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Antidepressants & Suicide (and a black box warning)

How to Prevent Depression

“My psychiatrist prescribed an antidepressant for my depression, but I’m afraid to take it. What if I become suicidal?”

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior
(suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.

The FDA “black box” label warning accompanying all antidepressants.

Before we get started, how ‘bout I do my own bit of “disclaiming.” Chatting suicide from afar is a dicey proposition for any emotional/mental health professional/blogger. Each client’s situation is unique, so one has to be careful not to paint with too broad a brush.

That said, I’m bringing you some fresh information regarding antidepressants and the potential for suicidal thoughts and behavior. And my primary mission is to quell ill-based fears that may keep one from embarking upon a recommended antidepressant regimen.

How’s that?

So, is the antidepressant/suicide “black box” warning warranted? According to a brand-new review of clinical data published in Archives of General Psychiatry, perhaps not.

Seems the review submits there’s no link between suicide and at least two antidepressants. And it concludes that treatment with antidepressants actually decreases the risk of suicide among adults of all ages.

According to lead author Robert Gibbons, a University of Chicago professor…

These results have to instill some additional confidence that prescribing these medications is not necessarily going to lead to suicidal thoughts or behavior.

So what meds were targeted in the clinical review? Fluoxetine (Prozac) was studied within the realm of children, adolescents, and young adults. And it was venlafaxine (Effexor) for adults.

Now, in all fairness, the review has its detractors. One is Jeff Bridge, a researcher at Nationwide Children’s Hospital, Columbus OH (US). Bridge says…

The authors in this study examined the risk of suicidal thinking or behavior associated with one drug, fluoxetine. My view is that the weight of evidence shows a small but significant increased risk of suicidal ideation/suicidal behavior in pediatric patients treated with antidepressants.

Well, Gibbons’ position goes back to when the black-box warning was first being considered. As an advisory board member to the FDA, he voted against adding the warning to antidepressant packaging.

His reasoning? Heading straight to the bottom-line, he simply didn’t find the data convincing. ‘Course, he was also concerned that docs would stop prescribing antidepressants because of the warning – and folks who may do well with them would go without.

Some specifics?

Of the 708 childhood cases studied, suicidal thoughts or attempts after eight weeks was no different between children who used fluoxetine and those who took a placebo.

For adults and the elderly? Treatment with fluoxetine and venlafaxine resulted in a 90% decreased risk of suicidal thoughts or behaviors after eight weeks. The placebo results were 79%.

Alrighty, then – given his hard work, does Gibbons support removing the warning? Actually, he won’t say. But he submits that the FDA needs to gather more data to better evaluate if the warning should stay.

So there you have it, a fresh perspective on antidepressants and suicidal thoughts and behavior – and the FDAs black-box warning.

I’m always eager to bring you breaking news in the emotional/mental health arena. And though I’m not saying whether or not you ought to take that antidepressant your physician prescribed (your decision), I’d sure hate to see suicidal fears hold you back.

Something to think about…

  • Megan

    I had this fear with Prozac. It turned out that Prozac was not a good fit for me. I knew that Prozac was the medication that really opened up the black box warning label and so I asked my doctor about it. She said I did not have to take it if I were afraid of the side effects. I took it but that did not go over well. After weeks of uncontrollable crying fits and other emotional problems, I was off the Prozac. I still think there’s something fishy going on with Prozac. But, I know that everyone reacts differently. She had said that if I had had suicidal thoughts before the Prozac that the drug may give me the energy to take them out on myself but that the drug itself would not CAUSE suicidal thoughts. However, she is an excellent doctor and I just think Prozac is not a good fit for me personally.

    • Thanks for the input, Megan…

  • Summer

    I was on Prozac before and I had so many thoughts about taking my life that I tried a few times while on it- it also made me feel like I was looking out of rose colored glasses and i felt numb.

