Comparative safety of antidepressant agents for children and adolescents regarding suicidal acts.
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.
Schneeweiss
Sebastian
S
Harvard Medical School, Brigham and Women's Hospital, Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Patrick
Amanda R
AR
Solomon
Daniel H
DH
Dormuth
Colin R
CR
Miller
Matt
M
Mehta
Jyotsna
J
Lee
Jennifer C
JC
Wang
Philip S
PS
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
D000928:Antidepressive Agents; D015283:Citalopram; D005473:Fluoxetine; D016666:Fluvoxamine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
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