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The Food and Drug Administration (FDA) issued a black box warning for increased risk of suicidal thoughts or behavior in children and adolescents treated with medications typically used to treat mental disease, such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), or other antidepressants, and some newer antipsychotics. These medications may be used in the treatment of many mental diseases including anxiety, depression, or bipolar disorder, to name a few. Later, the warning was updated to include adults under the age of 25.
The FDA also issued a warning for increased suicidal thoughts or behavior in people taking medications to treat seizures (antiepileptic medications). Some of these medications are also used to treat mental diseases such as bipolar disorder.
The FDA reviewed clinical trials to see if people who received antidepressants had more suicidal thoughts and behaviors than those who received placebo (sugar-pills). The risk for suicidal thoughts or behavior in children, adolescents and adults under the age of 25 was slightly higher that placebo in the first few weeks of treatment.1 No patients died by suicide in the reviewed studies. The FDA also assessed many studies for medications used to treat seizures and observed a similar increased risk of suicidal thoughts.2
There are limits to these findings of increased risk of suicidal thoughts and behaviors. The way information was collected on suicidal thoughts and behaviors was not the same in each study. The studies were designed to see how well the medications worked, not to see if there was any difference in suicidal thoughts and behaviors. Although the risk was two times higher with antidepressant medications, the total percent of suicidal thoughts and behavior was 4% with antidepressant medications and 2% with placebo.1 The increased risk was small and not the same in each study.
The risk of suicidal thoughts and behaviors, no matter how small, still matters. However, the risks of suicide associated with not treating depression are much higher. Antidepressants and antipsychotics work well in treating mental diseases and are recommended as standard treatment. Antiepileptic medications work well to treat seizures and are recommended as standard treatment.
Mental health care providers are trained to recognize and treat mental diseases. This includes psychiatric pharmacists, psychiatrists, psychiatric nurse practitioners, and social workers, to name a few. They can help patients better understand their symptoms such as if they feel sad, worried, or have changes in their mood. Over time they can help patients feel better and show them how to cope with negative thoughts. If you ever feel unsafe or think you may harm yourself, there are resources you can use to seek help.
Autumn Walkerly, PharmD, December 2020
To view the references for this resource, please visit aapp.org/471018.
©2022 American Association of Psychiatric Pharmacists (AAPP). AAPP makes this document available under the Creative Commons Attribution-NoDerivatives 4.0 International License. Last Updated: January 2016.
This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the topic. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.