title: Adolescent angst or true intent? Suicidal behavior, risk, and neurobiological mechanisms in depressed children and teenagers taking antidepressants.
abstract: Suicide is one of the major causes of morbidity and mortality amongst children and adolescents. In 2004 the Food and Drug Administration (FDA) issued a "black-box" warning for antidepressants in children and adolescents, stating that these drugs may increase suicidality, a term encompassing both suicidal thoughts and behavior, especially in the first few weeks of treatment. The warning was extended in 2007 to antidepressants prescribed to adults aged 25 and under. The evidence behind this decision stemmed from meta-analyses of antidepressant clinical trials that demonstrated a slight increase in suicidality in those receiving antidepressants versus those treated with a placebo. Due to methods of this pooled data compilation, the relationship between antidepressants and suicidality remains controversial. This report investigates a case where a 14 year old with major depressive disorder (MDD) developed suicidal ideation shortly after being prescribed a selective serotonin reuptake inhibitor (SSRI). Investigating the role antidepressants may play in suicidality suggests the need to explore the neurobiological mechanisms within the serotonin system. This case and its theoretical explanations attempt to bridge the gap between neurobiology and pharmacology in order to better delineate the etiology of this adverse effect.
authors.forename: Julia
authors.initials: J
authors.lastname: Morrison
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D025461:Feedback, Physiological; D005260:Female; D006708:Homicide / Q000523:psychology; D006801:Humans; D009474:Neurons / Q000187:drug effects / Q000502:physiology; D010343:Patient Admission; D011903:Raphe Nuclei / Q000187:drug effects / Q000503:physiopathology; D044282:Receptor, Serotonin, 5-HT1A / Q000187:drug effects / Q000502:physiology; D012307:Risk Factors; D012701:Serotonin / Q000502:physiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects* / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology / Q000523:psychology; D059020:Suicidal Ideation
chemical_list: D000928:Antidepressive Agents; D044282:Receptor, Serotonin, 5-HT1A; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline