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Suicidality, aggression rates double in children taking antidepressants

Meta-analyses of clinical study reports indicated significantly higher rates of suicidality and aggression in children taking antidepressants, despite study limitations that may have led to underreporting.

To assess harms associated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), researchers studied clinical reports for duloxetine, fluoxetine, paroxetine, sertraline and venlafaxine from European and United Kingdom drug regulators and summary trial reports for duloxetine and fluoxetine from Eli Lilly. Analysis included 70 trials among 18,526 patients.

Differences in mortality (OR = 1.28; 95% CI, 0.4-4.06), suicidality (OR = 1.21; 95% CI, 0.84-1.74) and akathisia (OR = 2.04; 95% CI, 0.93-4.48) were not significant, though individuals taking antidepressants exhibited more aggressive behavior (OR = 1.93; 95% CI, 1.26-2.95).

Odds ratios for suicidality were 0.81 (95% CI, 0.51-1.28) for adults vs. 2.39 (95% CI, 1.31-4.33) for children; 1.09 (95% CI, 0.55-2.14) for aggression in adults vs. 2.79 (95% CI, 1.62-4.81) in children; and 2 (95% CI, 0.79-5.04) for akathisia in adults vs. 2.15 (95% CI, 0.48-9.65) in children.

However, these findings are limited due to limiting study designs and discrepancies in reporting which may have led to serious underreporting, according to researchers.

In the summary trial reports from Eli Lilly, almost all deaths were reported but all suicidal ideation events were missing and information on remaining outcomes was incomplete.

“We believe our study shows that, despite using clinical study reports, the true risk for serious harms is still uncertain. The low incidence of these rare events and the poor design and reporting of the trials makes it difficult to get accurate effect estimates,” the researchers wrote. “Therefore we suggest minimal use of antidepressants in children, adolescents and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant. Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered, although psychotherapy trials also suffer from publication bias.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.