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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 antidepressant labels.

"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 things:

  • 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."

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