Link between antidepressant use and youth suicide?

Abstract

The Australian Therapeutic Goods Administration (TGA) is investigating the relationship between antidepressant use and the rate of suicide in children, adolescents and young adults. Details of a safety investigation review conducted by the TGA and recommendations based on the findings were published in April 2021. Based on findings of this safety review, the TGA is liaising with professional colleges in Australia and exploring potential analysis of linked Pharmaceutical Benefits Scheme (PBS), Medicare Benefits Schedule, hospital and death data. The aims of the safety investigation were to assess the strength of current evidence for a causal association between antidepressant prescribing and youth suicide rates; international regulations on antidepressant use and risk minimisation in children and adolescents; the role of antidepressants in the treatment of psychiatric and developmental disorders in young Australians; and whether Australia has adequate risk minimisation measures. Young people may experience worsening depressive symptoms and/or the emergence of suicidal ideation regardless of whether they are taking antidepressants, noted the TGA. A review article by Whitely et al. published in July 2020 found that there was a trend for increased youth suicide rates in Australia over a 20-year period, and antidepressant dispensing for young people increased during the same period. A TGA analysis of PBS dispensing data found an increase in the antidepressant prescribing rate for young people between 2013 and 2019, and increased suicide rates in young people. The Australian Advisory Committee on Medicines (ACM) advised that there is an important role for use of antidepressants in children and adolescents with moderate-to-severe depression and noted that although psychological therapy is recommended as first-line treatment, access to publicly funded psychological therapy for young people is limited in Australia. The ACM recommended development of further guidance to support safe prescribing of antidepressants in young people, when appropriate. While the increasing use of antidepressants is a concern, the strength of the current evidence is insufficient to conclude that a casual relationship exists between prescribing of antidepressants and increasing rates of youth suicide. Analysis of PBS data and suicide data is required to further explore an potential causal relationship, said the TGA. This work is expected to commence in early 2021, according to the TGA.