Hi, I am the mother of a 16-year-old girl who has had significant difficulties with depression over the last year. We have a family history of depressive symptoms. Her symptoms started when her boyfriend moved away and he did not keep in contact with her. She has become progressively more withdrawn and her grades have dropped.

Her therapist thinks that we should consider treating her with antidepressants but I am worried because of all of the new saying that the antidepressants can cause suicidal thoughts and suicide itself.

Am I wrong to have these concerns?

Worried mother of depressed teen.

Answer:

Dear Worried Mother,

This is a very good question and one that you and your daughter should discuss with her therapist.

In March 2004, a decision was made by the Food and Drug Administration (FDA) to warn consumers of increased suicide possibilities associated with SSRI (Selective Serotonin Reuptake inhibitors) use. These medications are antidepressants, and include, among others, Prozac, Zoloft and Paxil. Prior to this decision, the American Academy of Child and Adolescent Psychiatry held discussions and created a policy statement. The overall decision was that:

The AACAP supports the ACNP report that the current research indicates that the evidence for the benefits of SSRI's -- as a treatment for depression -- outweigh their risks. Research findings to date point to the role of depression itself as the most likely cause of suicide. AACAP is adamant that continued research into SSRI use in children and adolescents to conclusively determine their effect.

A fuller summary of the decision itself and the thinking behind it can be found at the following link:

http://www.aacap.org/page.ww?section=Psychiatric+Medication&name=March+2004+FDA+Advisory

Since March of 2002, there have been numerous studies looking retrospectively at outcome from treatment of children and adolescents with SSRI medications. In June of 2006, a particularly good, large study, done in Denmark, was published in the European Child and Adolescent Psychiatry Journal. This study was designed “to examine the association between treatment with SSRI’s and completed suicide in children and adolescents”. The participants were “all persons aged 10 to 17 years treated with antidepressants from 1995 to 1999; 2569 children and adolescents. This population was compared with a “randomly selected control population” of 50,000 Danish children/adolescents in the same age range.

The very large numbers of this study make the results much more significant. The conclusion was:

“Use of SSRIs among children and adolescents increased substantially (more than 5 fold) during the study period, but the suicide rate remained stable. Among 42 suicides nationally aged 10 to 17 years at death, none was treated with SSRIs within 2 weeks prior to suicide. Suicide rarely occurred in close proximity to starting SSRIs, but rather was closer in time to discharge from hospitalization. There was an increased rate of suicide associated with SSRIs, however, not quite significant when adjusted for severity of illness.”

They further concluded that:

“A significant association between treatment with SSRIs and completed suicide among children and adolescents was not proven; when in indication for treatment was taken into account:”

The information from this study is very reassuring. However, this does not mean that children and adolescents with significant depression should not be followed closely.

All individuals with depression should have their risk of suicide followed closely by a mental health professional.

I hope that this is helpful to you and your daughter in making your decision. I have included two other web links to similar discussions of this issue.

Kay S. Browne MD
Behavioral Pediatrician

http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200304000-00005.htm;jsessionid=G1CRyMwJGNrTjN0bZnLyNjvJ1Y9hRywLF3pyqtPBGv9ylG1G4tl1!994528763!-949856145!8091!-1

http://nyspi.org/kolb/News%20Releases/ACNPSSRIPress.htm