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Updates
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Antidepressant Use and Suicide Risk - An Update
December 2006
The report on antidepressants on this Web site warns that some people who take antidepressants may experience an increase in thoughts about suicide. This is most likely to occur in the first few weeks of taking the medicine. The report recommends that if you have just begun taking an antidepressant (or your dose has been changed, especially increased) and you begin to feel more depressed or begin having frequent thoughts of suicide, you should contact your doctor or therapist immediately to discuss this.
In addition, we advise you to be alert to symptoms such as agitation, irritability, hostility, or feelings of panic or dread if you have just begun taking an antidepressant or your dose has changed. These symptoms can be triggered in some people taking antidepressants and can be warning signs of emerging suicidal thoughts or behavior. See a doctor or therapist immediately if you have these symptoms. Do not stop taking your medicine before you do see a doctor.
This advice pertains to adults, teens, and children.
This alert updates you on the link between antidepressants and thoughts of suicide, or actual suicide attempts. This issue has been controversial for many years. Prompted by numerous studies, in October 2004 the Food and Drug Administration (FDA) began requiring drug companies to put a warning on labels and ads for antidepressants indicating that children and teens may be at higher risk of suicidal thoughts when they started taking the medicine. Then in July 2005, the agency said studies indicated that adults may be at risk, too. The agency asked companies to take a second look at the studies they had done in the past - involving people of all ages.
On May 12, 2006, GlaxoSmithKline, the maker of the antidepressant paroxetine (Paxil), said that its reanalysis of studies involving nearly 15,000 people did indeed turn up evidence that people aged 18 to 24 who took Paxil (for depression, anxiety, or obsessive compulsive disorder) had more than twice the incidence of suicidal behavior - including actual attempts - as those who took placebo (sugar) pills.
The number of people in that age bracket who took Paxil and exhibited suicidal behavior was low - about 2.2%. The analysis found that suicidal behavior increased - though not as much - in adults up to age 30 being treated for depression. The analysis found no increased risk of suicidal behavior in people over age 30 who took Paxil compared to those taking a placebo. In a letter to doctors, GlaxoSmithKline advised that "all patients, especially young adults and those who are improving, receive careful monitoring during paroxetine therapy regardless of the condition being treated."
Most recently, on December 12 and 13, 2006, the FDA issued yet another analysis of the data from past studies on antidepressants, and an FDA expert advisory panel met to consider the findings and what should be done. The study confirmed a higher risk of suicidal thoughts and behavior among children, teens, and young adults up to age 25 taking antidepressants - about seven cases per 1,000 taking the drugs compared to three per 1,000 among those not taking the drugs. So the "absolute risk" is still quite low.
The panel recommended that the FDA tell doctors and the public of this heightened risk. But the panel also advised the agency to do this is a way that does not discourage appropriate use of the medicines among depressed young people, and that people be told that the risk of suicidal behavior appears to decline with age.
Indeed, existing data suggests that, over time, people age 25 and older who take antidepressants are substantially less likely to try to commit suicide.
In the wake of these new findings and the FDA panel's advice, we would underscore our recommendation that anyone in their middle twenties or younger who takes an antidepressant should be monitored regularly by doctors and loved ones for signs they are reacting adversely to the drug. This is especially advised at the beginning of treatment, when a person first starts taking the medicine.
People older than their mid-twenties would be well advised to also learn about these possible ill effects of antidepressants and be alert to signs of trouble.
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