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SPECIAL ARTICLES: US Preventive Services Task Force Screening and Treatment for Major Depressive Disorder in Children and Adolescents: US Preventive Services Task Force Recommendation Statement Pediatrics 2009; 123: 1223-1228 [Abstract] [Full text] [PDF]

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Safety of Antidepressants

Kelly J. Kelleher, The Research Institute at Nationwide Children's Hospital   (12 June 2009)

Safety of Antidepressants 12 June 2009
Kelly J. Kelleher, Professor The Ohio State University, The Research Institute at Nationwide Children's Hospital Send letter to journal: Re: Safety of Antidepressants Kelly.Kelleher{at}nationwidechildrens.org Kelly J. Kelleher, et al.	The U.S. Preventive Services Task Force (USPSTF) has advanced the health and well-being of adolescents through its new recommendations to screen for depression during primary care visits.1 We were surprised, though, to see the summary statement on treatment with antidepressant medications that stated, “There is convincing evidence that there are harms with SSRIs (i.e. suicidality)” (emphasis added). This evaluation conflicts with the results of the meta-analysis detailed in the USPTF assessment,2 with methodological critiques of the randomized clinical trial data,3 with data from many observational studies,4 with additional statements later in the summary recommendations,1 and with the reading of the evidence presented in the USPSTF’s accompanying review of the evidence.2 Noting that there were no completed suicides in any of the trials, the available evidence supports a more qualified estimate of the risk of suicidal ideation/suicide attempt associated with SSRI treatment in adolescents. In our view, it is not yet clear whether SSRIs promote or prevent suicidal ideation or behavior in representative samples of depressed adolescents. It is clear that depressed adolescents are at increased risk of suicide and suicidal behavior and that they should be carefully monitored regardless of what treatment they receive. The USPSTF’s assertion that there is convincing evidence about the suicidal ideation/suicide attempt risks of SSRI treatment, despite evidence of benefit over harm from our work5 and that of others,6-8 will likely fuel the continued decline in effective treatments for adolescents.9 This may result in the greater public health risk, which is untreated depression. K Kelleher, J Greenhouse, J Bridge, W Gardner, J Klima, T McInerny 1. Pediatrics. Apr 2009;123(4):1223-1228. 2. Pediatrics. Apr 2009;123(4):e716-735. 3. Stat Med. May 20 2008;27(11):1801-1813. 4. Int Rev Psychiatry. Apr 2008;20(2):209-214. 5. JAMA. 2007;297:1683-1696. 6. Am J Psychiatry. Jul 2007;164(7):1044-1049. 7. JAMA. Feb 27 2008;299(8):901-913. 8. Am J Psychiatry. 2006;163(1):41-47. 9. Am J Psychiatry. 2007;164:884-891. Conflict of Interest: None declared