SSRIs and Youth Suicide

I may have missed it, but I have yet to see a review or “root-cause analysis” in the major literature by anyone knowledgeable about the recent controversy over whether SSRIs cause suicide in children and adolescents, which was discussed in your March 5 issue.

For example, how many of these children committed suicide while on SSRIs in the hospital, and how many did so just after being released? Has anybody recently addressed the well-known clinical phenomenon that antidepressants first decrease psychomotor retardation and only later tend to “brighten” one’s world view and improve morale (particularly with competent psychotherapy and a good therapeutic alliance)? Were severely depressed children denied adequate inpatient treatment because of having poor insurance coverage? How many of these deaths were the result of “hit-and-run” treatment, that is, prescription of the drugs without intense follow-up and supervision of the child? In how many cases did the initial “improvement” in energy level and executive functions then allow the victim to carry out suicidal impulses that would have been relatively harmless with adequate therapeutic structure and supervision?

I remember well that as a resident in Topeka in the 1960s, our supervisors cautioned us against discharging our hospitalized depressed patients too soon, since even though they seemed improved, they were still a suicide risk because of their increased later-onset impulsiveness in the process of recovering from depression.