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November 1, 2006
Regular follow-up important during antidepressant treatment
Advice comes amidst conflicting studies on suicide
Seattle—Because individuals can react differently to
antidepressant medications, regular follow-up is important during the first
few weeks of treatment, according to an editorial by Group Health
psychiatrist and researcher Greg Simon, MD, MPH.
Simon’s advice, published in the November issue of the American Journal
of Psychiatry, comes amidst several recent conflicting studies on the
link between antidepressant use and suicide risk in children and adolescents.
In the absence of clear evidence—along with proof that antidepressants’
effects differ across individuals—Simon suggests that patients and
providers stay well connected as drug therapy begins.
Simon’s editorial was prompted by an article in the same journal by Robert
D. Gibbons, PhD, and colleagues, reporting that counties with higher rates
of SSRI antidepressant use had lower rates of suicide death in children
and younger teens. While this finding is consistent with two other recent
observational studies, it contradicts data from several other studies,
Simon comments.
Also, data from recent studies in adults find no significant difference in
suicide risk among those taking antidepressants compared to those taking a
placebo. The issue is further complicated by recent evidence that effects
on suicide risk may differ depending on the antidepressant and depending
on the individual patient, explains Simon.
He states that additional studies cannot give a definitive answer to the
question because of difficulties conducting this type of research. Still,
he believes that observational research has provided “some reassurance.”
For example, increasing use of newer antidepressants has been accompanied
by lower rates of suicide mortality in teens and adults.
Finally, he suggests that providers caught between concerns about
precipitating a suicide attempt and concerns about untreated depression
tell their patients this:
“The Food and Drug Administration requires a warning that antidepressant
medications can sometimes cause or increase thoughts of suicide. Studies
in children and adolescents have shown that antidepressants can increase
suicidal thoughts. However, other studies have shown that the overall risk
of attempting suicide goes down after starting antidepressant medication.
Even if antidepressants help most people that take them, some people may
have very negative reactions, Thus, it is important that we have regular
contact over the next few weeks. If you have thoughts about suicide or
about harming yourself, please contact me right away.”
About Group Health Center for Health Studies
Founded in 1947, Group Health is a consumer-governed, nonprofit health
care system that coordinates care and coverage. Based in Seattle, Group
Health and its subsidiary health carriers, Group Health Options, Inc. and
KPS Health Plans, serve more than 568,000 members in Washington and Idaho.
Group Health Center for Health Studies conducts research related to
prevention, diagnosis, and treatment of major health problems. It is
funded primarily through government and private research grants.
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