Suicidal behaviour in young adults on SSRIs

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Newly published research is calling for doctors to be careful when handing out prescriptions to treat depression in teens and young adults, and when they do they should monitor the youngsters closely, particularly if they are on an elevated dose, due to an increased risk of suicidal behaviour and self harm.


Twice as likely


The research, which was published in the Journal JAMA Internal Medicine at the end of April 2014, found that those between the ages of 10 and 24 receiving very high doses of drugs known as SSRI antidepressants (Selective Serotonin Reuptake Inhibitors) were twice as likely to try to harm themselves as those receiving lower or the recommended doses of these drugs.


The risk also appeared to be age dependent with those under the age of 25 and on higher than normal doses the most at risk. The risk was also highest during the first three months of taking the drugs. The same risk was not found in older people on high doses of these drugs.


SSRIs nearly 70 percent of all prescriptions


The study was led by Dr. Matthew Miller from the Harvard School of Public Health and involved over 162,000 people aged between 10 and 64 who had been treated for depression with one of three different types of SSRI drugs; citalopramhydrobromide, sertraline hydrochloride, and fluoxetine hydrochloride. These drugs are also sold under the trade names of Celexa, Zoloft and Prozac and were chosen for the study because these are the drugs that account for nearly 70 percent of all prescriptions initially issued to treat depression.


The researchers compared those who were taking an average or recommended dose of these drugs with those who were receiving higher than normal doses between 1998 and 2010.

They checked at intervals of one month, quarterly and a year after initially being prescribed these drugs for evidence of attempted suicide or incidents of deliberate self harm.


After analysis of the results, they found that one out of every 150 patients who were treated with high dose antidepressants deliberately self harmed.


“If I were a parent, I definitely wouldn’t want my child to start on a higher dose of these drugs” said Dr. Miller.


Alarm bells


It isn’t the first time alarm bells have been rung because of the risk of suicidal behaviour when taking antidepressants. Back in October 2004 after a government review the FDA issued a warning about the risk of self harm in children prescribed SSRIs. The FDA directed manufacturers to add a ‘black box’ warning to the healthcare professional labelling of all antidepressant medications to describe this risk and emphasize the need for close monitoring of patients started on these medications.


However, one research study published inJournal of the American Medical Associationin 2007 concluded that the benefits of prescribing antidepressants to young people suffering from depression far outweighed the risks. Yet another study published in the American Journal of Psychiatry in the same year found that suicide rates in the young had increased despite a drop in the number of SSRI prescriptions issued. Some researchers reckon that this is evidence that SSRIs actually offer some protection against suicidal behaviour.


However, no studies have ever looked at the dosages of these antidepressants and the risks of suicidal behaviour and self harm like this most recent US study did.


Unanswered questions


There are still questions that remain unanswered though. For example, it’s not clear exactly why high doses lead to an increased risk of suicide in younger people. It is also not clear why some people are affected and not others or why some types of drugs carry a greater risk than others. We also don’t know if the same risks apply when treatment is started at the average or recommended dose and is increased progressively afterwards.


The results also don’t explain why some people in the study were prescribed very high doses of these antidepressants in the first place. The requirement was that those included in the study shouldn’t have been prescribed an antidepressant in the previous year, however, that didn’t preclude people who may have been prescribed them prior to that. It could be that these people had different circumstances than those newly prescribed antidepressants.


Regardless, it would seem clear that doctors should look for other alternatives than starting children and young adults on very high doses of these drugs.


Official Recommendations


According to NICE (National Institute for Health and Clinical Excellence) the CHMP (Committee for Human Medicinal Products) noted that suicidal behaviour and hostility were seen more frequently in clinical trials where children and adolescents were treated with these antidepressants compared to those treated with a placebo and advised that SSRIs “shouldn’t be used in children and adolescents except in their approved indications – usually not depression”.


However, doctors can make a decision based on the individual needs of a patient. In these cases, CHMP recommends that patients are monitored carefully, especially at the beginning of treatment, for signs of suicidal behaviour, self harm and/or hostility.







Learn how I beat Depression


  1. Mani
    Posted June 16, 2014 at 7:17 am | Permalink

    Wow! I really appreciated reading your personal story on depression. I really can feel where you’re coming from and share your mission in making as many people aware of this growing epidemic as possible.

    Apologies for the approach, but I was hoping if you would be so kind as to allow me permission to include your personal story on depression within a book that I am compiling on the subject. I personally have felt this growing epidemic brush pass and impact my life too. I later realised there are so many approaching me for help, I am a coach and a lecturer on CBT (cognitive behaviour therapy) and practice on all things psychotherapeutic (non-medical but psychological help). I started writing my book in response to provide help and advice to a friend, but soon realised how much information there is out there to compile a single book on the subject with stories of survivors such as yourself. I plan to publish this book and distribute it either freely or at a very low cost (not for any form of profit, but to simply make sure the purchasers read it), and any additional funds to be sent to charity.
    Take care, Mani

  2. admin
    Posted June 16, 2014 at 10:16 am | Permalink

    Hi Mani

    Please feel free to use anything from the site ,

    Good luck best wishes !!

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