Did Antidepressant Trigger Suicide?

I have been tryint to wean off lexapro for two weeks now. I was put on anti depressants for pain.I have never felt so crazy in my life. I remember being on Clonzapan and feeling the same way. I was able to get off them right away. Thank God!
I am currently taking StJohn's Wort and 5-HTP. I am really looking forward to feeling better.

I am very saddened by the news of your daughter's death. I can't tell you precisely why she committed suicide and this is one of the most troubling aspects of this devastating event.

However, it is not at all clear that antidepressants contribute to suicidal acts. I have read every bit of the evidence reviewed by the FDA and much more. In the 24 FDA studies which included hundreds (perhaps a 1000) of depressed youngsters treated either with placebo or with one of the antidepressants, there was not a single suicide; and if I recall correctly only about 3 suicide attempts occured (too few to make any conclusions). This is why the FDA used data derived from the rating scales about feelings of suicide as well as the patient's medical charts which in some cases reported the patient's statements and acts that might be related to suicide or self injury. In these short term studies (lasting several weeks) these less dangerous statements and acts were seen about 3 times in the drug treated group for every 2 times they occured in the placebo group. It is very hard to know, therefore, what the relationship to suicide would be in the world at large but it was the justification for the FDA required black box warning.

There are several ways in which the antidepressants in these studies could be related to suicide: First and best known is that the drugs are being used in clinically depressed persons. Depression is the best known of all suicide risk factors. Treatment for depression often begins either during a period of worsening depression or, paradoxically, during a period of improving depression (both times of increased risk during the course of the illness). Second, please keep in mind that the antidepressant effects of the drugs are usually not apparent until 2 to 6 weeks after beginning treatment, so whatever else they do, they do not protect depressed youngsters during the early weeks of treatment. And even longer term, any one antidepressant produces a signficant improvement in only half to two thirds of depressed patients. Third, the drugs can have somewhat unpredictable transient effects on moods and anxiety in the first week or 2 of treatment and in this way it is possible that they could increase risk in these vulnerable youngsters.

In studies done since the FDA analysis and the warning, it appears that regular and close follow up visits to the doctor or therapist diminsh the events that were counted as possibly suicide related in the FDA studies. This would be logical if the antidepressants were causing unpredictable transient mood and anxiety changes in some patients. Finally, though not in your daughter's case, we know that a fairly large number of youngsters go on and off the drug on their own either intentionally or because they simply forget to take the drug at times. These on and off events are also frequently associated with both the unpredictable effects on mood and in many the worsening of their depression. In the long run (which requires survival in the short run) the drugs are associated with fewer suicidal ideas in depressed youngsters and adults.

My take home message is that when youngsters are clinically depressed, most of the ones with moderately severe to severe forms can benefit from antidepressant medications but they all need regular and frequent follow up visits for assessment and therapy in which suicidal ideas are monitiored and any effects of the medications good or bad are examined.

Since the black box warning was put on the label, suicide rates in American youngsters have rather dramatically shifted upwards after several years in which they were going down. We don't know if this is related to the warning, but we do know that the number of antidepresant prescriptions given to young people has gone down sharply since the warning was published.

These are difficult and complex events that neither the doctors nor the FDA understand yet. I encourage parents go with their children to listen and to speak to the doctors who are evaluating them for depression. And after that the parents should stay on the treatment team encouraging frank and open discussions with their child and with the therapists and doctors who treat them. I think this close follow up is essential whether or not they are taking antidepressants.

Again I am sorry for your loss. (Yes I am a doctor and I am painfully aware that we do not understand the causes of clinical depression and we do not understand why the antidepressants work when the work or why they fail when the fail. We need to support and insist on much more research to answer these fundamental questions).

A few years ago my middle-schooled aged son was losing weight, and did not want to go to school. Once there, he would become "sick to his stomach" and call asking to come home. I suspected anxiety/or depression as I had a history of depression. I took him to my family doctor and let him speak to him alone.

He confirmed that he was suffering from serious anxiety and depression due to severe bullying at school. These kids had been his friends since preschool and he was devastated. We tried 3 different medications, counseling, home schooling and hospitalization before we started Cymbalta. After 6 months on Cymbalta and regular therapy he was back to his usual happy, inquisitive, and social child.

He's excelled in school, his music and with his friends. NO antidepressants are recommended for use in children. The drugs deal with brain chemistry and require constant monitoring. Hopefully doctors and researchers can learn more about depression and suicidal inclinations to prevent such a tragedy ever occurring again.

My heart bleeds for you and your loss. My thoughts and prayers are with you and your grandchild.