title: Comparative safety of antidepressant agents for children and adolescents regarding suicidal acts.
abstract: OBJECTIVE
  The objective of this study was to assess the risk of suicide attempts and suicides after initiation of antidepressant medication use by children and adolescents, for individual agents.
  
  
  METHODS
  We conducted a 9-year cohort study by using population-wide data from British Columbia. We identified new users of antidepressants who were 10 to 18 years of age with a recorded diagnosis of depression. Study outcomes were hospitalization attributable to intentional self-harm and suicide death.
  
  
  RESULTS
  Of 20,906 children who initiated antidepressant therapy, 16,774 (80%) had no previous antidepressant use. During the first year of use, we observed 266 attempted and 3 completed suicides, which yielded an event rate of 27.04 suicidal acts per 1000 person-years (95% confidence interval [CI]: 23.9-30.5 suicidal acts per 1000 person-years). There were no meaningful differences in the rate ratios (RRs) comparing fluoxetine with citalopram (RR: 0.97 [95% CI: 0.54-1.76]), fluvoxamine (RR: 1.05 [95% CI: 0.46-2.43]), paroxetine (RR: 0.80 [95% CI: 0.47-1.37]), and sertraline (RR: 1.02 [95% CI: 0.56-1.84]). Tricyclic agents showed risks similar to those of selective serotonin reuptake inhibitors (RR: 0.92 [95% CI: 0.43-2.00]).
  
  
  CONCLUSIONS
  Our finding of equal event rates among antidepressant agents supports the decision of the Food and Drug Administration to include all antidepressants in the black box warning regarding potentially increased suicidality risk for children and adolescents beginning use of antidepressants.
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, MA 02120, USA. schneeweiss@post.harvard.edu
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Patrick
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Colin R
authors.initials: CR
authors.lastname: Dormuth
authors.forename: Matt
authors.initials: M
authors.lastname: Miller
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Mehta
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lee
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D016666:Fluvoxamine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D005473:Fluoxetine; D016666:Fluvoxamine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
references.citation: Ann Intern Med. 2002 Oct 15;137(8):693-5
references.pmid: 12379071
references.citation: Br J Psychiatry. 2006 Nov;189:393-8
references.pmid: 17077427
references.citation: JAMA. 2004 Jul 21;292(3):338-43
references.pmid: 15265848
references.citation: Arch Gen Psychiatry. 2006 Mar;63(3):332-9
references.pmid: 16520440
references.citation: Epidemiology. 1996 Jul;7(4):335-6
references.pmid: 8793355
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2000 Jul;35(7):288-96
references.pmid: 11016523
references.citation: J Clin Epidemiol. 2005 Apr;58(4):323-37
references.pmid: 15862718
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004851
references.pmid: 17636776
references.citation: N Engl J Med. 1978 Sep 28;299(13):690-4
references.pmid: 355881
references.citation: CNS Drugs. 2004;18(15):1119-32
references.pmid: 15581382
references.citation: J Child Adolesc Psychopharmacol. 2006 Feb-Apr;16(1-2):25-32
references.pmid: 16553526
references.citation: Am J Epidemiol. 1985 Sep;122(3):495-506
references.pmid: 4025298
references.citation: Clin Ther. 2006 Jun;28(6):964-78; discussion 962-3
references.pmid: 16860179
references.citation: Arch Gen Psychiatry. 2006 Dec;63(12):1358-67
references.pmid: 17146010
references.citation: Arch Gen Psychiatry. 2006 Aug;63(8):865-72
references.pmid: 16894062
references.citation: Am J Epidemiol. 1993 Dec 1;138(11):923-36
references.pmid: 8256780
references.citation: BMJ. 2005 Feb 19;330(7488):389
references.pmid: 15718538
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Epidemiology. 2009 Jul;20(4):512-22
references.pmid: 19487948
references.citation: Br J Clin Pharmacol. 2005 Nov;60(5):519-25
references.pmid: 16236042