29 Jan Antidepressants May Raise Suicide and Aggression Risk in Youth
MedicalResearch.com Interview with:
Tarang Sharma, PhD candidate
Nordic Cochrane Centre, Rigshospitalet
University of Copenhagen, Faculty of Health and Medical Sciences,
Medical Research: What is the background for this study? What are the main findings?
Response: These newer antidepressants are some of the most prescribed medications in the world and previous research in the area has suggested an increased suicide risk on these drugs in young people, but only when unpublished clinical study report data is used. Such risk is missing when the published articles are considered due to severe selective reporting and publication bias.
In our study we found that the research design of most of the trials was very poor and there were major discrepancies in the reporting, leading to the under-estimation of harms. Despite these problems we still found that both suicidality and aggression were more than doubled in children and adolescents on antidepressants compared to those on placebo.
Medical Research: What should clinicians and patients take away from your report?
Response: It is our job as researchers to provide information and it should now be up to doctors and patients to take this evidence and inform practice and policy. The research we cite in our paper has shown that the evidence for benefit for antidepressants is limited and is below what is clinically relevant. They also appear to work just as well as psychotherapy and worse than exercise for this age group. Considering our research indicates the doubling of suicidality and aggression on antidepressants, it seems obvious using evidence-based principles that the other two alternatives should be offered to this age group, while antidepressants should be slowly stopped under good clinical guidance (especially as both other effective treatments do not carry with them such serious harms). Patients and their families should work with their clinical professionals to discuss properly the benefits and harms of the treatment options available to them.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: One of the outcomes we considered was “akathisia” a very extreme form of agitation that has been linked to increased suicidal and violent behaviour. As most of the trials included were short, a few weeks only, such precursor outcomes are very important to estimate. Akathisia was very poorly reported and was often miscoded to other milder activation terms such as nervousness etc., but as we did not have access to verbatim terms and individual patient data for all the trials, it was very difficult to get an accurate estimate.
The risk of increased akathisia was seen in all ages but due to the low numbers, did not reach statistical significance. Further work on getting more accurate risk of such activation symptoms is key to understanding the true nature of the harms of these drugs.
Medical Research: Is there anything else you would like to add?
Response: All data, including individual patient data and case report forms, need to be made publically available, such that different independent researchers (without conflicts of interests) can undertake their own analyses and validate or disagree with previous results, to ensure that the drugs made available to patients, are safe.
Tarang Sharma, PhD candidate (2016). Antidepressants May Raise Suicide and Aggression Risk in Youth