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Previous Suicidality a Greater Risk Than Antidepressant Medication in Suicidal Teens: Presented at AACAP

By Maria Bishop

BOSTON, MA -- October 30, 2007 -- Antidepressant drugs have a lesser effect on teenagers' risk of suicidality than do female gender and previous plans to kill oneself within the past year, according to research presented here at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry (AACAP).

Lead author Neera Ghaziuddin, MD, MRCPsych, Associate Professor, Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, United States explained that previous paediatric studies have not examined antidepressants in conjunction with other psychiatric medications in the teenage population. Additionally, antidepressant trials with depressed youth have generally excluded acutely suicidal patients.

In 2004, the United States Food & Drug Administration issued a black-box warning that antidepressants may be associated with an increased risk of suicidality in the paediatric population.

Dr. Ghaziuddin and colleagues examined 133 adolescents who had been treated for depression with psychotropic medications. In group 1 (n = 54), subjects were taking antidepressants alone, while in group 2 (n = 79), subjects were taking antidepressants plus either a mood stabiliser or a neuroleptic. Antidepressants included in the study were SSRIs (n = 102), bupropion (n = 37), venlafaxine (n = 5) and mirtazapine (n = 2).

Depression was measured by the Children's Depression Rating Scale (CDRS-R) and suicidal ideation was measured by the Suicidal Ideation Questionnaire-Junior (SIQ-JR).

At baseline, participants in group 2 reported significantly more Youth Self-Report (YSR) internalising problems (P =.05), more recurrent suicidal ideation in the past year (P =.05), and a suicide plan in the past year (P =.01). At 3 months, depression and suicidal ideation decreased for both groups (P =.01). There was no difference between the groups at 3 months for reported depression, suicidal ideation, or number of suicidal incidents.

Using analysis of variance, baseline suicidality and female gender were predictive of greater suicidal ideation at 3 months, whereas the medication group was not significant.

Critical incidents in the 3 months after psychiatric hospitalisation were associated with recurrent suicidal ideation and medication group. Group 2 had a 3-fold increase in the number of critical incidents over group 1 (P =.008). Recurrent suicidal ideation led to a four-fold increase in the number of critical incidents at 3 months (P =.004).

Dr. Ghaziuddin concluded that further research is needed to determine the degree to which psychiatric medications have an impact on the course of depression and suicidality in teens following psychiatric hospitalisation.

This study, the researchers noted, was limited by its inability to examine all combinations of psychotropic medications. It was also limited in its ability to make cause-and-effect interpretations, because the medication groups were not randomised.


[Presentation title: Antidepressant Treatment and Critical Incidents Among Suicidal Adolescents Following Hospitalization: Abstract B17]

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