No Link to Suicidal Behavior?

SAN FRANCISCO – Youths treated for anxiety with antidepressants or psychotherapy show similarly increased risks for suicidal behaviors regardless of the type of treatment, new research shows.

These findings add support to evidence that antidepressant medication may not, on their own, cause suicidality but that the mental illness itself that may be the culprit.

“Youth with anxiety disorders who subsequently develop depressive symptoms as adolescents or young adults are at an increased risk of suicidal ideation or behavior, regardless if they receive treatment with an antidepressant or psychotherapy,” senior author Dara Sakolsky, MD, PhD, assistant professor of psychiatry at the University of Pittsburgh and associate medical director of Services for Teens at Risk (STAR) at Western Psychiatric Institute and Clinic, in Pennsylvania, told Medscape Medical News.

Dr Sakolsy presented the study here at the Anxiety and Depression Association of America (ADAA) Conference 2017.

Black Box Warning

The findings are from the Child/Adolescent Anxiety Multi-Modal Extended Long-term Study (CAMELS), which evaluated outcomes of youths and adolescents for up to 5 years after they had undergone treatment for anxiety in the original Child/Adolescent Multi-Modal Study (CAMS). Treatment consisted of either the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft, Pfizer), cognitive-behavioral therapy (CBT), a combination of the two, or placebo.

The original study of 488 patients showed that the strongest treatment effects occurred in the patients who received combination treatment, followed by those who received CBT and those who received antidepressants, which had similar effects.

In delving into a multitude of long-term outcomes observed at 5-year follow-up, the investigators examined the relationship between anxiety treatments and subsequent suicide behaviors, outcomes particularly relevant following the issuance of a black box warning on SSRIs by the US Food and Drug Association (FDA) after some studies linked the drugs to suicidal behaviors.

The black box warning was expanded in 2007 to include the important caveat that depression was itself associated with a risk for suicide.

In the follow-up study of 319 youths, aged 7 to 17 years, who were enrolled from the previous CAMS trial, 54.9% of patients used any SSRI medication (sertraline being the most commonly used [37.6%]); 7.8% used any serotonin norepinephrine reuptake inhibitor; 12.2% used other antidepressants; and 43.9% used other medications.

Overall, 33% of patients in the CAMELS follow-up study reported any suicidal events. Of these patients, 32.7% reported suicidal ideation, described as wishing to be dead, and 8.5% reported suicidal behavior, described as preparatory acts or suicide attempts.

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