Clinician's Digest


Clinician's Digest

By Garry Cooper

March/April 2007


Now that the Food and Drug Administration (FDA) has heeded the warnings that selective serotonin reuptake inhibitor (SSRI) antidepressants may induce suicidal thoughts and attempts in some adolescents, there's been a sharp drop in the number of prescriptions written. In 2004, when the FDA first mandated the warning labels, prescriptions dropped 20 percent. Now many psychiatrists, citing other research that shows an overall decrease in suicides among adolescents who take SSRIs, worry that with the drop in prescriptions, adolescent suicide rates will begin rising.

An article in the December 28 New England Journal of Medicine by psychiatrist Gregory Simon, a researcher with Seattle's Group Health, manages to make some sense out of the controversy.

Basically, says Simon, controlled studies find that the risk of adolescent suicidal ideation and of actual attempts doubles with SSRI antidepressants, but it's still extremely low—about 7 cases per 1,000. Observational studies find that actual suicides decrease with antidepressants. The conflicting research is further complicated by the fact that observational studies, which take place in naturalistic settings, can't isolate variables or determine cause and effect as accurately. Further research isn't likely to yield better answers, notes Simon. More definitive studies would require about 6,000 participants—50 percent more than the current largest study. And in the end, they'd probably find…

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