New Research on Antidepressant Dosage for Young People

A new research study on antidepressant dosage is getting news coverage. The LA Times summarizes:

About a decade after the Food and Drug Administration first warned that antidepressant medications increase the risk of suicidal thoughts and behaviors in children, new research has found that kids and young adults starting on high doses of antidepressants are at especially high risk, especially in the first three months of treatment.

I’ve heard this claim that “antidepressant medications increase the risk of suicidal thoughts and behaviors in children” many times, and I’ve always been skeptical. Antidepressants are prescribed for people, young or old, who are suffering from depression. One symptom of depression is suicidal thoughts. More severe depression is more likely to involve suicidal thoughts, and those with more severe depression are probably more likely to be prescribed antidepressant drugs.

So is it really a matter of antidepressant meds causing suicidal thoughts? Or are people with severe depression experiencing a common symptom of severe depression despite receiving treatment?

I’m sure that there are very smart people involved in these research studies and that this question has occurred to them too. On the other hand, mass media science writers often misrepresent complicated research, jumping to conclusions and attributing causality where the actual scientists were more cautious.

At the end of the LA Times article is this proviso:

The authors acknowledged that they could not discern why younger patients on high initial doses of antidepressant were more likely to try to harm themselves. Although it could have been the dose at which these young patients began their therapy, it is equally plausible that younger patients who are correctly perceived to be in a mental health crisis are more likely to be treated more aggressively, but not more likely to get better with SSRIs.

That seems like an important qualification. The scientists are not nearly so certain about which factor causes which result.

Possible dangers of drug therapy certainly should be researched carefully. But unwarranted panic carries its own danger, the danger that young people suffering from depression won’t get the treatment they need because someone heard that antidepressant drugs cause suicide.

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