Antidepressant/Child Suicide Risk Slim
Study: Depression Drugs' Benefits for Kids Far Outweigh Suicide Risk
Weighing Antidepressants' Suicide Risk
None of the kids or teens in antidepressant clinical trials actually tried
to kill themselves. But some said they thought about suicide or even made
preparations for suicide. Even the Brent study found some link between this
"suicidality" and antidepressant use.
"Did the drugs make people more disinhibited and more likely to report
suicidal thoughts?" Brent asks. "Almost all of these events were
suicidal thoughts that increased. There were no suicide attempts and no suicide
completions. So while this is a concern, it is not clear what the importance of
these events really is."
The real question, Brent says, is whether the possible benefits of
antidepressant treatment outweigh the possible risks. One way of looking at
this is to compare the "number needed to treat" -- that is, the number
of kids who must be treated to ensure that one kid gets a benefit -- to the
"number needed to harm," in this case the number of kids who must take
antidepressants before one has a suicidal thought.
Brent and colleagues found that for every three to 10 children and teens
treated with the drugs, one got a significant benefit. Out of every 112 to 200
children and teens treated, one had suicidal thoughts.
"Our goal was to try to make the decision-making more transparent by
presenting the risk/benefit ratios," Brent says. "We leave it up to
families and their doctors to choose whether the possible benefits are worth
the possible risks. We are trying to take some of the emotion out of it, and
put the risks and benefits side by side."
"Brent and colleagues have very accurately characterized the real risks
and the real benefits of pediatric antidepressants," Gibbons says.
Both Gibbons and Brent would like to see the black-box warning taken off
"We need to consider the risk of doing nothing. Especially with the
diagnosis of depression, these are potentially fatal illnesses," Brent
says. "The stakes are high. That is why looking at the risks in context of
benefits is so important."
This doesn't mean that putting a child on antidepressants is an easy
decision. Brent says families must be carefully educated about three
- Antidepressant risks and benefits
- Assessment for response to the drugs. If a child or teen doesn't respond to
the medication, there's no way to compare benefit to risk.
- The need for careful patient monitoring
And Brent warns that successful treatment of depression, OCD, or anxiety
isn't a simple matter of giving children or teens a few months of pills.
"These conditions tend to be chronic and recurrent," he says.
"There is no way an eight- to 12-week study will answer questions about a
several-year treatment plan, which is what it takes to get people better and
keep them better."