In 2004, the Food and Drug Administration announced that antidepressant packages should carry a "black box" warning describing an increased risk of suicide and suicidal thoughts in children and youths up to age 25. The FDA action triggered a significant decline in antidepressant use among children and teens.
Now, however, an analysis suggests there is no reason to believe that antidepressants influence suicidal thinking in kids.
The paper, published online Monday in the Archives of General Psychiatry, analyzed data from 41 clinical trials involving more than 9,000 adults and children. The adults were taking either the antidepressant fluoxetine or venlafaxine. The children were taking fluoxetine (Prozac). The study showed that adults had a decreased risk of suicidal thoughts and behaviors while taking an antidepressant. Among children, medications neither increased nor decreased suicidal thoughts or behavior.
The new study draws from a larger database than the research performed in 2004 that led to the "black box" warning. However, the data on children are limited to the one medication -- fluoxetine.
Several important points can be drawn from the new study, said the lead author of the paper, Robert Gibbons, a professor of medicine, health studies and psychiatry at the University of Chicago. It suggests that antidepressants reduce suicide rates by treating the underlying depression. If the treatment does not work, suicide risk remains the same or rises.
Moreover, antidepressants appear to affect children differently than adults with regard to suicide.
"Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants," Gibbons said in a news release.
The impact of the "black box" warning, he said, was to reduce antidepressant prescriptions to kids -- which was correlated with an increase in suicide rates in subsequent years.
"I hope that the warnings will not prevent depressed children and adults from getting treatment for depression," he said. "The greatest cause of suicide is untreated or undiagnosed depression. It's very important that this condition be recognized and appropriately treated and not discarded because doctors are afraid to be sued."
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