The second leading cause of death for individuals ranging from ages 5 to 24 years old is suicide especially among children, adolescents, and young adults. Approximately 21.4% of children and adolescents, who attempts suicide, have been diagnosed with a severe mental disorder, usually depression. Most environmental and clinical studies have found that a general increased in suicide rates is significantly associated with higher rates of prescribing modern antidepressants. Antidepressant medications are commonly prescribed to decrease the warning signs of depression and to reduce the possibility of suicide. During a pediatric study conducted in 2003, the U. S. Food and Drug Administration (FDA) discovered a number of clinical-trial adverse of the antidepressant drug, serotonin reuptake inhibitors (SSRI), involved suicidal behavior or ideation. Researchers found evidence that individuals taking antidepressant medication (SSRI) may be at even higher risk of suicide than individuals whose depression is alleviated for other reasons. This controversy has not yet been completely determined. This paper propose to investigate the question: Do antidepressants increase the risk of suicide in children and adolescents?
Antidepressants and Suicidal Behaviors among Children and Adolescents
Depression, the modern plague speeding across the world, is having an effect on adults, teenagers, and even children. Depression and anxiety rates in particular among teenagers have increased by seventy percent (70%) during the past 25 years (Schachar & Ickowicz, 2014). Clinical depression studies have shown that one in every five teenagers and twenty percent (20%) of adolescents are diagnosed with a disorder by the time they become adults (Schachar & Ickowicz, 2014).
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While a diagnosis of depression is vital, it is really only half of the battle of fighting the illness. There are still several options for treatment that can be choose from, as well as dealing with side effects that are associated with each treatment. Of all the treatments, antidepressants tend to have the most side effects. Some severe side effects may include: frequent urinating, decreased appetite, heart complications, and suicide. It is last side effect, suicide, which has recently caused some controversy within the medical field. With recent research revealing an association between antidepressants and suicide, as well as the Food and Drug Administration systematizing warning labels for suicide on antidepressant medication, physicians have to cautious recommending the drugs, especially to children and adolescents.
In the early 1990s, concerns related to safety were originally cultivated with accounts that described a possible correlation with suicidality. A number of published reports were based on research related to participants taking fluoxetine (Prozac). For example, Lopez-Leon, Lopez-Gomez, Warner, and Ruiter-Lopez, L. (2018) reported on the case of a 10-year-old boy was diagnosed with mild suicidal ideation relentlessly have gotten worsen following trials with selective serotonin reuptake inhibitors (SSRIs).
In recent times, an extremely complex issue has continues to rise on whether antidepressant drugs, especially the selective serotonin reuptake inhibitors (SSRIs) used in the treatment, cause suicide ideas to development or worsening in defenseless patients especially children and adolescents. Over the past ten years, there has been a tremendous increase in preteen and teen suicides. According to the Centers for Disease Control and Prevention (CDC), suicide among our youth ages 10-24 has doubled from 2008 to 2015, making it the second leading cause of death, behind unintentional injuries (Rojas, Leen-Feldner, Blumenthal, Lewis, & Feldner, 2015). There is substantial indication that a majority of these youth may possibly suffered from some form of mental disorder, often depression and anxiety.
Statement of the Problem
Treatment of children and adolescents for depression by the means of medication comes in an assortment of shapes and sizes. In order to understand the unique challenge of how antidepressant drugs could elevate risk of suicide and aggressive behavior. Evidence has shown that the use of SSRI medications among children and adolescents ages 10 to 19 has escalated noticeably in the past several years (Lopez-Leon et al., 2018). The main risk component causing the movement of high rates of antidepressant prescription is mental healthcare providers is having complexity in discovering effective treatments for depression in children and adolescents. This literature review examines the effectiveness of antidepressants and their link to children and adolescent suicide.
Purpose of the Study
The purpose to this study is to analyzing the effectiveness of antidepressant treatment in general and the relationship of suicide rates to treatment among children and adolescents which is a greater risk. Questions were raised in the 1990 regarding a possible relationship between antidepressants and suicide which was influenced by a series of publicized case reports. The case reports introduced evidence that the SSRIs medications were associated with the ostensible development of suicidal thoughts and behavior. In the fall of 2004, the U.S. Food and Drug Administration (FDA) issued a public warning in relation to an increased risk of depression and likely to commit suicide (suicidality) in children and adolescents treated with SSRI antidepressant medications (DeLucia, Kelsberg, & Safranek, 2016). In 2006, a counseling committee to the FDA recommended that the agency incorporate the warning to include young adults up to the age of 25 (DeLucia et al., 2016). One approach used for this study is the use of ecological datathat relate changes in drug prescription rates to suicide rates in large populations.
