|New NIMH Research Strives to Understand How
Antidepressants May Be Associated with Suicidal Thoughts and
The National Institute of Mental Health (NIMH), part of the National
Institutes of Health, is funding five new research projects that
will shed light on antidepressant medications, notably selective
serotonin reuptake inhibitors (SSRIs), and their association with
suicidal thoughts and actions (suicidality).
Studies have shown that most individuals suffering from moderate
and severe depression, even those with suicidal thoughts, can substantially
benefit from antidepressant medication treatment. However, use
in children and adolescents has become controversial. In 2005,
the U.S. Food and Drug Administration (FDA) adopted a “black
box” warning — the most serious type of warning in prescription
drug labeling — for all SSRIs. The notice alerts doctors
and patients of the potential for SSRIs to prompt suicidal thinking
in children and adolescents, and urges diligent clinical monitoring
of individuals of all ages taking the medications. This can be
particularly challenging because it is difficult for patients,
their family members and practitioners to determine whether suicidal
thoughts may be related to the depression, the medication, or both.
“These new, multi-year projects will clarify the connection between
SSRI use and suicidality,” said NIMH Director Thomas Insel, M.D. “They
will help determine why and how SSRIs may trigger suicidal thinking
and behavior in some people but not others, and may lead to new
tools that will help us screen for those who are most vulnerable,” he
The projects are listed below.
- Kelly Kelleher, M.D., of the Columbus Children’s Hospital and
the Ohio State University, and Joel Greenhouse, PhD., of Carnegie
Mellon University, will build on data initially collected by
the FDA to analyze antidepressant medication use and suicidal
behavior among youth, adults and older adults. Dr. Kelleher will
use new and more sensitive statistical approaches to integrate
data from numerous other studies — both randomized and
non-experimental — to paint a more complete picture of
the relationship between antidepressant medication use and suicidal
thoughts or actions.
- Marcia Valenstein, M.D., of the University of Michigan, will
examine the records of 994,000 individuals from the U.S. Department
of Veterans Affairs National Registry for Depression, Medicare
records and the National
Death Index to determine what relationships exist between
the use of antidepressants and suicide attempts and/or deaths,
and use of any concurrent medications or treatments. The study
will help determine the relative effectiveness of different depression
treatments in reducing suicidal thoughts and actions.
- Wayne Goodman, M.D., of the University of Florida, will investigate
if and how SSRIs may induce in some young people an “activation
syndrome” — a set of symptoms such as irritability, agitation
and mood swings that may lead to suicidal thoughts or actions.
He will study this potential syndrome among pediatric patients
diagnosed with obsessive compulsive disorder. By focusing on
patients with a disorder that is less likely to be associated
with suicidality, he will be able to better assess whether SSRIs
are related to an actual activation syndrome, and whether suicidality
is a component of the syndrome. The study will improve recognition
and understanding of the syndrome, and help identify interventions
that will reduce the risk of suicide.
- Sebastian Schneeweiss, M.D., of Brigham and Women’s Hospital,
will assess critical issues surrounding the safety of antidepressant
medication use by comparing several large datasets of SSRI users.
He will measure rates of suicidality; identify social and demographic
factors that may be associated with SSRI use and suicidality;
and examine the impact of FDA actions on use of SSRIs. The study
aims to develop and better target prescribing and risk management
- Prudence Winslow Fisher, PhD., of the New York State Psychiatric
Institute, will develop better and more reliable ways of monitoring
for adverse reactions to the use of antidepressant medication.
The study’s long-term goal is to construct a standardized computer
tool for adolescents and parents that could be used to screen
for suicidality associated with the use of antidepressant medications.
In addition to these new projects, NIMH is currently funding other
studies that aim to find the best treatments for individuals suffering
from depression, and reduce or prevent suicidal behavior. Studies
focused on youth depression and suicidal behavior include the Treatment
for Adolescents with Depression study, the Treatment
of SSRI-Resistant Depression in Adolescents, and the Treatment
of Adolescent Suicide Attempters.
The National Institute of Mental Health (NIMH) mission is
to reduce the burden of mental and behavioral disorders through
research on mind, brain, and behavior. More information is available
at the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.