It’s the center of a huge ongoing debate in the medical world: how significant a risk are antidepressants in terms of suicide risk, particularly among adolescents?

And are adults at risk?

It is perhaps a cruel twist of fate that medications intended to help treat those suffering from depression would, in a rare few, pose an increased risk for the greatest complication of depression itself: suicide.

That is the concern, and the reason for black box warnings on antidepressants, that they can increase the risk of suicidal behavior or thoughts in children and adolescents.

But do they truly cause completed suicides, and in whom is the risk the greatest?

The latest research in the Archives of General Psychiatry shows severely depressed children and adolescents ages 6 to 18 years were 1.5 times as likely to attempt suicide and also significantly more likely to complete suicide if they were treated with an antidepressant medication than if they were not treated with an antidepressant.

Children and adolescents who died from suicide were more likely to have been treated with an antidepressant in the prozac and zoloft family--the SSRI’s--than those who weren’t.

But in this huge study of more than 5,000 patients hospitalized for depression, there were still only eight suicide cases.

Dr. Mark Olfson, the lead author at the New York State Psychiatric Institute, says it is possible that because the sickest children were more likely to be treated with antidepressants, they were perhaps already at a higher suicide risk, skewing the results.

And is it the drugs themselves causing the suicide risk and thoughts, or simply the fact that when patients come out of a deep depression, they start to have the energy to commit suicide they have already contemplated.

Dr. Olfson says, “We don’t know if that is true or not, and it may be for example that these antidepressants are helping give people more energy, and they are helping to restore their sleep or their appetite, but it is taking more time for their mood to catch up but that combination might pose an increased risk for more people that is speculation,”

The ones that appear to increase suicide risk in adolescents in terms of suicide attempts are paxil and zoloft, and another called venlafaxine. The group of medicines called tricyclic antidepressants also had a higher risk.

Prozac did not show an increased risk.

There was a powerful piece of good news, though: among adults age 19 to 64 years, antidepressants were not associated with either suicide attempts or suicide deaths.

So the focus now is on watching kids placed on antidepressants when they are severely depressed.

“I need to emphasize that this is a very difficult thing to study and there needs to be many more studies like this before we can have more certainty with the findings, it still may be the case overall if you look across the board in our society at how antidepressants are being used in our young people that they are actually saving more lives then not, but within certain populations particularly the severely ill, the severely depressed, teens coming out of the hospital, those are at high risk time for suicide,” Dr. Olfson states.

Dr. Olfson says if the child says he or she is feeling different, if parents feel that their child is becoming agitated, angry, or sees significant changes in their mood, that should be taken very seriously, but shouldn’t be done is is take them off of these medications outside of a physicians supervision.

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