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    Child Suicide and Antidepressants: A Comparison

    Child Suicide and Antidepressants: A Comparison
    Peter M. Yellowlees, MBBS, MD, in Medscape News
    April 24, 2014

    Recent data showing a possible increased risk for suicidal behavior among children and adolescents treated with antidepressants have created significant concern among patients, families, and providers.

    Now a team of investigators[1] from Vanderbilt University in Nashville have undertaken a study to compare the risk for medically treated suicide attempts among new users of sertraline, paroxetine, citalopram, escitalopram, and venlafaxine compared with the risk for new users of fluoxetine. Their retrospective cohort study included 36,842 children aged 6 to 18 years. A total of 419 medically treated suicide attempts were identified, including 4 who completed suicide.

    They found that the adjusted rate of suicide attempts did not differ significantly among current users of any of the antidepressants compared with current users of fluoxetine. This is an important finding suggesting that there is nothing specific about individual antidepressants that makes one more potentially dangerous than the others. It reminds us that childhood depression itself is associated with suicidal behavior, and that all patients must be carefully assessed and treated.

    References
    1. Cooper WO, Callahan ST, Shintani A, et al. Antidepressants and suicide attempts in children. Pediatrics. 2014;133:204-210.

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    Re: Child Suicide and Antidepressants: A Comparison

    Thank you for this article. It is interesting to me because my son (grandson) is on citalopram and his dose was just raised and he is again talking of suicide. However, that being said, his mom is not in his life very much and she recently came to town for a visit with him and it did not go well. I do not know if that was the trigger for him talking this past week about suicide again, something he really has not done since starting citalopram. I was curious to find out if it is something he is doing for attention or if he had thought it through. He told me exactly how he would do it so it wouldn't hurt him. I am scared because the neuropsychiatrist he is seeing feels he should be off of both the abilify and the citalopram and perhaps they are just giving him a placebo effect. I completely disagree as he is better than he was before the meds. We tried to lower the dose and after 3 days he asked for it back because he felt his anger was really getting out of control again and it was scaring him. I truly believe there is both an emotional and biological component to his mental illness and I am afraid that if he is taken off the meds he will go back to being violent and doing self harm. I also want to make sure that it is not me wanting him on these meds for my own fears, but at the same time being honest I can see the difference in him with the meds compared to without.

    If the neuropsychiatrist feels he should be off of them I want to try but I don't feel good about this, in my heart I know my son needs meds as well as the therapy he is getting for the past year or more. We just cannot seem to reach him to help with these thoughts he has and I feel there is more to his condition than meets the eye. His therapist is also concerned about his distorted thinking because of the meds and the amount of time that he has been seeing her and he keeps going back to this kind of thinking. I feel it is going to get worse as he gets older (he just turned 10) and I am afraid for him and what kind of life he is going to have if he cannot be helped, if he doesn't do something first. I am so very scared for him. It is how he says it not so much that he is saying it, he is serious and I don't know where to go from here.

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    Re: Child Suicide and Antidepressants: A Comparison

    I believe you need to make your case to the neuro psychiatrist that your observations of your son and his own feedback suggest there is benefit from the medications, and ask for the doctor's rationale for withdrawing the medications and if they are withdrawn, then what are the options should symptoms re-emerge.

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    Re: Child Suicide and Antidepressants: A Comparison

    Steve, I did talk to him about it at the last appt and he felt it was just a placebo effect that was making the meds help my son. Because he was taking meds he was better, however, if that was really the case then how is my son suddenly able to do more to control the rages he had been having? They are only about 10% of what they were. He is not controlling them, the meds he is taking are helping him. His moods while not perfect have improved until recently making me wonder if with his growth the dose needs to be increased not decreased. I have decided to have our family doctor write a letter regarding my son's rages and moods and her feelings about the meds being withdrawn. She doesn't think it is a good idea either, esp given that he recently told me and admitted to both her and his therapist that he said not to doubt that he would commit suicide when he is older, he even told them how he was going to do it, by hanging himself because he didn't think it would hurt. He says his emotional pain is too great, obviously there is something still going on, perhaps the meds are not the right ones for him but taking them away completely scares me to no end. I feel he may act sooner rather than later on his threat. The family doctor feels if he is taken off his meds it should be considered that it be done inpatient because of the violent rages he had before the meds, it is going to be a danger for me if he goes off them and rages as I have been physically attacked by him previous to the medicine. When I have forgotten to give him his dose of meds he is different than when it is given on schedule, he gets very antsy and agitated and angry and his anxiety goes sky high.

    We did try to lower the dose last month by 1 mg and after 3 days my son was asking for it back because he said his anger was feeling out of control. The doctor did not seem happy that I gave the dose back to my son, he felt I should have persevered. I asked him how long it takes for the meds to leave his system and he said about 24 hours. The fact that he went 3 days with the lowered dose and begged for it back makes me believe that it is not placebo effect. I truly believe in my heart there is a chemical missing in my son's brain, he was not on the meds very long in the first place when they started helping him. Why would he want to take medicine that he doesn't need? He is not the type to bring attention to himself, he prefers to be quiet and won't talk to the psychiatrist on most occasions because he is a new Dr. and my son says he doesn't know him. My son at times denies there is anything wrong with him so why would he ask for meds if he doesn't see what is going on with him? If he could cope now without the meds why was he not able to previously? I don't want to have to go back to having to call police and ambulance when is is having a rage blackout like he did previously. That is not fair to him and makes him feel that he should have been able to control it, even while telling me he couldn't, it feels like I would be setting him up to fail.

    Do I try to find another Dr. for him to see? I know he stopped talking with a previous therapist when he didn't feel they were listening to him that he was not just a bad kid as they suggested who could control his anger if he tried. It gets a hold of him and he doesn't remember it afterwards. I have wondered if that is why he is not talking with this psychiatrist, he feels he is not being heard so he shuts down. One of the statements in the psychiatrists letter to the family doctor is that my son doesn't like to hear the word no and reacts to that, if that was the case then how come now I can tell him no and 90% of the time he is okay with that, he doesn't like it but he doesn't rage about it.

    I feel like I am more confused now than I was before. People are telling me to listen to the psychiatrist but it just doesn't feel like the right decision for my son to take him off the meds. My heart tells me they are necessary to allow him to cope. It is allowing him to be more like a child without the rage issues, I can reason with him now where before he would not even be capable of hearing me.

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    Re: Child Suicide and Antidepressants: A Comparison

    Imbetts,

    Have you read the series on rage episodes (Parts 1,2 and 3) in the Anger section of the Tourette Forum?Those posta are at the top of the section among the "sticky" posts

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    Re: Child Suicide and Antidepressants: A Comparison

    I have read them over and over again, thanks Steve. They really helped me to understand him a bit better. One thing that has come up yesterday is that he is telling me he is seeing visions. When I asked him what he meant he told me that he dreams of things and then they happen. It may be several days before that he says he dreamt them. Is he in a dissociative state when this happens to him and does not realize that maybe they weren't dreams he had? This is new to me.

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    Re: Child Suicide and Antidepressants: A Comparison

    Is he in a dissociative state when this happens to him and does not realize that maybe they weren't dreams he had?
    This question is beyond my understanding and would have to defer to someone more knowledgeable to address this.

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    Re: Child Suicide and Antidepressants: A Comparison

    That's not a question I could answer online either. I would suggest you bring it to the attention of his physicians and/or therapists.

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