Suicide and Antidepressants
All antidepressants must be used with caution if a person is suicidal. When this is the case, the person will need to see his or her doctor for frequent follow-up visits and will receive a prescription for a relatively small number of pills at a time. Suicide attempts or suicidal thoughts are common symptoms of depression, and the risk of suicide may increase as depression begins to respond to treatment because the person might regain just enough energy and motivation to follow through on a suicidal urge.
In 2004, a federal panel of drug experts said that antidepressants could increase the risk of suicide in children and teenagers. Later that year, the U.S. Food and Drug Administration (FDA) required the makers of antidepressants to add a black box warning to that effect to the drug labels of these medications. In 2005, the agency issued a public health advisory stating that suicidal thoughts and behaviors may also increase among adults on antidepressants. The risk of suicide is higher at the start of drug therapy and when the dosage is changed, according to the FDA.
Antidepressants are the fourth leading cause of drug overdose and the third leading cause of drug-related death when taken improperly. (Tricyclics such as amitriptyline are the most common cause of death from an antidepressant overdose.) In addition, when a person with latent bipolar disorder starts taking antidepressants, manic symptoms may develop and require treatment.
Although up to 70 percent of people with depression respond positively to antidepressants —and some studies suggest that use of antidepressants, particularly newer SSRIs, decreases the risk of suicide —it is true that some people might have responded just as well to a placebo. But whether a person responds to an antidepressant because of the action of the medication or the placebo effect, or possibly a combination of the two, the fact remains that antidepressants provide real relief to many people. Moreover, because studies of the placebo effect have only followed people for a limited period of time, there are no data showing whether the placebo effect can be sustained in the long term; by contrast, there are data showing that the positive effects of medication are sustained long term.
When it comes to the length of treatment for depression, there is no "one size fits all." However, recent evidence shows that many people require a year or more of antidepressant therapy to treat a major depressive episode adequately. (This includes roughly three months of acute treatment to significantly improve depressive symptoms and an additional six months to a year of continuation/maintenance treatment.) People with severe or recurring depression and older adults may require much longer maintenance therapy.