SSRIs and Youth Suicide

In the article titled “FDA Poised to Intensify Suicide Warnings on SSRIs” in the March 5 issue, the focus is only on the possibility that the medications may cause or not stop suicidal ideation and attempts. Data show the incidence of impulsive, self-destructive behavior begins in early adolescence and increases to the 15- to 25-year-old cohort in which accidents (especially drunken driving), homicide, and suicide are the leading causes of death. Managed care has reduced the length of time that the protection offered by inpatient care may be available, if not discouraging hospitalization altogether. To rely totally on a medication has never been good practice, and parents are not well prepared to deal with these issues around the clock, seven days a week.

In the days of tricyclic antidepressants, we were aware that after two or four weeks there was a window of suicidal risk when the patient was activated, but the antidepressant effect had not yet been experienced. Length of hospitalization was built around these observations, with good results. Has the situation changed? Do we expect our medications to provide more rapid response than the data show? Perhaps the risk of suicide is not medication related, but due to the lack of protection while waiting for the medication to work.