New analysis suggests all SSRIs pose risks to young
Young people taking antidepressants are at increased risk from self-harm or suicidal behaviour, according to a new analysis that supports previous studies.
It also indicates that fluoxetine, the only antidepressant to be given
a favourable risk benefit profile by the Committee on Safety of Medicines
for use in children and adolescents, may be no less risky than some other
newer antidepressants.
Researchers from the University of Manchester’s biostatistics group
examined data collected from randomised placebo-controlled trials of
children and adolescents aged six to 18 years treated with fluoxetine,
sertraline, citalopram, paroxetine, venlafaxine or mirtazapine.
Self-harm, suicidal thoughts or attempted suicide occurred in 71 of the
1,487 (4.8 per cent) young people treated with antidepressants compared
with 38 of the 1,254 (3.0 per cent) given placebo. Expressed differently,
this means that 57 young people need to be treated for one additional
event to occur.
The researchers observed that fluoxetine was associated with an overall
small risk of any event (relative risk 1.6, 95 per cent confidence interval
0.9–3.1). The risk of suicide attempts was similar to but higher
than that for paroxetine. However, they warn that the results for individual
drugs and events need to be interpreted cautiously because they are based
on small numbers with relatively few incidences of adverse events.
The researchers warn that to get an accurate picture of suicidal behaviour
prospective studies are needed that do not exclude the most depressed
suicidal children (British Journal of Psychiatry 2006;189:393). |
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