For the purpose of the study, the following hypothesis can be focus on:
- Could antidepressant medications mainly used in for depression treatment, serotonin reuptake inhibitors (SSRI); essentially increase the risk of suicide in children and adolescents?
This question is contrary to common-sense expectation. Several randomized controlled trials conducted in 2003 discovered that certain classes of SSRIs, except fluoxetine, have not been proven successful in the use of depression; therefore, they may increase the risk of suicidal thinking or attempts in children and adolescents (Elraiyah & Murad, 2016).
The second hypothesis for this study can be focus on:
- Do antidepressant medications reduce suicidal ideas or thoughts (suicidal ideation), struggles, or fulfilled suicides in children and adolescents?
Evidence that antidepressant medication treatment decreases suicide risk or suicide attempts is mixed. Despite the fact that antidepressant medication may be linked with risk for suicide, no medication has yet to be made known to lower suicide risk in depressed patients, especially children and adolescents (Nischal, Tripathi, Nischal, & Trivedi, 2012).While treatment with SSRIs are designed to decrease the symptoms of depression, carefully monitored and managed should be conducted during the treatment phase. Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered.
Definition of Terms
In experimental, observational, and epidemiological studies, it is essential that these styles of studies are used to define the investigation the use of SSRIs and their association with suicidality:
- Antidepressants – medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions (Isacsson & Rich, 2014, p. 117).
- Suicide – the act of taking one’s own life on purpose (Isacsson & Rich, 2014, p. 120).
- Selective serotonin reuptake inhibitors (SSRIs) – commonly prescribed antidepressants (Isacsson & Rich, 2014, p. 122). SSRIs block the reuptake, or absorption, of serotonin in the brain. This makes it easier for the brain cells to receive and send messages, resulting in better and more stable moods (Isacsson & Rich, 2014, p. 122).
While antidepressants are projected to decrease the symptoms of depression, they sporadically have conflicting influence and can increase suicidal thoughts and actions, especially among children and adolescents. Least ten percent of American is prescribed antidepressants making it the third most prescribed medication in the United States (DeLucia, et al., 2016). Literally selective serotonin re-uptake inhibitors (SSRIs) are the most extensively dispersed antidepressant treatments when it comes to children and adolescents. In spite of the given information, numerous experiments conducted in 2003 raised an apprehension about the effectiveness of SSRIs in children.
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The Food and Drug Administration conduct an extensive research comparing SSRI versus placebo (sugar pill), the research suggested that children prescribed an antidepressant has approximately a four percent (4%) possibility of acquiring suicidal thoughts or behavior compared to only two percent (2%) risk of children taking a placebo (sugar pill) (Isacsson & Rich, 2014). So what mechanisms linked to antidepressants that cause an interaction in the brain that may trigger suicidal tendencies? One apparatus, akathisia, causes intense anxiety or the lack of ability to sit or stand still for a satisfactory interval of time, which may lead to acts of suicide. Prozac and Symbyax are two forms of antidepressant can have a chemical imbalance stimulant (similar to amphetamines), which can lead to suicide (Isacsson & Rich, 2014).
The other apparatus basically involves the passageway to recovery from depression. Not all symptoms of depression are treatable at once; the physical symptoms of depression may results in some patients experiencing a change in energy levels, difficulty concentrating, sleeping and eating disturbances. While still struggling with depressed mood, these symptoms can motivate the patient to act on sudden suicidal thoughts that adjunct to the depression. As patients begin treated for depression may have an increased of energy and functionality. These levels of risk increases are at their greatest one week to 10 days after starting treatment; risks began to slowly decrease by 2–3 weeks of treatment (Lopez, Jaussent, Gorwood, & Courtet, 2016).
