Hello,

My daughter is currently a junior in high school. She has been an excellent student until last year when her grades began dropping and she seemed to withdraw from contact with her friends and even from extracurricular activities. The guidance counselor at school called me after talking with my daughter and suggested that my daughter was depressed and would benefit from counseling. Apparently, the stressors of sophomore and junior years in high school are heavy for those students planning to go ahead to college.

My daughter has been seeing a psychologist for about 6 months and antidepressant medication has been recommended. I have been researching these medications on the web and talking with professional friends. It worries me that there has been an increased risk of suicide reported with the more commonly used antidepressants. My daughter is willing to take medication and has a good relationship with her psychologist, but I am feeling that I need to know more about the risks associated with such treatment. Can you help us?

Thank you,
Concerned mom

Answer:

Dear “Concerned mom”,

Your worries are quite reasonable and shared by many parents of depressed children and teens. Fortunately, a great deal of pertinent research has been done and published. This should calm your concerns about potentially harmful side effects.

The research that I have read has been well circulated among child psychiatrists and should be readily available to any psychiatrist that might be prescribing medications.

Concern grew several years ago when the food and drug administration decided to put a warning on the packaging of some of the more commonly used antidepressants, the SSRI group, selective serotonin reuptake inhibitors. They are frequently prescribed with least side effects of the available antidepressants. They include Prozac and Zoloft and other similar medications. The warning stated that these medications may be associated with increased suicidal ideation in children and adolescents.

Current studies include comparisons of suicide rates in children and adolescents before and after these medications were available for use, (these are all relatively recent medications). The studies indicate that there has not been an increased suicide rate after these medications became available.

There are many many well-done studies that compare suicide rates and suicide ideation after children and teens have begun taking these drugs. It appears that there is an increased rate of thoughts about suicide in people up to the age of 25 that have begun taking these medications. However, the studies have shown that the actual suicide rate has not statistically increased. There has been speculation about why the suicide thoughts increase but no actual mechanism has been proved.

Many child psychiatrists have been concerned that the FDA (food and drug administration) moved too quickly in putting warnings on the labels for these medications. In fact, recent statistical reviews have shown that these medications are prescribed less since the warning has been put on the labels. The suicide rate has actually increased with the decreased use of antidepressants.

Most of the reviews that I have read end up with the conclusions that these medications are very helpful for children/teens and adults affected by depression. Recommendations are that young individuals with significant depression be treated with these medications and that they, as should always be the case, be closely monitored for suicidal thoughts and intent. Overall, the value of the antidepressant effect is felt to outweigh the worry about suicide thoughts.

I hope that this has been helpful to you. I would love to hear about your daughter in the future. Depression is very common in young people of her age and she is lucky that it was identified and that she is getting treatment.

Kay S. Browne MD
Behavioral pediatrician