Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults: A Case-Control Study | Adolescent Medicine | JAMA Psychiatry | JAMA Network
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Original Article
August 2006

Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults: A Case-Control Study

Author Affiliations

Author Affiliations: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Drs Olfson and Shaffer); and University of Pennsylvania School of Social Policy and Practice, Philadelphia (Dr Marcus).

Arch Gen Psychiatry. 2006;63(8):865-872. doi:10.1001/archpsyc.63.8.865

Context  The Food and Drug Administration has issued a boxed warning concerning increased suicidal ideation and behavior associated with antidepressant drug treatment in children and adolescents. It is unknown whether antidepressant agents increase the risk of suicide death in children or adults.

Objective  To estimate the relative risk of suicide attempt and suicide death in severely depressed children and adults treated with antidepressant drugs vs those not treated with antidepressant drugs.

Design  Matched case-control study.

Setting  Outpatient treatment settings in the United States.

Participants  Medicaid beneficiaries from all 50 states who received inpatient treatment for depression, excluding patients treated for pregnancy, bipolar disorder, schizophrenia or other psychoses, mental retardation, dementia, or delirium. Controls were matched to cases for age, sex, race or ethnicity, state of residence, substance use disorder, recent suicide attempt, number of days since hospital discharge, and recent treatment with antipsychotic, anxiolytic/hypnotic, mood stabilizer, and stimulant medications.

Main Outcome Measures  Suicide attempts and suicide deaths.

Results  In adults (aged 19-64 years), antidepressant drug treatment was not significantly associated with suicide attempts (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.86-1.39 [521 cases and 2394 controls]) or suicide deaths (OR, 0.90; 95% CI, 0.52-1.55 [86 cases and 396 controls]). However, in children and adolescents (aged 6-18 years), antidepressant drug treatment was significantly associated with suicide attempts (OR, 1.52; 95% CI, 1.12-2.07 [263 cases and 1241 controls]) and suicide deaths (OR, 15.62; 95% CI, 1.65-infinity [8 cases and 39 controls]).

Conclusions  In these high-risk patients, antidepressant drug treatment does not seem to be related to suicide attempts and death in adults but might be related in children and adolescents. These findings support careful clinical monitoring during antidepressant drug treatment of severely depressed young people.