Psychiatric suicidal behavior, antidepressants

The FDA provided a summary of 52 adverse psychiatric reactions reported over the prior year for Concerta and Ritalin, including cases of overstimulation (agitation and mania), depression, psychosis, aggression and violence, and suicidal behavior (FDA, 2006b). Notice the similarity to the dangerous effects that the FDA previously recognized as associated with the newer antidepressants. The similarity between stimulant and antidepressant adverse effects is probably due to the stimulating effects of the newer antidepressants. 

As regular psychiatric assessment is not always possible, the identification of easily detectable predictive factors of severe psychiatric disorders may help select which patients should undergo close psychiatric assessment. In 71 patients treated with interferon alfa alone or combined with ribavirin for chronic hepatitis C, female sex, scores on the MADRS at 4 months of treatment, sleep disorders, and prior antidepressant use were independent risk factors of suicidal behavior or depression (349). This study also suggested that prolonged follow-up is required, as 8% of patients still had suicidal behavior 6 months after the end of treatment. 

Suicidaiity in chiidren and adoiescents Antidepressants increased the risk of suicidal thinking and behavior (suicidaiity) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone... 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

On November 13, 2006, NIMH announced a new NIMH initiative aimed at studying the connection between SSRIs and suicidality and in the process made clear that consensus exists within the psychiatric establishment that SSRI antidepressants cause suicidality. NIMH director Thomas Insel, M.D., was quoted These new multi-year projects will clarify the connection between SSRI use and suicidality and they will help determine why and how SSRIs may trigger suicidal thinking and behavior in some people but not others, and may lead to new tools that will help us screen for those who are most vulnerable. ... 

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