Antidepressants - depression & suicide
Suicidal Thoughts and Behavior With Antidepressant Treatment
Reanalysis of the Randomized Placebo-Controlled Studies of Fluoxetine and Venlafaxine
Arch Gen Psychiatry. Published online February 6, 2012. doi:10.1001/archgenpsychiatry.2011.2048
Robert D. Gibbons, PhD; C. Hendricks Brown, PhD; Kwan Hur, PhD; John M. Davis, MD; J. John Mann, MD
Do antidepressants work in adolescent depression?
Do they increase the risk of suicide?
See this paper and this commentary by Daryl Efron. The results seem reassuring.
Mike
Important paper.
we know SSRI antidepressants are not fantastic for depression in adolescents, and probably have little if any effect on depression in pre-pubertal kds - although excellent anti-anxiety agents of course. So are they worth using for depression at all? and is the risk of suicidal thinking/ behaviour real, beyond paroxetine. I do use them to treat adolescent depression, and sometimes see apparent good benefit.
These authors looked at all longitudinal RCT data on fluoxetine from Lily (incl non-published), as well as data from the NIMH TADS study (Treatment for Adolescents With Depression Study - fluoxetine again). The findings are encouraging (my bold in abstract below).
Intrerestingly there was no relationship between reduction in depressive symptoms and reduction in suidicality, suggesting perhaps an alternate mediating factor / behaviour / mood state - although the numbers with suicidality are small so v hard to study. From the results:
"we could find no difference between treated and control patients in terms of suicide risk. The marginal ORs indicated a 61.3% decrease in the probability of suicidal thoughts or behavior for control patients after 8 weeks of study participation and a 50.3% decrease for treated patients."
My take - Fluoxetine may reduce depressive symptoms in adolescents, and is unlikely to incr risk of suicidaility
Daryl
The article is available at: http://archpsyc.ama-assn.org/cgi/content/abstract/archgenpsychiatry.2011.2048
Context The US Food and Drug Administration issued a black box warning for antidepressants and suicidal thoughts and behavior in children and young adults.
Objective To determine the short-term safety of antidepressants by standard assessments of suicidal thoughts and behavior in youth, adult, and geriatric populations and the mediating effect of changes in depressive symptoms.
Data Sources All intent-to-treat person-level longitudinal data of major depressive disorder from 12 adult, 4 geriatric, and 4 youth randomized controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride.
Study Selection All sponsor-conducted randomized controlled trials of fluoxetine and venlafaxine.
Data Extraction The suicide items from the Children's Depression Rating Scale–Revised and the Hamilton Depression Rating Scale as well as adverse event reports of suicide attempts and suicide during active treatment were analyzed in 9185 patients (fluoxetine: 2635 adults, 960 geriatric patients, 708 youths; venlafaxine: 2421 adults with immediate-release venlafaxine and 2461 adults with extended-release venlafaxine) for a total of 53 260 person-week observations.
Data Synthesis Suicidal thoughts and behavior decreased over time for adult and geriatric patients randomized to fluoxetine or venlafaxine compared with placebo, but no differences were found for youths. In adults, reduction in suicide ideation and attempts occurred through a reduction in depressive symptoms. In all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behavior.
Conclusions Fluoxetine and venlafaxine decreased suicidal thoughts and behavior for adult and geriatric patients. This protective effect is mediated by decreases in depressive symptoms with treatment. For youths, no significant effects of treatment on suicidal thoughts and behavior were found, although depression responded to treatment. No evidence of increased suicide risk was observed in youths receiving active medication. To our knowledge, this is the first research synthesis of suicidal thoughts and behavior in depressed patients treated with antidepressants that examined the mediating role of depressive symptoms using complete longitudinal person-level data from a large set of published and unpublished studies.
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
