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Most parents of children on psychiatric medications are aware that in 2004 the FDA put a “black box” warning on all antidepressants. They declared that the use of antidepressants in children and adolescents was associated with a higher risk of suicide. The warning is carefully worded not to say that antidepressants should not be given to children or adolescents, but that they patients should be carefully monitored.
This article in the American Journal of Psychiatry reports, though, that the black box warning may have unintentionally factored in to the overall rise in the adolescent suicide rate in 2004. After a decade of steady decline, there was an 18% increase in adolescent suicides the same year this warning was placed on the medications.
So what does this mean? No one is really sure. The FDA has studies showing that children and adolescents taking antidepressants were at an increased risk for suicidal thoughts. Other studies show that adolescents taking antidepressants were less likely to be suicide risks. Who’s right?
There are two issues here. This first is what happens when we (the collective we) misinterpret what a black box warning means. In this case, I think it’s misinterpreted in a big way. My mother, for example, called me with great concern about this warning when the doctor prescribed a low dose of antidepressant to her after my father died. She had read all the materials given to her at the pharmacy and was very worried about taking a medication that might increase her risk of suicide. If we hadn’t talked about it, and I hadn’t encouraged her to take the medication her doctor prescribed, she might not have gotten over the hump of depression she was facing.
The other issue is trying to make sense of how treating depression can make you more likely to be suicidal. The warning is scary indeed. Yet there is a lot of research out there that says the right antidepressants given to the right people can be life-changing. I ran across an article last week (and can not find the reference again) that gave an interesting perspective on what this warning may be all about. The article was addressing suicide and war veterans and the doctor who wrote provided this insight (I’m paraphrasing).
Patients who are given antidepressants often improve in energy level to the point that they are then more able to cohesively plan and attempt suicide. These patients should be carefully monitored until they can work through these thoughts with continued medication AND therapy.
I had never thought about this before, and never heard anyone else verbalize it quite like this. Perhaps taking antidepressants makes a person get just enough energy to feel good enough to act on their thoughts. Interesting point.
The other critical point this doctor brought up was the need to always…always…always combine any medication regime with the right therapy. Expecting that you can give your child a pill and their problems all go away is most decidedly the wrong approach. Don’t get me wrong – medications are sometimes necessary and often highly successful in helping children and adolescents with impaired brain chemistry. But without the right therapy and therapeutic approach to parenting that our children need, true healing can not occur.
