Regular follow-up important during antidepressant treatment

Advice comes amidst conflicting studies on suicide

Seattle—Because individuals can react differently to antidepressant medications, regular follow-up is important during the first few weeks of treatment, according to an editorial by Group Health psychiatrist and researcher Greg Simon, MD, MPH.

Simon's advice, published in the November issue of the American Journal of Psychiatry, comes amidst several recent conflicting studies on the link between antidepressant use and suicide risk in children and adolescents. In the absence of clear evidence—along with proof that antidepressants' effects differ across individuals—Simon suggests that patients and providers stay well connected as drug therapy begins.

Simon's editorial was prompted by an article in the same journal by Robert D. Gibbons, PhD, and colleagues, reporting that counties with higher rates of SSRI antidepressant use had lower rates of suicide death in children and younger teens. While this finding is consistent with two other recent observational studies, it contradicts data from several other studies, Simon comments.

Also, data from recent studies in adults find no significant difference in suicide risk among those taking antidepressants compared to those taking a placebo. The issue is further complicated by recent evidence that effects on suicide risk may differ depending on the antidepressant and depending on the individual patient, explains Simon.

He states that additional studies cannot give a definitive answer to the question because of difficulties conducting this type of research. Still, he believes that observational research has provided "some reassurance." For example, increasing use of newer antidepressants has been accompanied by lower rates of suicide mortality in teens and adults.

Finally, he suggests that providers caught between concerns about precipitating a suicide attempt and concerns about untreated depression tell their patients this:

"The Food and Drug Administration requires a warning that antidepressant medications can sometimes cause or increase thoughts of suicide. Studies in children and adolescents have shown that antidepressants can increase suicidal thoughts. However, other studies have shown that the overall risk of attempting suicide goes down after starting antidepressant medication. Even if antidepressants help most people that take them, some people may have very negative reactions, Thus, it is important that we have regular contact over the next few weeks. If you have thoughts about suicide or about harming yourself, please contact me right away."

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