HealthDay News — There was no difference in suicide risk among children and adolescents treated with a single antidepressant, regardless of whether the medication was a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI), results of a large retrospective cohort study indicate.

Among 36,842 children who were new users of SSRI and SNRI antidepressant medications there was no evidence that the use of paroxetine, sertraline, citalopram, escitalopram or venlafaxine was associated with a greater risk of medically treated suicide attempts than fluoxetine, according to William O. Cooper, MD, MPH, of Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues.

However, suicide risk was elevated among those taking multiple antidepressants concomitantly, the researchers reported in Pediatrics.

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Previous studies have suggested a possible increased risk for suicidal behavior among children and adolescents treated with SSRIs and SNRIs antidepressants and have prompted concern about the risk associated with individual antidepressants.

So Cooper and colleagues analyzed data from 36,842 children aged 6 to 18 years who were enrolled in Tennessee Medicaid between 1995 and 2006 and were new users of sertraline, paroxetine, citalopram, escitalopram, venlafaxine or fluoxetine. Medicaid files, vital records, and medical record review were used to identify and confirm medically treated suicide attempts.

The researchers identified 419 medically treated suicide attempts with explicit or inferred attempt to die confirmed through medical record review, including four completed suicides.

For the study drugs, the rate of confirmed suicide attempts ranged from 24.0 per 1,000 person-years to 29.1 per 1,000 person-years. Compared with current users of fluoxetine, the adjusted rate of suicide attempts did not differ significantly among current users of SSRI and SNRI antidepressants.

There was an increased risk for suicide attempt among users of multiple antidepressants concomitantly. This “likely reflects the increased severity of depression for these individuals rather than a drug effect,” the researchers noted.

Previous studies have raised concern about the risk of suicidality among patients taking venlafaxine specifically. The current study findings “suggest that we can rule out potential absolute excess risk of 13 per 1,000 person years for venlafaxine compared with fluoxetine,” according to the researchers.

A higher proportion of venlafaxine users in the study also had comorbid anxiety diagnoses and a greater proportion

filled prescriptions for anxiolytics in the year prior to the study, suggesting that anxiety may play a role in antidepressant associated suicide risk.

“In this population-based study of children recently initiating an antidepressant, there was no evidence that risk of suicide attempts differed for commonly prescribed SSRI and SNRI antidepressants,” the researchers concluded. “Use of any of the individual drugs studied would not be expected to increase risk for serious suicide attempts compared with the others.”


  1. Cooper WO. Pediatrics. 2014; doi:10.1542/peds.2013-0923.