Antidepressants, Suicide and Age: Is There a Light on the Horizon?
Murugaiah Andappan
Monday, 03 August 2009 17:44 UTC
While antidepressants have some success in improving the quality of depressed patients, they also seem to worsen the depression by increasing the suicide risk, esp., in young patients of <=24 age and in first few weeks of treatment. All the antidepressants (including the atypical, e.g., wellbutrin) carry the black box warning on suicide risk. There exist neither animal models nor biomarkers to predict suicide risk of antidepressants early on. Nevertheless, it is hard to explain scientifically the link between the young age and suicidal ideation, promoted by antidepressants. Is there a light on the horizon?
Thoughts, hypotheses, and possible solutions: all are welcome!
Disclaimer: Views, expressed herein, are those of the author and not those of his employer
Updated 28 August 2009 19:40 UTC
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Replies
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Hi, Murugaiah.
The increaded suicide risk after antidepressant treatment is indeed controversial. Several published clinical trials show conflicting results due to different statistical methods, trial design and patient selections. The black box warning on suicide has been imposed by regulatory authorities in order to err on the safe side. Since antidepressants are drugs used to treat depression, an illness which itself increases the suicide risk, measuring correctly an increased suicide risk just as a mere drug side effect is not easy. At the present time, we do not even know the mode of action downstream the primary molecular target for any antidepressant, and therefore a lot of basic research would be necessary in order to eluicidate the mechanism linking behaviour changes induced by antidepressants.
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Hi Mario,
Thanks for your comments. Here is the FDA statement:“Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children,adolescents, and young adults (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients”
This means that the clinical trials can detect the increase in the suicide risk, associated with antidepressants.
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