Introduction
the suicide rate in the United States fell approximately
14 percent from 1985 to 1999.1 the decline
was largely attributed to the increased use of
selective serotonin reuptake inhibitor (SSRI)
antidepressants during this same period.1
In 2004,
however, labeling for SSRIs, as well as all prescription
antidepressants in the United States, began to
include warnings of an increased risk for suicidal
thinking or behavior with use in children and
adolescents. this “boxed” warning also cautioned
prescribers, other healthcare providers, and
families to be vigilant for behavioral changes (e.g.,
hostility, agitation) in those taking antidepressants,
as these behaviors could be precursors to suicidal.
this class labeling change was based on a
meta-analysis conducted by the U.S. Food and Drug
Administration (FDA) that revealed a greater
incidence of possible suicidal (behavior or
ideation) in clinical trials of pediatric patients
treated with antidepressants, compared to
placebo.2
In 2007, following further analyses, the
FDA expanded the warning to include young adults
(18-24 years) among those potentially at risk