Judging when an adolescent’s mood swings are severe enough to warrant medical treatment is one of the toughest calls a parent has to make. And it just got tougher. In October federal health officials announced that antidepressants must carry a black box label—the Food and Drug Administration’s strongest warning—indicating the drugs can cause suicidal behavior in children and teenagers.
Since the generation of antidepressants known as selective serotonin reuptake inhibitors were introduced in the late 1980s, only one—Prozac—has been approved by the FDA for kids. Nonetheless, others, like Paxil, Celexa, and Zoloft, are commonly prescribed.
The FDA ruling was based in part on research that was sponsored by drug companies but never published. One study commissioned by the makers of Paxil—GlaxoSmithKline—found that children aged 7 to 18 who took the antidepressant were up to three times more likely to have suicidal thoughts or display suicidal behavior than children who received a placebo. Other studies found no benefit from taking the drug.
A study published in the Journal of the American Medical Association in July found that both children and adults are at highest risk just after they begin treatment. Data from a British survey showed that kids aged 10 to 19 who had been taking antidepressants for fewer than nine days were four times more likely to display suicidal behavior than patients who had been taking the drugs for three months or longer. One possible explanation is that these drugs reduce the lethargy associated with depression before lifting the feelings of depression itself, paradoxically giving some patients enough energy to act on suicidal impulses.
Critics charged that the FDA’s drug-safety analyst had made a connection between antidepressants and teenagers’ suicidal behavior as early as 2002, but agency higher-ups had rejected his findings and ordered an outside panel to reanalyze his data. That panel came to the same conclusion that he had.
The new warning creates a dilemma. Clinical depression is commonplace among teenagers, and the illness itself can be deadly if untreated. “Depressed teens are already at substantial risk of attempting suicide,” says Daniel Pine of the National Institute of Mental Health. “In parts of the country kids don’t have enough access to treatment, and I’m nervous about anything that’s going to decrease their access.”
