Successful Suicide in a Child: Depression-Related or Paroxetine-Induced?

K Aghakhani, S Soltani, N Farhidnia, F Fallah

744

Abstract

Background: Children and adolescents are prone to develop psychiatric problems after stressful life events. These problems need appropriate treatment because of negative consequences like disease-related suicide. Antidepressants (especially "Serotonin Selective Reuptake Inhibitors") are common treatments for psychiatric problems of children and adolescents; but different side effects, including drug-induced suicide, have been reported.

Case Report: In this article, we describe a nine-year-old girl who developed depression after parental divorce and was prescribed paroxetine. During pharmacotherapy, she had suicidal thoughts and several unsuccessful attempts which have been neglected and finally last attempt was successful. This report is an evidence for physicians to prescribe antidepressants cautiously with reasonable indication. As still there is no certain contraindication of using antidepressants in pediatric patients, importance of follow-ups and screening of suicide in pediatric patients during treatment with antidepressants seems essential.

Conclusion: This study discloses the magnitude of explaining the side effects of antidepressants to caregivers of children with psychiatric problems.

Keywords

Antidepressive Agents, Depression, Paroxetine, Suicide

Full Text:

PDF

References

Hjalmarsson L, Corcos M, Jeammet P. (Selective serotonin reuptake inhibitors in major depressive disorder in children and adolescents (ratio of benefits/risks)). Encephale. 2005;31:309-16.

Mikami K, Matsumoto H. Childhood and adolescent depression. Nihon Rinsho. 2007;65:1679-83.

Oldehinkel AJ, Ormel J. A longitudinal perspective on childhood adversities and onset risk of various psychiatric disorders. Eur Child Adolesc Psychiatry. 2015;24:641-50.

Hazell P. Depression in children and adolescents: complementary therapies. BMJ Clin Evid. 2015;2015. pii: 1008.

Cooper WO, Callahan ST, Shintani A, Fuchs DC, Shelton RC, Dudley JA, et al. Antidepressants and suicide attempts in children. Pediatrics. 2014;133:204-10.

Hammad TA. Laughren T, Racoosin JSuicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63:332-9.

McKeown RE, Cuffe SP, Schulz RM. US suicide rates by age group, 1970-2002: an examination of recent trends. Am J Public Health. 2006;96:1744-51.

Cousins L, Goodyer IM. Antidepressants and the adolescent brain. J Psychopharmacol. 2015;29:545-55.

Gallego JA, Rachamallu V, Yuen EY, Finkn S, Dugue LM, Kane JM. Predictors of suicide attempts in 3.322 patients with affective disorders and schizophrenia spectrum disorders. Psychiatry Res. 2015;228:791-6.

Wooltorton E. Paroxetine (Paxil, Seroxat): increased risk of suicide in pediatric patients. CAMJ. 2003;169:446.

Thomsen PH. The treatment of child and adolescent depression: a matter of concern? Acta Psychiatr Scand. 2007;115:169-70.

Wise J. Antidepressants may double risk of suicide and aggression in children, study finds. BMJ. 2016;352:i545.

Termorshuizen F, Palmen SJ, Heerdink ER. Suicide behavior before and after the start with antidepressants: a high persistent risk in the first month of treatment among the young. Int J Neuropsychopharmacol. 2015 Jul 18. pii: pyv081.

Giner L, Nicholas CM, Zalsman G, Oguendo MA. Selective serotonin reuptake inhibitors and the risk for suicidality in adolescents: an update. Int J Adolesc Med Health. 2005;17:211-20.

Morrison J, Schwartz TL. Adolescent angst or true intent? Suicidal behavior, risk, and neurobiological mechanisms in depressed children and teenagers taking antidepressants. Int J Emerg Ment Health. 2014;16:247-50.

Pozzi M, Radice S, Clementi E, Molteni M, Nobile M1. Antidepressants and, suicide and self-injury: Causal or casual association? Int J Psychiatry Clin Pract. 2016;20:47-51.

Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2012;11:CD004851.

Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry. 1990;147:207-10.

Scheeweiss S, Patrick AR, Solomon DH, Dormuth CR, Miller M, Mehta J, et al. Comparative safety of antidepressant agents for children and adolescents regarding suicidal acts. Pediatrics. 2010;125:876-88.

Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006;163:1898-904.

Olfson M, Shaffer D, Marcus SC, Greenberg T. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry. 2003;60:978-82.

Khan A, Khan S, Kolts R, Brown WA.Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry. 2003;160:790-2.

Busch SH, Frank RG, Leslie DL, Martin A, Rosenheck RA, Martin EG, et al. Antidepressants and suicide risk: how did specific information in FDA safety warnings affect treatment patterns? Psychiatr Serv. 2010;61:11-6. doi: 10.1176/appi.ps.61.1.11.

Cheung K, Aarts N, Noordam R, Van Blijderveen JC, Sturkenboom MC, Ruiter R.Antidepressant use and the risk of suicide: a population-based cohort study. J Affect Disord. 2015;174:479-84.

Jick H, Kaye JA, Jick SS.Antidepressants and the risk of suicidal behaviors. JAMA. 2004;292:338-43.

Kurdyak PA, Juurlink DN, Mamdani MM.The effect of antidepressant warnings on prescribing trends in Ontario, Canada. Am J Public Health. 2007;97:750-4.

Apter A, Lipschitz A, Fong R, Carpenter DJ, Krulewicz S, Davies JT, et al. Evaluation of suicidal thoughts and behaviors in children and adolescents taking paroxetine. J Child Adolesc Psychopharmacol. 2006;16(1-2):77-90.

U.S Food and Drug Administration (FDA). Concerns about Paxil for children. FDA Consum. 2003;37(5):4.

Waechter F. Paroxetine must not be given to patients under 18. BMJ. 2003;326(7402):1282.

Canadian Agency for Drugs and Technologies in Health. Second Generation Antidepressants for Pediatric Patients with Major Depressive Disorder and Anxiety Disorder: A Review of the Clinical Effectiveness and Safety (Rapid Response Report: Summary with Critical Appraisal). 2015.

Friedman RA. Antidepressants' Black-Box Warning — 10 Years Later. N Engl J Med. 2014;371:1666-8.

U.S Food and Drug Administration. FDA Statement on Recommendations of the Psychopharmacologic Drugs and Pediatric Advisory Committees. September 16, 2004. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108352.htm. Accessed 20 Feb 2016.

Dickerson Mayes S, Calhoun SL, Baweja R, Mahr F. Suicide ideation and attempts in children with psychiatric disorders and typical development. Crisis. 2015;36:55-60.

Valuck RJ, Libby AM, Sills MR, Giese AA, Allen RR. Antidepressant treatment and risk of suicide attempt by adolescents with major depressive disorder: a propensity-adjusted retrospective cohort study. CNS Drugs. 2004;18:1119-32.