The potential link between the use of certain medications and an increased risk of suicidal thoughts and actions has been a source of significant concern and debate in recent years. Research has been conducted into many medications and their likelihood to trigger suicidal thoughts and behaviors, although most of the attention has centered on the use of antidepressants by children and teenagers.

To date, the U.S. Food and Drug Administration (FDA) has only approved one antidepressant – fluoxetine (Prozac) – as a treatment for depression in children age 8 and older. However, after a drug has been approved by the FDA, any physician may prescribe it to any patient for any purpose, a common practice known as “off-label” prescription. In this manner, physicians have prescribed antidepressants other than fluoxetine to children.

A recent FDA analysis concluded that short-term therapy with the latest antidepressants also appears to increase suicidal thoughts and behaviors in young adults up to the age of 25. A U.S. panel has advised the FDA to amend the black box warning on antidepressant medications to reflect this new information. However, there is no evidence demonstrating that the use of antidepressants actually increases the risk for completing suicide.

Clinical studies of one such antidepressant called paroxetine (Paxil) indicated that children who took the drug were at increased risk for suicidal thoughts and actions compared to children who took a placebo (sugar pill).

As a result, the FDA investigated these findings. In October 2004, the agency issued a strong caution advising the public that antidepressants may increase the risk of suicidal thinking in some children and teens. Today, all antidepressants carry a “black box” warning about this potential danger.

Although the FDA does not prohibit the use of antidepressants in children, it has urged close monitoring of youths who use these drugs. Parents, teachers and others are asked to watch for any unusual changes in behavior after a child begins taking antidepressants. If these shifts occur, parents are urged to promptly notify the child's physician.

The potential link between antidepressant use and suicidal thoughts is not fully understood, although several theories have been proposed. For example, one popular theory suggests that antidepressants cause improvements in the physical symptoms of depression (such as relieving fatigue), before providing relief from the emotional symptoms of the illness, such as sadness. This may give individuals who had previously contemplated suicide the energy to act on their impulse.

It is important to note that in the vast majority of cases, people who take antidepressants, including children, are far more likely to be helped by the medications than hurt by them, including children. The FDA urges parents to consider several factors before deciding whether or not antidepressants are appropriate for their child. These include weighing the potential risks of not treating the child with medication against the smaller risk of using the medication.

In addition, the FDA and other experts urge parents of children who already take antidepressants to tell their child to not stop taking these drugs without first consulting a physician.

The FDA maintains ongoing monitoring of drugs and their effects. The agency also recently required the manufacturer of the attention-deficit hyperactivity disorder (ADHD) drug atomoxetine (Strattera) to include a label warning that this drug may increase the risk of suicidal thoughts and behaviors in children.

Some experts have similar concerns about the use of other medications, such as benzodiazepines and anticonvulsants. The therapeutic use of many other non-psychiatric medications can also be associated with depression and an increase risk for suicide.