Antidepressants can trigger suicidal thoughts in children -

Antidepressants and children

A prescription for antidepressant drugs is often given to alleviate migraines, anxiety, depression or chronic pain.

When the patient is a small child, however, there's added concern about the possibility of these drugs causing children to have suicidal thoughts which is also known as suicidality.  

The question of whether antidepressant drugs trigger suicidal behavior continues to be debated by scientists, but doctors say there are a number of cases reported that suggest a correlation.

"What you will usually see is the mood changes, the irritability, and then, something extreme," warns Dr. David Lelio, Director of Child and Adolescent Psychiatry at Carolinas Medical Center-Randolph.

In general, antidepressants can be very helpful in treating a wide range of medical conditions. 

The black box warning printed on the paperwork which comes with these pills was created to alert consumers about suicidality.

A study of clinical trials conducted by the U.S. Food and Drug Administration found that children taking antidepressants had a four percent chance of developing suicidal thoughts, as compared to a two percent chance among those who only received a placebo.

The bold, framed label, however, is not found on all prescription antidepressant medications.

Your physician should talk with you about the black box warning and your child's risk before beginning treatment.

Parents can also seek out a second opinion and look for other options.

If the issue is depression, psychotherapy might be the first stop before starting medication. 

Psychotherapy, or talk therapy, can determine the degree of depression and whether antidepressants are even necessary.

If antidepressants are the chosen remedy, Lelio says parents need to be mindful of the difference between a child being moody or suicidal.

"Can a 7-year-old really communicate, 'I'm depressed, I'm suicidal, I need help?'" Lelio asks.

He says children often don't know the words to describe how they are feeling. So, that's why adults should monitor their child's behavior and look to see if there are any sudden changes in the child's moodiness, appetite, energy level, or a tendency for them to cry.

You should also watch to see if they are sleeping more or playing less and if they appear to be aggressive, restless or isolated.

The FDA recommends children see their doctor every week during the first month while taking an anti-depressant drug. During the second month, visits to your doctor can be scaled back to every two weeks. You should have a follow-up visit with your doctor after 12 weeks of taking the drug, and meet thereafter based on your doctor's recommendation.

If a child exhibits feelings of aggression or hopelessness, make sure they are safe and immediately call your doctor.

Experts say you should never stop taking prescribed medications 'cold turkey' because it can cause withdrawal-like symptoms.

Ultimately, parents should not brush off any big changes in behavior for any reason.  

With anti-depressants, consider the risks versus the benefits for your child's unique case.

While there is lots of fine print information packaged along with any medication, when it comes to antidepressants, its worth peeling through all the paperwork to know as much as you can about these drugs.

Additional Information:

