Do antidepressants cause suicide?

This is the 4771th article of Da Yi Xiao Hu

One morning, a father and son came in to the outpatient clinic. After sitting down, the father took out a medicine box from his pocket and asked the doctor, "Doctor, my son has depression, and the doctor prescribed this medicine. After I went back, I read the instructions, and the instructions said that taking this antidepressant may cause suicide. I want to ask if he can still take this medicine."

This attentive family member found out when reading the instructions for antidepressants that the use of antidepressants could cause the risk of suicide, so he was afraid to take the medicine. Let's talk about this topic next.

The saying that "taking antidepressants can cause suicide" comes from the U.S. Food and Drug Administration (FDA), which requires all manufacturers of marketed antidepressants in the United States to add a black box warning to the drug instructions, warning that the use of antidepressants in children and adolescents is associated with an increase in suicidal thoughts and behaviors. These warnings directly lead to people being "fearful" when using antidepressants, especially serotonin reuptake inhibitors (SSRIs), especially children and adolescents. In fact, it is still unclear whether there is an inevitable link between SSRI antidepressants and suicide. If antidepressants increase the risk of suicide, the possible reason is that antidepressants cause anxiety and irritability, thereby exacerbating depressive symptoms or increasing the risk of suicide.

There is a general consensus in the academic community that depression itself carries a high risk of suicide. Therefore, even though the FDA adds a warning to the drug instructions, it does not prohibit the use of antidepressants. It only emphasizes that clinicians should closely observe the condition in the early stages of treatment and weigh the pros and cons of the necessity of using antidepressants and the possible increase in suicide risk.

So should we still take antidepressants?

The answer is yes. Antidepressants are one of the most important means of treating depression. Antidepressants can quickly and permanently improve patients' depressive symptoms and suicide attempts. In recent years, with the clinical application of antidepressants (including SSRIs), the suicide rate has gradually decreased.

So what should we pay attention to when using antidepressants?

Patients who use antidepressants, especially those with depression, should be closely monitored for worsening depressive symptoms and increased suicide attempts and behaviors. Close observation is particularly important when using antidepressants for the first time or changing the dose. When symptoms worsen while using antidepressants, including increased suicide attempts and behaviors, they should be evaluated by a doctor immediately. In short, we should be vigilant about the fact that antidepressants may increase the risk of suicide, but we cannot deny the use of antidepressants for this reason. The key is to choose the appropriate treatment plan under the guidance of a psychiatrist and in combination with the patient's specific condition, so as to achieve truly individualized treatment.

References:

1. "Talking about Mental Health", edited by Shanghai Medical Association, Shanghai Medical Association Psychiatry Branch, Shanghai: Shanghai Science and Technology Press, 2017.12.

2. "Guidelines for the Prevention and Treatment of Depression in China, Second Edition", edited by Li Lingjiang and Ma Xin, Chinese Medical Electronic Audio-visual Publishing House, 2015.

Author: Shanghai Fengxian District Mental Health Center

Psychiatry Department Attending Physician Wang Chunlian

Wang Jinde Attending Physician