Suicide Risk During Antidepressant Treatment

Simon, Gregory E.; Savarino, James; Operskalski, Belinda H.; Wang, Philip S.

doi:10.1176/appi.ajp.163.1.41

Cited by 359 publications

(236 citation statements)

References 24 publications

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“…48,49 Still other studies have used large databases to carry out naturalistic studies of possible associations between antidepressant use and suicidality. [50][51][52][53] In the only 1 of these studies that focused exclusively on youth, Valuck et al 50 conducted a propensity-adjusted retrospective cohort study to examine links between antidepressant treatment and suicide attempts in depressed adolescents (aged 12-18) by using a community sample of managed care enrollees. They found no increase in suicide rates with treatment with SSRIs, other antidepressants, or multiple antidepressants after a diagnosis of MDD, finding instead that treatment for at least 6 months reduced the likelihood of suicide attempts compared with treatment for less than 8 weeks.…”

Section: Antidepressant Treatmentmentioning

confidence: 99%

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting.METHODS. Using a combination of evidence-and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.RESULTS. These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized.CONCLUSIONS. These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression. that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teens having a history of depression at some point during adolescence. [1][2][3][4][5] In primary care (PC) settings, point prevalence rates are likely higher, with rates up to 28%. 6-10 Taken together, epidemiologic and PCspecific studies have suggested that despite relatively high rates, major depressive disorder (MDD) in youth is underidentified and undertreated in PC settings. 11 Because of barriers to adolescents receiving specialty mental health services, only a small percentage of depressed adolescents are treated by mental health professionals. 12 As a result, PC settings have become the de facto mental health clinics for this population, although most PC clinicians feel inadequately trained, supported, or reimbursed for the management of this disorder. [13][14][15][16][17][18] Although MDD management guidelines have been developed for specialty care settings (eg, see the American Academy of Child and Adolescent Psychiatry [AACAP] practice parameters 19 ) or for related problems such as suicidal ideation or attempts, 2...

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Section: Antidepressant Treatmentmentioning

confidence: 99%

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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“…While the estimated risk remained relatively stable over the next six months, their confidence intervals were wide, validating the lack to the number of observed events. Researchers assert that a significant increase of suicide risks or serious suicidal attempts existed after initiating SSRI therapy 48 . These findings were confirmed by Simon & Savarino, thus proving the reduction in the suicide rate after AD treatment 49 .…”

Section: Elapsed Time In Antidepressant Treatmentmentioning

confidence: 99%

Ten years after the FDA black box warning for antidepressant drugs: a critical narrative review

Martínez-Aguayo¹,

Arancibia²,

Concha³

et al. 2016

Arch. Clin. Psychiatry (São Paulo)

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Background: The United States Food and Drug Administration (FDA) has warned about the increased suicidality risk associated with the use of selective serotonin reuptake inhibitors (SSRI) and venlafaxine in children and adolescents. Objectives: To critically appraise the available evidence supporting the FDA Black box warning concerning to the use of antidepressants in child and adolescents. Methods: A critical review of articles in Medline/PubMed and SciELO databases regarding the FDA Black box warning for antidepressants, and the impact of FDA warnings on antidepressant prescriptions and suicide rates. Results: The warning was based on surveys that did not report either cases of suicide nor a significant difference supporting an increased suicidality rate. The concept was defined in an ambiguous way and there is currently more available evidence to support such definition. The use of SSRI and venlafaxine has been associated to lower suicidality rates, but the prescription fall due to the warning increased suicide rates. Discussion: Suicidality is an inherent feature of depressive disorders so it would be desirable to consider how much of the phenomenon may be attributed to antidepressants per se. It would be appropriate to consider that suicide rates might increase also as a consequence of the warning.

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“…22 However, in close parallel with the FDA review of data from randomized trials of modern antidepressants, 2,11 a recent review of clinical cohort studies 23 found evidence of age-related increases (adolescents) and decreases (older adults) of suicidal risks that included attempts and fatalities (see Figure 1). Dr. Fawcett: Simon et al 24 reported data showing that suicide attempt risk was highest during the month prior to antidepressant prescription and decreased throughout treatment (Figure 2). Dr. Baldessarini: Most large case series or cohort studies look favorable, but, in the randomized controlled literature, little evidence clarifies whether antidepressants specifically worsen or help suicidal behaviors (as opposed to self-reported suicidal ideation).…”

Section: Dr Fawcettmentioning

confidence: 99%

“…The suicide intervention information significantly reduced suicide attempts among students (P < .05). 24 Bars indicate 95% confidence intervals. (Table 2).…”

Section: -3mentioning

confidence: 99%