Suicidal Thoughts and Behavior With Antidepressant Treatment

Summary & key facts

Researchers combined detailed data from about 9,200 people who took part in many short-term randomized trials of two common antidepressants, fluoxetine and venlafaxine. They found that, in adults and older adults, people taking these medicines showed fewer suicidal thoughts and behaviors over time than people taking placebo, and this change was linked to the medicines reducing depressive symptoms. For young people, the medicines reduced depression but did not change suicidal thoughts or behavior compared with placebo, and the researchers did not find evidence that the medicines increased suicide risk in youths. These results come from many studies and only cover short-term treatment, so they do not tell us about long-term effects.

Key facts:

• The study pooled person-level data from about 9,200 people across many randomized trials of fluoxetine and venlafaxine.
• In adults and older adults, those given fluoxetine or venlafaxine had fewer suicidal thoughts and behaviors over time than those given placebo.
• In adults, the drop in suicidal thinking and attempts was linked to the medicines improving depressive symptoms — the medicines reduced depression, and that reduction was connected to less suicidal ideation and behavior.
• In young people, the medicines reduced depression but did not produce a difference in suicidal thoughts or behavior compared with placebo.
• The researchers did not find evidence that these antidepressants increased suicide risk in youths during the short-term trials.
• Across all age groups, worse depression was consistently related to more suicidal thoughts and behavior.
• These findings are based on short-term randomized trials and a mix of published and unpublished data, so they do not prove long-term safety or effects.

Abstract

CONTEXT: The US Food and Drug Administration issued a black box warning for antidepressants and suicidal thoughts and behavior in children and young adults. OBJECTIVE: To determine the short-term safety of antidepressants by standard assessments of suicidal thoughts and behavior in youth, adult, and geriatric populations and the mediating effect of changes in depressive symptoms. DATA SOURCES: All intent-to-treat person-level longitudinal data of major depressive disorder from 12 adult, 4 geriatric, and 4 youth randomized controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride. STUDY SELECTION: All sponsor-conducted randomized controlled trials of fluoxetine and venlafaxine. DATA EXTRACTION: The suicide items from the Children's Depression Rating Scale-Revised and the Hamilton Depression Rating Scale as well as adverse event reports of suicide attempts and suicide during active treatment were analyzed in 9185 patients (fluoxetine: 2635 adults, 960 geriatric patients, 708 youths; venlafaxine: 2421 adults with immediate-release venlafaxine and 2461 adults with extended-release venlafaxine) for a total of 53 260 person-week observations. DATA SYNTHESIS: Suicidal thoughts and behavior decreased over time for adult and geriatric patients randomized to fluoxetine or venlafaxine compared with placebo, but no differences were found for youths. In adults, reduction in suicide ideation and attempts occurred through a reduction in depressive symptoms. In all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behavior. CONCLUSIONS: Fluoxetine and venlafaxine decreased suicidal thoughts and behavior for adult and geriatric patients. This protective effect is mediated by decreases in depressive symptoms with treatment. For youths, no significant effects of treatment on suicidal thoughts and behavior were found, although depression responded to treatment. No evidence of increased suicide risk was observed in youths receiving active medication. To our knowledge, this is the first research synthesis of suicidal thoughts and behavior in depressed patients treated with antidepressants that examined the mediating role of depressive symptoms using complete longitudinal person-level data from a large set of published and unpublished studies.

Topics

Stress Responses and Cortisol Suicide and Self-Harm Studies Treatment of Major Depression

Categories

Clinical Psychology Psychology Social Sciences

Tags

Adverse effect Antidepressant Anxiety Clinical psychology Cognition Depression (economics) Developmental psychology Economics Environmental health Fluoxetine Internal medicine Macroeconomics Major depressive disorder Medicine Poison control Psychiatry Psychology Randomized controlled trial Rating scale Receptor Serotonin Suicidal ideation Suicide attempt Suicide prevention Venlafaxine

Substances

Other

Conditions & symptoms

Anxiety Sadness or low mood