What is the association between antidepressants and suicide?

The increased risk of suicide in children and adolescents taking antidepressant medications when compared to placebo is well established (Hamad, 2004). This led to the FDA Black Box warnings in the mid-2000s, serving as a warning that suicide is increased when antidepressants are prescribed to youths.

So what is the association of antidepressants and suicide in adults? For adults under age 25, the suicide risk is increased, compared to placebo, when they take antidepressants, and this increased suicide risk is similar to the increased risk seen in children and adolescents. However, no increased suicide risk was seen in adults aged 25 to 64, and there was decreased suicide risk in people aged 65 and older (Stone et al., 2009).

So how do you synthesize these studies and all the controversy surrounding the antidepressant suicide risk? For children, adolescents, and young adults under the age of 25, the prescription of antidepressant medications should be only reserved for the most severe cases of depression and anxiety. And when youths and young adults are prescribed antidepressants, they should be monitored closely by their doctor, preferably a psychiatrist. So what this means is that more benign treatments should be instituted for the majority of youths and young adults with depression and anxiety, like counseling and self-help interventions. Alternative treatments should also be considered instead of antidepressant medications, such as exercise, meditation, yoga, and natural supplements.

And for adults aged 25 and older, although the suicide risk is neutral for adults and decreased in adults aged 65 and older, they should still use caution when taking antidepressants, given their numerous adverse side effects. So for depressed and anxious adults aged 25 and older, the majority should also try more benign treatments first, such as counseling, self-help interventions, and alternative interventions.

So in general, antidepressants should only be prescribed to people who have severe cases of depression and anxiety, and also for people who do not respond to counseling. When you are prescribed an antidepressant, close monitoring should be provided by your doctor. Ideally, the prescribing doctor should be a psychiatrist.