Tendencias suicidas asociadas al uso de antidepresivos en niños y adolescentes

Abstract

INTRODUCTION Suicide is a public health problem in the infant and adolescent population and is one of the leading causes of death in that age range. Since the introduction of new classes of antidepressants in the early 1990s, concerns about the risk of suicidality associated with the use of these drugs in children and adolescents began to appear. Since then, numerous studies have been published in this regard, and several regulatory agencies have issued warnings concerning this possible increased risk. Despite this, the use of antidepressants in this population continues to increase. OBJECTIVE To analyse the evidence for the relationship between antidepressant use in children and adolescents and the risk of suicidality. In addition, to determine the relationship between this use and the onset of serious adverse events, as well as the treatment discontinuation due to such events. METHODS A literature search was carried out in MedLine and the Cochrane Library. Reviews were prioritised and, if necessary, the search was broadened to include randomised clinical trials. Studies concerning treatment with any antidepressant, irrespective of the diagnosis, compared with placebo, any non-pharmacological treatment or no treatment were analysed. Additionally, position papers from scientific societies and healthcare institutions were also identified. The prescriptions database of the Navarre Health Service was used to obtained information regarding antidepressant use in children and adolescents in Navarre, and the BIFAP (www.bifap.org) database was used to obtain this information for Navarre and Spain as a whole. CONCLUSIONS Current evidence indicates that antidepressants increase the risk of suicidality in children and adolescents. Therefore the use in this population should be restricted and they should only be used for the authorised indications. This risk is closely related to an increase in suicidal ideation. Indirect evidence suggests that the risk of suicidality may be higher with venlafaxine. There is insufficient evidence that any antidepressant reduces this risk. There is a large body of evidence that antidepressants increase the risk of serious adverse events and discontinuations due to adverse events under any indication in comparison with placebo. In the studies available, the safety is analysed when treatment starts and, in general, these are short-term studies, therefore the risk of this type of adverse event in the long term cannot be ruled out.