For nearly twenty years, there has been a concern pertaining to the connection between antidepressants and the risk of suicide especially among children and adolescents. This concern finally piloted the U.S. Food and Drug Administration (FDA) into issuing a public health advisory in 2004. The warning suggested a strong probability that children and adolescents treated with certain antidepressants can increase the risk of suicide. In October 2004, the FDA instructed prescribed drug manufactures to implement what is known as a black box warning to packing relying important concerning the increased risk of suicide conjoined with the use of antidepressants in patients under the age of eighteen (18) years old (Elraiyah & Murad, 2016). By the year 2007, the warning was extended to young adults ranking from the ages of 18 to 24 years during the first two months of treatment (Lopez et al., 2016).
In the wake of the early advisory report in 2004, some primary care physicians have discontinued treating patients for depression and as an alternative recommend them to psychiatrists for mental health treatment. Due to the lack of psychiatrists in deprived areas, patients with depression were at higher risk for receiving second-rate care. Recent studies have shown that suicide rate among children and adolescents has escalated since 2004, some contributed this movement to the decreasing consumption of selective serotonin reuptake inhibitors (SSRIs) prescribed by universal healthcare providers. Questions regarding connection linking antidepressant usage and suicidality still remain, despite numerous observational studies and analyses that have strived to elucidate this yearning issue.
Although, numerous observational studies and analyses have acknowledged negative relationships between antidepressant treatments and suicide rates, only one focused on youth ranging 10-19 years old. Given that the suicide rate is six times higher in older adolescents and those approaching adulthood, the decision to explore younger generations ranging (5-14 years) where little is known of either SSRI usefulness or safe to administer. As a result, physicians may be indecisive about how to care for children and adolescents who are diagnosed with depression.
Verification Motivating FDA Advisory Actions
In 1990, questions linking between antidepressants and suicide quickly started to arise after a discovery by Dr. Martin Tecicher and his colleagues. The professionals observed up to six patients suffering depression developed severe suicidal thoughts after assuming the SSRI fluoxetine medication for twenty-six days. Their suicidal perceptions continued and did not completely decline until the medication was suspended; the thoughts continued for a total of ninety days. Following numerous patients’ and families’ complaint, the FDA held public meetings to discuss fluoxetine’s possible responsibility in suicidal ideation. In response to the ease the public concern, the Prozac manufacturer (fluoxetine) performed a total of seventeen clinical trial studies involving children and adolescents with major depressive disorder to assess a possible association between fluoxetine and suicidal ideation (Nischal et al., 2012). As a result, the reports produced no increased risk of suicidal acts due to fluoxetine.
- DeLucia, V., Kelsberg, G., & Safranek, S. (2016). Which SSRIs most effectively treat depression in adolescents? Journal of Family Practice, 65(9), 632–634. Retrieved from http://ezproxy.mc.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=118400734&site=ehost-live
- Elraiyah, T., & Murad, M. H. (2016). Content, consistency, and quality of black box warnings.Annals of Internal Medicine, 165(1), 74–75. https://doi.org/10.7326/L16-0071
- Isacsson, G., & Rich, C. (2014). Antidepressant drugs and the risk of suicide in children and adolescents. Pediatric Drugs, 16(2), 115–122. https://doi.org/10.1007/s40272-013-0061
- Lopez, C. J., Jaussent, I., Gorwood, P., & Courtet, P. (2016). Suicidal depressed patients respond less well to antidepressants in the short term. Depression & Anxiety (1091-4269), 33(6), 483–494. https://doi.org/10.1002/da.22473
- Lopez-Leon, S., Lopez-Gomez, M. I., Warner, B., & Ruiter-Lopez, L. (2018). Psychotropic medication in children and adolescents in the United States in the year 2004 vs 2014. DARU, 26(1), 5–10. https://doi.org/10.1007/s40199-018-0204-6
- Nischal, A., Tripathi, A., Nischal, A., & Trivedi, J. K. (2012). Suicide and antidepressants: What current evidence indicates. Mens Sana Monographs, 10(1), 33–44. https://doi.org/10.4103/0973-1229.87287
- Rojas, S., Leen-Feldner, E., Blumenthal, H., Lewis, S., & Feldner, M. (2015). Risk for suicide among treatment seeking adolescents: The role of positive and negative affect intensity. Cognitive Therapy & Research, 39(2), 100–109. https://doi.org/10.1007/s10608-014-9650-8
- Schachar, R., & Ickowicz, A. (2014). Mental illness in the real world. Journal of the Canadian Academy of Child & Adolescent Psychiatry, 23(3), 156. Retrieved from http://ezproxy.mc.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=98780869&site=ehost-live
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