A Final Note
For the most part, antidepressants are safe and effective, but in some individuals, they can activate thoughts and feelings of suicide. In 2004, the FDA issued a "black box warning " based on an assessment of 2200 child and adolescent patients in which 4% of patients on antidepressants expressed suicidal ideation compared to 2% on placebo. Later the black box warning was extended to young adults under the age of 25.
The "take home" message from this is that when prescribing these medications, a patient must be watched closely, particularly in the first few weeks of treatment. We know that these medications can be activating and anxiety generating. We also know that increased anxiety can generate increased suicidal thoughts.
It is abundantly clear that when used appropriately, these medications are live saving. The relatively minor risk of increased suicidal thoughts is minor compared to the major risk of morbidity and mortality associated with untreated depression.
