The population-based study tracked children and adolescents who recently began taking newer selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) compared to new users of fluoxetine (brand name Prozac).
The study was not designed to compare the risk for suicide attempts for antidepressant users compared with non-users.
“These findings provide important information about the relative risks of the more recently approved antidepressants to help guide decision making by patients, their families and their providers,” said study author William Cooper, M.D., M.P.H.
For the past decade, many parents and health care professionals have worried that children and adolescents treated with antidepressant medications might be at increased risk of suicidal thoughts or behavior.
The Vanderbilt University Medical Center study is published in the journal Pediatrics.
In 2004, the U.S. Food and Drug Administration (FDA) and the UK Medicine Healthcare Products Regulatory Agency issued public warnings about the increased risk of suicidal thoughts or behavior in children and adolescents treated with certain antidepressant medications, and required that a “black box” warning be added to package inserts for antidepressants.
Because antidepressants differ in their characteristics, including effects on neurotransmitters, it has also been believed that the risk of suicidal behavior for individual medications might differ.
“It is important to study this group of children and adolescents because many children are treated with these medications in the U.S. each year and we need to understand the differential risks for suicide attempts and completed suicides,” said Cooper.
SSRIs like fluoxetine (brand name Prozac) are the most widely used antidepressant/antianxiety drugs, slowing down the rate at which serotonin, an important signaling molecule in the brain, is broken down.
An SNRI, like venlafaxine, is a newer type of antidepressant that does the same thing for another important chemical, noradrenaline, as well as serotonin.
The study compared suicide attempts among new users of sertraline, paroxetine, citalopram, escitalopram, and venlafaxine to attempts by new users of fluoxetine.
According to the American Academy of Child and Adolescent Psychiatry, suicide is the third leading cause of death for 15-24 year olds and the sixth leading cause of death for 5-14 year olds.
The Vanderbilt study reviewed the medical records of 36,842 children 6 to 18 years old enrolled in Medicaid between 1995 and 2006 who were new users of one of the antidepressant medications of interest.
Of those studied, 415 had a medically treated suicide attempt, including four who completed suicide.
Of those included in the study, 47.4 percent had a diagnosis of MDD and one-fourth had a diagnosis of attention-deficit/hyperactivity disorder.
Other common psychiatric conditions among the cohort members included conduct disorder and anxiety.
Source: Vanderbilt University