Antidepressant drug therapy and suicide in severely depressed children and adults: A case-control study.
BACKGROUND
The Food and Drug Administration has issued a boxed warning concerning increased suicidal ideation and behavior associated with antidepressant drug treatment in children and adolescents. It is unknown whether antidepressant agents increase the risk of suicide death in children or adults.


OBJECTIVE
To estimate the relative risk of suicide attempt and suicide death in severely depressed children and adults treated with antidepressant drugs vs those not treated with antidepressant drugs.


METHODS
Matched case-control study.


METHODS
Outpatient treatment settings in the United States.


METHODS
Medicaid beneficiaries from all 50 states who received inpatient treatment for depression, excluding patients treated for pregnancy, bipolar disorder, schizophrenia or other psychoses, mental retardation, dementia, or delirium. Controls were matched to cases for age, sex, race or ethnicity, state of residence, substance use disorder, recent suicide attempt, number of days since hospital discharge, and recent treatment with antipsychotic, anxiolytic/hypnotic, mood stabilizer, and stimulant medications.


METHODS
Suicide attempts and suicide deaths.


RESULTS
In adults (aged 19-64 years), antidepressant drug treatment was not significantly associated with suicide attempts (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.86-1.39 [521 cases and 2394 controls]) or suicide deaths (OR, 0.90; 95% CI, 0.52-1.55 [86 cases and 396 controls]). However, in children and adolescents (aged 6-18 years), antidepressant drug treatment was significantly associated with suicide attempts (OR, 1.52; 95% CI, 1.12-2.07 [263 cases and 1241 controls]) and suicide deaths (OR, 15.62; 95% CI, 1.65-infinity [8 cases and 39 controls]).


CONCLUSIONS
In these high-risk patients, antidepressant drug treatment does not seem to be related to suicide attempts and death in adults but might be related in children and adolescents. These findings support careful clinical monitoring during antidepressant drug treatment of severely depressed young people.
Olfson
Mark
M
New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. mo49@columbia.edu
Marcus
Steven C
SC
Shaffer
David
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D004348:Drug Labeling / Q000331:legislation & jurisprudence; D006801:Humans; D008483:Medical Assistance / Q000706:statistics & numerical data; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States; D014486:United States Food and Drug Administration
D000928:Antidepressive Agents