  • Click here for more information from the National Institute of Mental Health about antidepressant medications.
  • Knowledge of antidepressant treatments in youth, though growing substantially, is limited compared to what we know about treating depression in adults.
  • Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the U.S. Food and Drug Administration (FDA) issued a public warning in October 2004 about an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressant medications.
  • In 2006, an advisory committee to the FDA recommended that the agency extend the warning to include young adults up to age 25.
  • In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts-twice the rate of those taking placebo, or sugar pills.
  • In response, the FDA adopted a "black box" label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD. A black-box warning is the most serious type of warning in prescription drug labeling.
  • The warning also notes that children and adolescents taking SSRI medications should be closely monitored for any worsening in depression, emergence of suicidal thinking or behavior, or unusual changes in behavior, such as sleeplessness, agitation, or withdrawal from normal social situations. Close monitoring is especially important during the first four weeks of treatment.
  • The SSRIs include: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). Another antidepressant medication, venlafaxine (Effexor), is not an SSRI, but is closely related.
  • Use of SSRI medications among children and adolescents ages 10 to 19 has risen dramatically in the past several years. Fluoxetine (Prozac) is the only medication approved by the FDA for use in treating depression in children ages 8 and older. The other SSRI medications and the SSRI-related antidepressant venlafaxine have not been approved for treatment of depression in children or adolescents, but doctors still sometimes prescribe them to children on an "off-label" basis. In June 2003, however, the FDA recommended that paroxetine not be used in children and adolescents for treating MDD.
  • Psychotherapy often is tried as an initial treatment for mild depression. Psychotherapy may help to determine the severity and persistence of the depression and whether antidepressant medications may be warranted. Types of psychotherapies include "cognitive behavioral therapy," which helps people learn new ways of thinking and behaving, and "interpersonal therapy," which helps people understand and work through troubled personal relationships.
  • Once started, treatment with these medications should not be abruptly stopped. Although they are not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Families should not discontinue treatment without consulting their doctor.
  • Mayo Clinic:
  • The Food and Drug Administration (FDA) says that an extensive analysis of clinical trials showed that antidepressants may cause or worsen suicidal thinking or behavior in children and adolescents. The analysis showed that children taking antidepressants had about a 4 percent chance of developing suicidal thoughts or behavior, compared with only a 2 percent chance in children taking a sugar pill (placebo).
  • Some studies have reported opposite results - that suicide rates in children decrease when they take antidepressants.
  • A black box warning is now on all prescription antidepressants. The warning is printed in bold type, framed in a black border at the top of the paper insert that comes with the medication.
  • The Mayo Clinic recommends children have a physical exam and psychiatric exam done by a psychiatrist. A psychiatric evaluation should include: A detailed review of any potential risk factors your child may have that may make it more likely for him or her to hurt themselves, an assessment of whether your child may have other mental illnesses, such as anxiety disorders, attention-deficit/hyperactivity disorder and bipolar disorder, and an evaluation of whether there's a family history of mental illnesses or suicide.
  • The FDA has officially approved only one antidepressant for the treatment of depression in children - fluoxetine (Prozac). In addition to Prozac, escitalopram (Lexapro) is approved for the treatment of depression in adolescents age 12 and older.
  • Off-label use is when doctors prescribe other antidepressants for kids. Its legal. Fluoxetine is also FDA approved to treat obsessive-compulsive disorder (OCD) in children, as are the antidepressants sertraline (Zoloft), fluvoxamine (Luvox) and clomipramine (Anafranil).
  • The FDA advises that prescriptions be provided for the smallest quantity of pills possible. This may help reduce the risk of deliberate or accidental overdose by controlling how many pills your child has access to. This may mean you have to get prescriptions refilled more frequently, but that minor inconvenience can provide added safety for your child. When you get the prescription, be sure to carefully read the medication guide and package insert, and discuss any questions with your child's health care professionals.
  • The FDA recommends that your child see his or her health care professional on this schedule: Once a week during the first month of treatment, Every two weeks during the second month of treatment,  follow-up visit after 12 weeks of treatment, As recommended after those first 12 weeks.
  • The following are a list of signs that could indicate your child is experiencing suicidality:  

1. Thoughts about suicide or dying
2. Attempts to commit suicide
3. Self-injury
4. Feeling very agitated or restless
5. Panic attacks
6. Sleeping problems
7. Increasing sadness
8. An extreme increase in talking or activity
9. Aggression, violence or hostility
10. New or worsening anxiety
11. Social or academic problems at school
12. Spending more time alone

  • The highest risk for these side effects occurs during the first few months of treatment and/or when dosage is increased or decreased. (Source: Http://    
  • After the 2004 black box warning antidepressant prescriptions for young people fell... but the suicide rate in kids seemed to jump. In 2007, a study was published that tracked the rate of antidepressant prescriptions and suicides in the U.S. and Netherlands, in people under 19. Antidepressant prescriptions in both countries fell by about 22%. In the Netherlands the suicide rate rose by 49% over two years. In the U.S. it increased by 14% over a one-year period, apparently the largest since the government started tracking it in the 70s.
  • A new study points out that antidepressants decrease the severity of depression - but they do nothing for suicidal thoughts. For kids, the paradox is that there's a disassociation in suicide and depression.
  • List of antidepressants with medication guidelines:

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