Richard A. Friedman, writing for the NY Times, argues that the black box label on SSRI antidepressants warning of possible suicidal thoughts and urges, has done more harm than good for teenagers.

Teenagers, Medication and Suicide

excerpts from article:

In 2013, for example, 8.7 percent of people between the ages of 18 and 25 experienced a major depression episode in the previous year, but only half of them received any psychiatric treatment, according to the National Survey on Drug Use and Health. And in 57 percent of these episodes, patients were seen by a general practitioner or family doctor — neither of whom is typically an expert in the treatment of mental illness.

Worse, antidepressants, which can be lifesaving, are probably being underused in young people. Their use fell significantly after the Food and Drug Administration issued its so-called black-box warning in 2004, stating that all antidepressants were associated with a risk of increased suicidal feeling, thinking and behavior in adolescents. That warning was later extended to young adults.

One very large study, including 1.1 million adolescents and 1.4 million young adults, examined data for automated health care claims for 2000 to 2010 from 11 health plans in the United States Mental Health Research Network. Disturbingly, the study found that antidepressant use plunged 31 percent among adolescents and 24 percent among young adults within two years after the F.D.A. advisory was issued.

What the public and some in the medical community did not understand then — and perhaps still don’t know — is that the risk of antidepressant treatment is minuscule: In the F.D.A. meta-analysis of some 372 clinical trials involving nearly 100,000 subjects, the rate of suicidal thinking and behavior was 4 percent in people taking antidepressants, compared with 2 percent in people taking a placebo.

This very small risk of suicidal behavior posed by antidepressant treatment has always been dwarfed by the deadly risk of untreated depression: 2 to 15 percent of depressed people actually commit suicide.

[CANDC]

Thanks Jo Thorne for sharing that!

[Blue_Bird]

It's medication, it's going to affect everyone differently, especially when it affects something as unique as your mind. I was on antidepressants as a teen, I was on them before I attempted suicide but don't believe they caused it, and I was on them later and at one point Zoloft saved my life practically. There's good and bad in everything

I think AD's should be used when necessary with careful monitoring of those kinds of changes. That's just common sense. But the rate of suicide among teenagers who aren't identified and treated is far greater than the risk due to AD's. It has become rather epidemic.

In our school district, we have initiated a suicide education program for all students. In 2013-14, our district had around 450 cries for help or suicide events. That means students came to counselors saying they were having suicidal thoughts; or, students made an attempt or succeeded. Large district in Texas by the way with over 52,000 students. When the program was implemented in January 2015, the counseling department said they had already hit that number in half a school year of 2014-21015. It will be interesting to see if the numbers of actual attempts or suicides decreases after the program has been in place.

My fear about the black box warning is that parents will refuse medications for kids when those meds could be life saving. Our own son has needed AD's since that black box warning came out. Yes, I was concerned and watched him like a hawk for any signs that the meds might be creating a problem, but all turned out well and he only needed them for about 6 months along with therapy. He's doing well.

[AnxietyMaster]

Thank you very much for sharing this!!