Antidepressants in Young People: Still Controversial

The FDA has revised the label warning on antidepressant medications after reports that they may increase suicidal thinking in young adults through age 24, especially during the first two months of taking them. The previous warning related only to children and adolescents.
The new FDA warnings resulted from an advisory committee review of 295 research studies of antidepressants that included more than 77,000 people with major depression. It showed no change in suicidal thinking in adults ages 25 to 64, and a reduction in suicidal thinking among those older than 64.
This new "black box" warning — the highest level of caution for approved medications — has been added to all 36 medication brands that are antidepressants or include an antidepressant as part of a combination pill. But I am not convinced that such a warning will have the intended result of preventing suicides among the young.
Research studies have shown a slight increase in thoughts about suicide in young people taking antidepressants compared with those taking a placebo. About 4 percent of depressed children and adolescents who took antidepressants showed some evidence of suicidal thinking, compared to 2 percent for the placebo group. There was, however, no increase in suicide attempts or deaths among those taking the antidepressants.
The FDA cautionary statements about antidepressants and suicidal thinking have been very controversial among health care providers treating depressed young people. It is obvious that untreated depression leads many people not only to experience suicidal thoughts but actually to kill themselves.
The suicide rate for children and adolescents had been decreasing over a long period of time but now the rates are rising again. The new warnings might actually discourage people from taking antidepressants and could increase the suicide rate.
The best solution in my view is to continue treating young people who have major depression with antidepressants, while monitoring them closely for any new thoughts of self injury. The benefits of these medications vastly outweigh the risks.