Selective serotonin reuptake inhibitors and the risk for suicidality in adolescents: an update

Abstract

The controversy regarding Selective Serotonin Reuptake Inhibitors (SSRIs) and suicidality dates back to the early 1990s. The first agent reported to be associated with suicidality was fluoxotine. In 2003, the British Medicines and Healthcare Products Regulatory Agency (MHRA) warned about possible risk of suicidality in children and adolescents treated with paroxetine for Major Depressive Disorder (MDD). This warning was soon extended to all the SSRIs as well as venlafaxine and mirtazapine. Similarly, the United States Food and Drug Administration (FDA) issued a "black box warning" on these medications in 2004. We address the debate concerning this warning and its clinical implications and review the latest contributions to the literature.