Researchers say the finding supports the FDA’s current "black box" warning on all antidepressants detailing the increased risk of suicide attempts and suicides in children and teens who start to take the drugs. A "black box" warning is the FDA's most severe warning label.
Previous studies have shown that children and teenagers who begin to use SSRI (selective serotonin reuptake inhibitor) antidepressants may have an increase in suicidal thoughts and behaviors, but researchers say this is the first study to compare the child and teen suicide risk among different individual SSRI antidepressants.
The study followed 20,906 children in British Columbia between the ages of 10 and 18 who had been diagnosed with depression and prescribed an antidepressant over a nine-year period.
During the first year of antidepressant use, there were 266 attempted suicides and three suicides.
Researchers found no significant difference in child and teen suicide risk among the five SSRI antidepressants studied (fluoxetine, fluvoxamine, citalopram, paroxetine, and sertraline). Tricyclic antidepressants showed risks similar to the SSRIs.
Overall, the child and teen suicide rate after initiation of antidepressant use among participants in the study was five times higher than the rate reported among all teens aged 13 to 17 in British Columbia, which researchers say reflects the higher suicide risks among the depressed.
"Our analysis supports the decision of the Food and Drug Administration to include all antidepressants in the black box warning regarding increased suicidality risk for children and adolescents initiating use of antidepressants," write researcher Sebastian Schneeweiss, MD, ScD of Harvard Medical School and colleagues in Pediatrics. "Once a decision to initiate pharmacotherapy is made, treatment decisions should be made on the basis of efficacy and less so on the basis of safety. Clinicians should be vigilant in monitoring children and adolescents for whom use of any antidepressant agents is initiated."