant manufacturers to update their product labels to include language about the possibility of an increased risk of suicidal thoughts in children, particularly at the start of therapy or at the time of dose adjustments. Based on escalating adverse event reports and post-marketing data, in October of that same year, the agency mandated that all antidepressants (including SSRIs, tricyclic antidepressants, and monoamine oxidase inhibitors) to include a black box warning concerning suicidal ideation and behavior in both children and adolescents.
Among the more common brand names of antidepressants included in this list are:
How do antidepressants lead to suicidal thoughts in children?
Since severe depression may entail a higher suicide risk, it is often challenging to determine a direct link between antidepressant use and suicidal ideation or suicide. Potential reasons for this increased risk in children may be tied to the side effects of SSRIs, including agitation, hostility, increased anxiety and impulsive behavior. These kinds of adverse side effects may be a sign of worsening depression or point to a possible risk for suicidal behavior.
While the FDA’s black box warning on suicidal behavior in children treated with antidepressants is the agency’s most stringent, during its review, no completed suicides were reported among the 2,200 children treated with SSRI medications. However, four percent showed an increase in suicidal ideation (such as actual suicide attempts), compared with 2 percent of those taking a placebo.
Conflicting research on causal relationship
As with any major medical decision, families and their physicians should carefully consider the risks and potential dangers of antidepressant treatment for the individual patient. Some clinical studies have implied that any benefits of antidepressants outweigh their risks to children who suffer moderate forms of depression and anxiety disorders. One such study, which reviewed pediatric trials, was published in the Journal of the American Medical Association in 2007.
On the other hand, mental health practitioners remain divided on whether warnings for SSRI suicide risks in children are truly warranted. They see these warnings as a cautionary measure, alerting parents to weigh the pros and cons of any medication before initiating treatment. Careful monitoring of behavior and side effects is crucial, as the highest risk of suicidal thoughts occurs during the first few months of treatment and when the dosage levels are changed.
Warning signs that parents should look out for
The early signs of potential self-harm may be subtle among children who are taking antidepressants. A teenager may be reluctant to share these inner feelings with a parent. The following are some warning signs that a child’s depression is deepening, putting them at risk for self-harm:
- Spending more time alone
- Self injury
- Increased agitation or restlessness
- Sudden panic attacks
- Extreme sadness
- Volatile mood swings
- Aggression or hostility
- New or worsening anxiety
- Problems at school either socially or with academics
- Talks of dying or suicide
Alternative treatments for children with depression
A thorough medical evaluation can help determine whether antidepressant therapy is appropriate for a child. Other treatments that may be considered as a safer alternative include cognitive behavioral therapy, to help learn new ways of thinking and enhance coping skills, and interpersonal therapy, which can help the patient adapt and make changes in personal relationships.