In a study of selective serotonin reuptake inhibitor (SSRI) use in counties across the USA, researchers have found that those with the highest rates of prescription have the lowest rate of suicide among children aged 5 to 14 years.
These findings counter concerns that SSRI use may be linked to suicidal ideation in children and adolescents. Reports providing evidence of such a link prompted the US Food and Drug Administration to change the labeling on SSRI drugs to include a black box warning for all age groups.
Robert Gibbons (University of Illinois, Chicago, USA) and colleagues noted, however, that as "the age-adjusted suicide rate is about six-times higher in 15–19 year olds compared with 10–14 year olds, the risk–benefit ratio may be different in younger children."
To investigate, the team examined the association between antidepressant medication prescription rate and suicide rate in US children aged between 5 and 14 years between 1996 and 1998.
The average population of such children during this period was 38,812,743, and the number of suicides was 933, at 0.8 per 100,000 children per year.
If there were no SSRI prescriptions, the team estimated that there would be 253 more suicides per year, an increase of 81%.
In US counties with the lowest decile of SSRI prescriptions, based on number of pills per person per year, the overall observed suicide rate was as high as 1.7 per 100,000 children per year, whereas for counties with the highest decile of SSRI prescriptions, the suicide rate was as low as 0.7 per 100,000 children per year.
The association between SSRI prescriptions and a reduced suicide rate among children remained significant after taking into account income and access to mental health care.
Thus, Gibbons and team report that the findings "suggest that the risk–benefit ratio in 5–14 year olds may be favorable."
They write in the American Journal of Psychiatry: "Our results are in agreement with pharmaco-epidemiologic studies reporting a decline in suicide attempts and suicide in adults and adolescents prescribed antidepressants."
This may reflect "antidepressant efficacy, treatment compliance, better quality mental health care, and low toxicity in the event of a suicide attempt by overdose," the researchers add.
In a related editorial, Gregory Simon, from the Center for Health Studies in Seattle, Washington, USA, makes the observation that "even if randomized trials and large observational studies find no effect of antidepressants on average rates of suicide attempt or suicide death, average effects may not apply to all individuals."
He said that it is important to have regular contact with patients in the weeks following initiation of antidepressant treatment and for them to be aware of suicidal thoughts as a potential side effect.
Free abstract
MedWire Links
Discuss this article on MedWire Open