Pediatric Drugs

, Volume 16, Issue 2, pp 115–122 | Cite as

Antidepressant Drugs and the Risk of Suicide in Children and Adolescents

  • Göran Isacsson
  • Charles L. Rich
Current Opinion


Government agencies have issued warnings about the use of antidepressant medications in children, adolescents, and young adults since 2003. The statements warn that such medications may cause de novo ‘suicidality’ in some people. This review explores the data on the treatment of depression that led to these warnings and subsequent data that are relevant to the warnings. It also addresses the effectiveness of antidepressant treatment in general and the relationship of suicide rates to antidepressant treatment. It concludes that the decisions for the ‘black box’ warnings were based on biased data and invalid assumptions. Furthermore, the decisions were unsupported by the observational data regarding suicide in young people that existed in 2003. The following recommendations would seem to follow from these observations. First, drug authorities should re-evaluate the basis for their imposed warnings on antidepressant medicines, and analyze the actual public health consequences the warnings have had. In the absence of substantial evidence supporting the warnings, they should be removed. Second, physicians and other providers with prescription privileges should continue to be educated regarding the importance of aggressively treating depression in young people, using antidepressants when indicated. Third, physicians and other professionals who treat depressed young people must always be aware of the risk of suicide (albeit quite low) and observe them closely for any signs of increased risk of suicide. This is necessary regardless of the type of treatment being provided.


Fluoxetine Suicide Rate Antidepressant Medication Cognitive Behaviour Therapy Pediatric Depression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Neither Göran Isacsson nor Charles L. Rich has any conflicts of interest. Göran Isacsson was funded by the Karolinska Institutet funds (ALF). No other funding were used to prepare the review.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Department of Clinical Neuroscience, Karolinska InstitutetKarolinska University Hospital-Huddinge, M59StockholmSweden
  2. 2.Professor Emeritus of PsychiatryUniversity of South AlabamaMobileUSA

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