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. 2022 May 26:13:880496.
doi: 10.3389/fpsyt.2022.880496. eCollection 2022.

Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies

Kuan Li  1   2 , Guibao Zhou  1 , Yan Xiao  1 , Jiayu Gu  1 , Qiuling Chen  1 , Shouxia Xie  1 , Junyan Wu  3
Affiliations

Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies

Kuan Li et al. Front Psychiatry. .

Abstract

Objectives: Although several studies have reviewed the suicidal risk of antidepressants, the conclusions remain inconsistent. We, therefore, performed a meta-analysis of observational studies to address the association between exposure to antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and the risk of suicide and suicide attempt in children and adolescents.

Methods: MEDLINE and Embase were searched from January 1990 to April 2021. Seventeen cohort and case-control studies were identified that reported suicide or suicide attempt in children and young adults (aged 5-25 years) who were exposed to any antidepressants. We extracted the estimates and corresponding 95% confidence intervals (CIs) from each publication.

Results: The results showed that antidepressant exposure significantly increased the risk of suicide and suicide attempt when compared with no antidepressant usage among children and adolescents. The pooled relative risk (RR) was 1.38 (95% CI: 1.16-1.64; I 2 = 83.1%). Among the antidepressants, SSRI use was associated with an increased risk of suicide and suicide attempt, and the pooled RR was 1.28 (95% CI: 1.09-1.51; I 2 = 68.8%). In subgroup analysis, the attempted suicidal risk of antidepressant and SSRI was significantly increased (RR = 1.35, 95% CI: 1.13-1.61; I 2 = 86.2% for all antidepressants; and RR = 1.26, 95% CI: 1.06-1.48; I 2 = 73.8% for SSRIs), while the completed suicidal risk of antidepressant and SSRI was not statistically significant (RR = 2.32, 95% CI: 0.82-6.53; I 2 = 6.28% for all antidepressants; and RR = 1.88, 95% CI: 0.74-4.79; I 2 = 52.0% for SSRIs). In addition, the risk of suicide and suicide attempt between SSRIs and other antidepressants was similar (RR 1.13, 95% CI: 0.87-1.46, I 2 = 32.4%).

Conclusion: The main findings of this meta-analysis provide some evidence that antidepressant exposure seems to have an increased suicidal risk among children and young adults. Since untreated depression remains one of the largest risk factors for suicide and the efficacy of antidepressants is proven, clinicians should evaluate carefully their patients and be cautious with patients at risk to have treatment emergence or worsening of suicidal ideation (TESI/TWOSI) when prescribing antidepressants to children and young patients.

Keywords: SSRIs; antidepressants; children and adolescents; suicide; suicide attempt.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of literature search and study selection.
FIGURE 2
FIGURE 2
Forest plot of antidepressant exposure and the risk of suicidal behavior among children and adolescents.
FIGURE 3
FIGURE 3
Forest plot of selective serotonin reuptake inhibitor (SSRI) exposure and the risk of suicidal behavior among children and adolescents.
FIGURE 4
FIGURE 4
Subgroup analysis of SSRI exposure and risk of suicidal behavior according to the comparisons.
See this image and copyright information in PMC

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References

    1. Hartz I, Skurtveit S, Hjellvik V, Furu K, Nesvåg R, Handal M. Antidepressant drug use among adolescents during 2004-2013: a population-based register linkage study. Acta Psychiatr Scand. (2016) 134:420–9. 10.1111/acps.12633 - DOI - PMC - PubMed
    1. U.S. Food and Drug Administration. Suicidality in Children and Adolescents Being Treated with Antidepressant Medications. Silver Spring, MD: US FDA; (2004).
    1. FDA. Antidepressant Use in Children, Adolescents, and Adults. Silver Spring, MD: FDA; (2007).
    1. Lawton A, Moghraby OS. Depression in children and young people: identification and management in primary, community and secondary care (Nice Guideline Cg28). Arch Dis Child Educ Pract Ed. (2016) 101:206–9. 10.1136/archdischild-2015-308680 - DOI - PubMed
    1. Fu X, Qian Y, Jin X, Yu H, Wu H, Du L, et al. Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychol Med. (2021) 1–11. 10.1017/s0033291721001549 - DOI - PubMed

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