Use of selective serotonin reuptake inhibitors and youth suicide: making sense from a confusing story

Abstract

This review provides an update on use of selective serotonin reuptake inhibitors and youth suicide, and describes an informed examination of the social and professional dimensions of this issue. Recent studies, using various methodologies to analyze experimental and observational data, suggest that concerns about the effect of selective serotonin reuptake inhibitors on suicide and suicide-related phenomena may have been overstated. Also, contrary to much public and medical opinion, treatment of depression with selective serotonin reuptake inhibitors does not increase but rather may decrease youth suicide fatalities. A recent reanalysis by the US Food and Drug Administration of existing data from clinical trials across the lifespan suggest an age-dependent effect on nonfatal suicide attempts and suicidal ideation, in which risk appears to be increased in youth and reduced from mid-adulthood and onward. Selective serotonin reuptake inhibitors are a modestly effective and generally safe treatment for postpubertal major depressive disorder, but their use requires collaborative decision making and a predetermined, shared monitoring plan.