Suicide is the third-leading cause of death for teenagers and young adults aged 15 to 24. Most people remain unaware that more than 90% of the young people who commit suicide have a serious mental illness. Depression is the most common cause of teen suicide in both boys and girls.
Antidepressant medications are often effective in treating depression and anxiety in teens. However, antidepressant use in children and adolescents must be closely monitored.
Antidepressants come with a black box warning from the Food and Drug Administration (FDA) of an increased risk of suicidal thinking and behavior in certain people under the age of 25.
Although the suicide warnings can be alarming at first, it is important to get the facts. Learn what the warnings mean and ask about all recovery choices. This will help make an informed decision about your child’s health and weigh the advantages and risks of treatment choices with your child’s doctor.
What Are Antidepressants and How Do They Work?
Antidepressants are a type of medication that reduces the effects of depressive disorders. They resolve chemical imbalances in the brain’s neurotransmitters. Mood and behavior may be affected by chemical imbalances.
Neurotransmitters are important because they work as a link of communication between nerve cells in the brain. They are present in vesicles, which are found in nerve cells released from one nerve and taken up by other nerves. Neurotransmitters that are not taken up by other nerves are taken up by the nerves that released them. This is known as “reuptake.” Serotonin, dopamine, and norepinephrine are the most common neurotransmitters in the brain. They are closely linked to depression.
In general, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), treat depression by increasing levels of serotonin in the brain. Serotonin is prevented from being reabsorbed (reuptaken) into neurons by SSRIs. This increases the availability of serotonin, which improves the transfer of signals between neurons.
Why Antidepressant Medications Are Being Linked To Teenage Suicide
On February 2, 2004, Mark Miller of Overland, Kan., appeared at a public forum in Washington, D.C., saying things that no parent should ever have to say:
This is important for you to understand, he told an FDA advisory committee. Matt hanged himself from a bedroom closet hook that was barely taller than he was. To commit this unthinkable act, which he had never done before, had never threatened another family member. He was able to pull his legs up from the floor and hold himself there until he lost consciousness and forced himself to leave us.
Matt Miller Was 13 Years Old When He Committed Suicide In The Summer Of 1997
His father testified that he died after a psychiatrist he didn’t know gave him three trial bottles of a pill he’d never heard of for a perceived illness that his doctor could only guess at. We were advised with confidence that Matt has a chemical imbalance that could be helped by a new, wonderful drug named Zoloft. It was safe and effective, with only two mild side effects reported to us: insomnia and indigestion.
The FDA released a public health warning in March 2004 on the possibility of increased suicidal thoughts and behavior by people who take antidepressants. Antidepressants work by allowing the body to make more use of the brain’s chemical serotonin. It is a transporter involved in mood, emotion, appetite, and sleep control. Celexa, Lexapro, Paxil, Prozac, and Zoloft are some of the most commonly prescribed brand-name medications in this class.
Following the advisory committee’s findings, the FDA ordered all antidepressant drug makers, not just SSRIs, to include a “black box” notice and cautionary statements on medication labels in October 2004. This will warn health-care providers of an elevated risk of suicidality in children and teenagers receiving these drugs.
According to a study, when SSRIs were linked to placebo, there is evidence of a non-significant tendency toward increased suicidality.
In early December, the U.K.’s Medicines and Healthcare Products Regulatory Agency issued similar alerts, urging physicians to:
- Consider alternative therapies
- Prescribe antidepressants in low doses
- Carefully monitor patients
Warning Signs
A black box on a product label serves as a stark warning in the pharmaceutical industry that for every benefit, every “miracle drug,” there is a risk. In the case of commonly used and heavily marketed antidepressants, the effects of symptom relief from major clinical depression must be balanced against the relatively rare but highly devastating risks of depression worsening or suicide.
There is little doubt that antidepressants have helped millions of people suffering from severe depression. However, there are a growing concern among doctors, child protection advocates, and parents. They think these highly sold mind-altering drugs are being consumed too freely and with little research on their effects on children and teenagers.
Should Children Be Treated with Antidepressants At All?
The warnings about a possible link between antidepressants and suicidal thoughts do not prevent the use of antidepressants in children. The warnings are also not intended to scare people away from taking antidepressants.
However, we should see the warnings as a caution to carefully balance the benefits and disadvantages of using antidepressants in children.
Antidepressants are an effective way to combat depression, anxiety, obsessive-compulsive disorder, etc. If we do not handle these conditions effectively, the child may be unable to lead a better life.
Which Antidepressants Can Children Take?
Antidepressants are packaged with a medication guide that informs parents and guardians of possible risks and precautions. Read the medication guide and packaging carefully. And discuss any concerns with your prescribing physician and pharmacist.
We can also use antidepressants to treat other medical problems. The antidepressant imipramine (Tofranil) has been approved by the FDA to treat spontaneous urination (childhood enuresis) in children aged 6 and up.
Doctors can use their medical judgment to give other antidepressants to adolescents for what’s called off-label use. This is clinically common practice with a wide range of medications used in both children and adults.
When Your Child Is Taking Antidepressants, What Warning Signs Should You Check Out?
Sometimes the signs and effects of suicidal thoughts or self-harm are difficult to detect. And your child may not express those thoughts directly to you. Here are some warning signs that your child’s condition is worsening or that he or she is at risk of self-harm:
- Talk of suicide or dying
- Suicide attempts
- Self-injury
- Agitation or restlessness
- Anxiety or panic attacks that are new or worsening
- Irritability
- An increase in sadness or worsening depression symptoms
- Impulsiveness
- Excessive talking, energy, or activity
- Aggression, violence, or hostility
- Difficulty sleeping or worsening insomnia
- Spending more time alone
If any of these symptoms occur, worsen, or cause concern for you, your child, a teacher, or some other caregiver, contact your child’s health care provider right away.
The Bottom Line
Be sure that your child should not discontinue antidepressant medication without the permission of the prescribing doctor. Stopping an antidepressant suddenly can result in flu-like symptoms, an increase in anxiety, and other side effects such as discontinuation syndrome. Stopping suddenly can also result in the return of depression symptoms.
