Volume 183 - Issue 5
Depressed youth, suicidality and antidepressants
Author: Robert D Goldney
Med J Aust 2005; 183 (5): 275-276. || doi: 10.5694/j.1326-5377.2005.tb07038.x
Published online: 5 September 2005
Published online: 5 September 2005
Robert D Goldney
Professor of Psychiatry, University of Adelaide, The Adelaide Clinic, 33 Park Terrace, Gilberton, SA 5081. Robert.goldneyATadelaide.edu.au
To the Editor: Two recent items in the Journal might potentially lead to misinterpretation of the evidence on managing depression in young people.
The first was the book review entitled Darker side of “wonder drugs” by Jureidini1 in which there was no disclosure that the author of the review is president of Healthy Skepticism, a body which has been quite strident in its opposition to antidepressant therapy. The second was the unattributed comment in the editorial by Rey and Dudley describing “parents who believe their children killed themselves because they were taking SSRIs [selective serotonin reuptake inhibitors] . . .”,2 which may imply subtly that this has occurred frequently.
In a review of the United Kingdom General Practice Research Database of more than three million people,3 there were no suicides among the 6976 aged 10–19 years who had been prescribed one of two SSRIs or two tricyclic antidepressants; however, 15 people in that age group who had not received an antidepressant drug died by suicide. Furthermore, in a review of 14 857 suicides in Sweden, of the 52 involving people under 15 years, no SSRIs were detected, and in the 15–19-years age group, those taking SSRIs had a lower relative risk of commiting suicide than those taking other antidepressants.4
Clinicians with responsibility for children and adolescents can be reassured by these data, and also by the fact that the American Food and Drug Administration “black box” warning (their most potent warning) about antidepressants has recently been modified.5 Furthermore, the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have provided a new resource about the use of medication in treating childhood and adolescent depression,6 which has been endorsed by over a dozen United States organisations comprising a “national coalition of concerned parents, providers, and professional associations”. This should allay questions that have rightly been raised, but that have been answered in favour of the judicious use of antidepressants, along with other therapeutic measures for children and adolescents with severe depression.
In view of the strong association between child and adolescent mood disorders and suicide,7 the above research findings and the recommendations of respected professional bodies raise the issue of potential legal action for not at least trialling antidepressant medication in young people with severe depression if non-pharmacological measures are ineffective.
Competing interests
I have received honoraria and research grants from a number of pharmaceutical companies for presentations and research on depression.
References
- Jureidini JN. Darker side of “wonder drugs” [book review]. Med J Aust 2005; 182: 293. 0_CBBDDICH
- Rey JM, Dudley JM. Depressed youth, suicidality and antidepressants. Med J Aust 2005; 182: 378-379. 0_i1091550
- Jick H, Kaye JA, Jick SS. Antidepressants and the risk of suicidal behaviors. JAMA 2004; 292: 338-343. 0_i1091552
- Isacsson G, Holmgren P, Ahlner J. Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14 857 suicides. Acta Psychiatr Scand 2005; 111: 286-290. 0_CBBFGECC
- Hanson E. AACAP/APA Press conference introduces new guides for educating parents, consumers about antidepressants. Am Acad Child Adolesc Psychiatry News 2005; 36: 60-61. 0_CBBEEFDA
- American Psychiatric Association and American Academy of Child and Adolescent Psychiatry. The use of medication in treating childhood and adolescent depression: information for patients and families. Available at: http://www.parentsmedguide.org (accessed May 2005).
- Shaffer D, Gould MS, Fisher P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 1996; 53: 339-348. 0_CBBJBFFA