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Is suicide linked to antidepressants?
Results so far:
| Yes | 65% | 113 votes | Total: 174 votes | |
| No | 35% | 61 votes |
Yes
by Dr. Deborah Bauers
Created on: April 27, 2010
The link between the use of antidepressant medication and increased risk of suicide in a small fraction of the child and adolescent population appears to exist. However, clinical trials remain inconclusive and call for further study. Antidepressant medications have been shown to be effective in treating adolescent depression. But in a small percentage of cases, it has also been linked to increased agitation and suicidal ideation.
In May of 2007 the Federal Food and Drug Administration instructed drug manufacturers of antidepressants to include a supplement to the original “black box warning” on all antidepressants. It supplied physician and patients with information about a potentially heightened risk of suicidal thought and behavior for adolescents and young adults between the ages of 18 and 24. This warning applied to early treatment within the first couple of months of administering the drug. The black box revision was adjunctive to a similar warning issued in 2005 that identified children and adolescents being treated with antidepressants as being at a higher risk for suicidal ideation.
A link between a potential increase in suicidal thought and behavior and the child, adolescent, and young adult populations raises an important question. Why is this group at greater risk than an older adult population? Although the answer, like the result of all clinical trials to date, remains inconclusive, psychologists believe that the link may be due to a greater risk of general volatility and emotional instability that sometimes characterizes this population.
Additionally, prior studies have already suggested an increased risk of treating bipolar patients with SSRIs in the absence of a mood stabilizer. Since young adulthood is frequently the time when bipolar symptoms are first identified, it is possible that a part of the risk involved in treating this diagnosis with an SSRI is an increase in agitation and suicidal thought associated with a depression that is more complicated and accompanied by manic episodes.
More recent studies on the impact of antidepressant medication in older adults suggests that the threat of suicide decreases with age. These early findings leave room for more clinical trials in light of increasing concerns about the increased suicidal risk among the elderly population.
Prozac (fluoxetine) remains the only SSRI that has been approved by the FDA for treating adolescent depression. Physicians continue to prescribe other antidepressants to children and teens, “off label.” Physicians, mental health professionals, and parents should all maintain vigilance in monitoring the child and adolescent population who is undergoing initial treatment for depression with an antidepressant.
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No
by Catherine Marr
Created on: April 25, 2010
Is suicide linked to antidepressants? In short, no, suicide is not linked to antidepressants. While there may be a high correlation between the two, neither is indicative of a causal relationship nor can it be said that antidepressants cause higher rates of suicide.
The DSM IV-TR lists criteria for a Major Depressive Episode as having five (or more) of the following symptoms: depressed mood, diminished interest or pleasure in most all previously pleasurable activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation ('restlessness' or 'being slowed down'), loss of energy, feelings of worthlessness or inappropriate guilt (often delusional), diminished ability to think or concentrate, or indecisiveness, and recurrent suicidal ideation without a specific plan or a suicide attempt or a plan for committing suicide. The individual must have one of the first two symptoms within the five overall diagnostic criteria.
In theory, antidepressants are used by individuals who are not helped by other forms of treatment, i.e. psychotherapy. As the antidepressants begin working, the mood is elevated. Along with an elevation in mood, they symptoms begin to change; some dissipate and some seem to amplify during the healing process. The individual who is beginning the road to recovery will most likely have increased levels of energy, sleep more effectively, be more decisive, and have better concentration. While these signs are positive, the depression is still not cured and negative symptoms still exist.
Instead, I would propose the supposed 'link' between antidepressants and suicide is that of the beginning elevations in energy, concentration, and decisiveness while still having a above average depressed mood and suicidal ideation or a plan. The individual is now caught in limbo between depression and normal while not knowing which way they will teeter.
In a way, this phenomenon correlates with Season Affective Disorder (SAD) and higher rates of suicide during the spring time. If SAD affects people in the winter due to lack of sunlight and neurotransmitter production, when the sun becomes more prevalent they should begin feeling better. However, there is a higher rate of suicide during the season that marks improvement, not the season which holds the strongest symptom. Why?
As Virginia Wolfe said in her final letter before her suicide, she was not sure if she could go through another of those terrible times. With chronic, recurrent depression (that is treated with antidepressants) or SAD, the individual may be feeling better but ultimately, they "know" it will not last. The increase in energy, concentration, decisiveness coupled with the oh-so fresh feelings of depression, one may end the cycle before they are psychologically unable to. It is not the antidepressants that do it, but the cyclical pattern of depression and the straw that breaks the camels back.
Learn more about this author, Catherine Marr.
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