The FDA issued a black-box warning on antidepressants in 2003 alerting the public that the drugs were associated with an increased risk of suicidal thinking and behavior in adults and children. Therefore, researchers must implement new strategies to combat depression with the decrease in usage of antidepressants.
Here are 10 things to know:
1. In 2007, the FDA expanded the black-box warning about the risks of antidepressants, increasing the age range to 18 to 24. The language also was amended to include other psychiatric disorders associated with increased suicide risk.
2. The language included in the black-box warning further contributed to the decreased treatment of depression. This change followed meta-analyses of research demonstrating the rate of suicidal thinking doubled among those taking antidepressants to 4 percent of patients, an increase from 2 percent of patients given a placebo.
3. Many critics of the FDA findings state none of the young patients in the study successfully took their own lives and that depression by itself, as noted on the warning label on antidepressants, increases one's risk of suicide.
4. Adam Kaplin, MD, an assistant professor of psychiatry and neurology at John Hopkins University School of Medicine in Baltimore, and his researchers sought to find a way for health providers to help the small percentage of young people who exhibit suicidal thinking and behavior while taking the drugs.
5. The team administered selective serotonin reuptake inhibitors, the most widely prescribed class of antidepressants, to mice and found although they exhibited more anxiety in the short-term, the drugs generally decreased anxiety over the long-term.
6. Dr. Kaplin explains patients who were not suicidal before do not become suddenly become suicidal after taking the antidepressants. Rather, patients who were at risk may become more inclined toward suicidal thoughts or behaviors within the first few weeks until the drugs have ample time to take full effect.
7. Researchers conducted studies to determine the best dosing strategies for faster-acting drugs, therefore helping patients see improvements faster while minimizing the side effects. The results showed dosing strategies already implemented for adults with anxiety work well, starting at half the full dose and then slowly increasing to the full dose.
8. Despite advancements in research demonstrating the effectiveness of this half dosage approach, many physicians and patients forgo antidepressants because of the black-box warning. Dr. Kaplin and his researchers are conducting further research to find other strategies to treat depression in young patients.
9. Dr. Kaplin understands animal studies aren't sufficient enough to dictate clinical practice, but funding would help to test the novel depression treatment strategies aimed at helping find the best treatment for those with depression.
10. While researchers devise new strategies, children suffering from depression must not forgo treatment in fear of a black-box warning. Rather, patients must have conversations with their healthcare providers about what treatment option would be best and monitor the patient throughout the process.
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