When it comes to treating depression in children, newer antidepressants all seem to carry about the same risk for suicidal thoughts and behaviors, a new study shows.
Previous studies, including a review from the U.S. Food and Drug Administration, have concluded that children and teens who take antidepressants might be at higher risk for suicidal thoughts and behaviors, especially in the first few weeks of treatment. In 2004, the FDA added its highest-level warning to the labels of antidepressant drugs regarding the increased risk for suicide in children.
What's been less clear is whether some drugs are riskier in that respect than others.
The new study, published online Jan. 6 in the journal Pediatrics, reviewed the medical records of nearly 37,000 school-aged kids who were enrolled in Tennessee's Medicaid program between 1995 and 2006.
All were new users of one of six antidepressant medications: Prozac, Zoloft, Paxil, Celexa, Lexapro or Effexor. The average age of children in the study was 14.
Before they entered the study, about 3 percent of the children had tried to kill themselves and 10 percent had been hospitalized for psychiatric treatment.
After they were medicated, about 1 percent of kids who were treated with newer antidepressants -- including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) -- attempted suicide. There were 419 serious attempts at self-harm noted in the children's medical records, including four completed suicides.
None of the antidepressants in the study appeared to be significantly riskier than Prozac, the first antidepressant approved for use in children and the drug that's considered the gold standard for treatment in this age group. For every 1,000 children taking Prozac for one year, the study counted about 25 documented suicide attempts.
"There doesn't seem to be a different or higher risk for one medication over another," said study author Dr. William Cooper, a professor of pediatrics and health policy at Vanderbilt University in Nashville.
The risk of suicide was significantly higher, however, for children who were taking multiple antidepressants at the same time. Cooper said that probably reflects the severity of their depression, however, not any increased threat from the medications.
The findings echo the conclusions of a 2010 study published in the same journal that also found no differences in suicide risk between antidepressants among nearly 21,000 Canadian children who were followed for nine years.
Experts who were not involved in the research said it was good to have a confirmation of the earlier findings.
But they also felt an important point was left out of the discussion of suicide risk: the idea that depression itself puts a child at greater risk for suicide.
"I think the most important point about antidepressant use and suicide is not even mentioned in the paper, which is that failure to treat depression with an antidepressant may be associated with a much higher risk of suicidal behavior and suicide than the choice of which antidepressant," said Dr. Victor Fornari, director of the division of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.
Another expert agreed, but noted that those answers were beyond the scope of this study.
"The current study was not designed to address the issue of whether or not antidepressant medication is associated with an increased risk of suicide," said Dr. David Fassler, a clinical professor of psychiatry at the University of Vermont College of Medicine, in Burlington. "Nonetheless, the results may provide some degree of assurance for physicians and parents with respect to the choice of specific medication."
"However, I agree with the authors' conclusion that additional work is needed to further characterize the relationship between antidepressant use and suicidal behaviors," Fassler said.
