Clinical evidence of the use of pharmacological treatment compared to psychotherapy in the occurrence of suicidal ideation or suicide among adolescents and children

Abstract

Depression among children and adolescents has become increasingly more recognized in the medical setting. Up until recently clinicians believed they were successfully and safely treating their patient’s depression with a variety of antidepressant medication. Since the realization of the risk of treating with tricyclic antidepressant medication, selective serotonin reuptake inhibitors have been the first line of treatment. However, in 2004 the FDA labeled these medications with a black box warning stating there was a possible increase in the risk of suicide when using the medications among young patients. Since that time medical providers have been left to shift through the evidence in medical literature to ascertain the safest treatment options.

Methodology: The purpose of this paper was to perform a systematic review of the literature and examine the cumulative data addressing the issue, in the end being able to present a clearer picture to providers. Articles used included children and adolescents, ranging from infancy to 18 years of age, who meet the Diagnostic and Statistical Manuel of Mental Disorders, Fourth Edition criteria of major depressive disorder from 1971-2004. Variable included psychotherapy, pharmacotherapy, and the combination of both, and suicide.

Results: Twenty six articles matched the criteria and were reviewed using evidence-based methods. After close analysis of the presented data, it appeared there was no direct evidence linking antidepressant medications and an increase risk in suicide regardless of whether subjects were taking the medication alone or in combination with psychotherapy. The safest and best outcome was combination therapy.

Conclusion: The most effective and safe treatment option for young patients with depression was a combination of cognitive based therapy and fluoxetine.