    • Hey Summer! Sure appreciate your sharing such sensitive material. Here’s hoping you’re on the up-and-up. May I ask if you’ve had a reasonable amount of sucess with another antidepressant? Would you share which one? Bill

  • Linda

    I became cynical regarding the efficacy of these medications while
    working on antidepressant trials in the
    years leading up to the warnings. I did not see any medication in the
    SSRI class with a strong effect over placebo. Better placebo studies more recently are leading to a growing
    consensus that there there may not even be the “minimal to modest”
    effect over placebo found in the past. I suggest that one read all research in this field very carefully as well as check the industry sponsorship of the authors. Dr. Gibbons research has been criticized. For example see http://archpsyc.jamanetwork.com/article.aspx?articleid=1151018#COMMENT
    The evidence that the risk of suicidal and homicidal thoughts and
    behavior is increased is strong, but that does not mean that most people
    taking medications have this response it means they to be closely
    followed especially at the beginning of therapy- i.e. not over 6 month
    gaps when seeing a PCP. However, the jury is still out on evidence
    for efficacy of this class of medications.

    • Thank you for your visit and contribution, Linda. This is excellent information, and I’m certainly not stunned by it. I’m going to post on Chipur Fan Page so as many eyes as possible can absorb the details. Bill
      https://www.facebook.com/pages/Chipur/128077027224478?ref=hl

    • Patricia Miller

      I am only able to respond in specific detail based on my personal research on the two different antidepressants I’ve tried (Celexa, not very effective for me, and Viibryd, extremely effective for me) as supplemented by the direct impact they’ve had on my life. However, I am also a person that believes the research that supports the contention that medication alone will only be effective about 60% of the time for depression, just as counseling alone will only be effective about 60% of the time. If you blend the two, you can raise your efficacy and chances of resolution to 90%. To expect depression to be fully biological or fully emotionally/behaviorally based does not seem to be born out in either my personal experience or in the research.

      Now to add to the mix I will also say that as an educator and school administrator with 25 years of experience, I have seen many adults and children who failed to follow through with either/both pieces of the intervention and the results were not great. When you do look further at the research, and note that within that first six months an average of 40% of people require an antidepressant change in order to find one that works for them individually, that could also explain your disenchantment with this class of medication. I just hate to see a category of medication be discarded when I have seen positive results in far too many lives and negative results in far fewer.

      • Point very well taken, Patricia. Any and all points of view are welcome here on Chipur. In my mind, anyway, that’s what makes it such a strong resource. Chipur wouldn’t be nearly as meaningful without reader contributions. Thank you for your part…
        Bill

  • Kris

    Why not look at the real data–hidden by the drug companies and the FDA–that show these drugs do more harm than good for children. Children’s brains (anyone 24 and under covered by the FDA Black Box warnings) are not the same as adult brains. Given that the drug companies studies were faulty, at best, these drugs should not have been approved for children. Further, since there have been no long term studies about the long-term effects of these SSRI drugs on children, the risk seems to far outweigh the benefits. And don’t get me started on the fact that the idea of a “chemical imbalance” in one’s brain causes depression. This is just a theory promoted by psychiatrists and the drug industry. Parents ought to ask their doctors for the “chemical imbalance” test prior to medicating their children. There is no such test. To prescribe mind-altering drugs to children on the basis of a theory–drugs that have proven to be no more effective than a sugar pill–but a lot more harmful, is simply child endangerment. If more health care consumers new the real story behind SSRI drugs, fewer would agree to take such risks.

    • Appreciate your visit and comment, Kris. Point very well taken.

      For the sake of discussion, I’d like to briefly address the “chemical imbalance” matter. Though there may not be a “test” for a “chemical imbalance,” I don’t think the concept is at all far-fetched. That applies to depression, bipolarity, anxiety, and psychosis. I see plenty of cases in which the onset of, say, depression isn’t associated with some sort of life-stressor or traumatic event. Heritability also seems to be at play. How, then, does one explain its existence, other than there’s some sort of “chemical imbalance” or anatomical issue?

      Again, I’m glad you stopped-by and shared your opinion…

      Bill