The risk of suicidal behavior associated with antidepressant treatment is an issue of debate and concern. The US FDA has required that antidepressants carry a black box warning that there may be a risk of suicidal ideations in depressed pediatric patients treated with these medications, and recently extended the warning to include individuals up age 24. However studies of antidepressant-induced suicidality in adults have yielded contradictory findings and conclusions. This article discusses investigations of this poorly understood phenomenon and the clinical implications of research findings and FDA warnings for clinicians treating adults with depression. Although antidepressant-induced suicidality apparently occurs only rarely, close monitoring and follow up care after the initiation of a new antidepressant is indicated.
Key Points
* Antidepressant medications may in some cases increase the risk of suicide, particularly early in the course of treatment.
* Patients and their families or caregivers should be educated to be watchful for worsening depression, emergence of suicidality, and activation symptoms, and be encouraged to report any changes to their health care provider.
* Health care providers should carefully monitor antidepressant-treated patients for worsening depression or emergence of suicidality, especially at the beginning of treatment or after any change in dose.
* If depression worsens or suicidality emerges in a patient being treated with an antidepressant, the patient should be evaluated carefully to determine what intervention, including stopping or changing the antidepressant, is needed.