Antidepressants double suicide risk in children

Children and teenagers who take one of the five most commonly prescribed antidepressants have a doubled risk of depression and suicide, a team of Danish researchers have found.

Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed drugs for depression.

The researchers recommend minimal use of antidepressants in children, adolescents and young adults as "serious risks seem to be greater". Instead the scientists advised exercise or psychotherapy.

The scientists completed a systematic review and meta-analysis of 70 trials, some double blind placebo controlled trials, that included more than 18,500 patients, examining antidepressant use and associated risks such as deaths, suicidal thoughts, attempts and akathisia – restlessness that can increase suicide and violence. Double blind placebo controlled trials were also included.

Clinical study reports and summary trial reports were analysed as the risks associated with antidepressants are often not included as part of published trial reports released by pharmaceutical companies.

The limitations of clinical trials have also been revealed by this study, with researchers noting the serious under-estimation of the harms of antidepressants.

“The true risk for serious harms is still unknown,” said the researchers, “as the low incidence of these rare events, and the poor design and reporting of the trials, makes it difficult to get accurate effect estimates.” Access to anonymised individual patient data is needed to “elucidate the harms reliably,” they said.

There was no significant association observed with adults taking the same antidepressants and experiencing higher rates of aggression,violence and suicide.

Sertraline, venlafaxine, paroxetine, duloxetine and fluoxetine were the drugs investigated in the reports.

The study was published in the BMJ.