In my clinical work, I often encounter parents who are concerned about putting their kids on psychiatric medications. In the case of anti-depressants, such concerns are grounded on a large literature that has linked anti-depressant use by adolescents with a mild increase in the risk of suicide. Contrary to some common explanations, it is not simply that kids who are more likely to attempt suicide (those who are clinically depressed) are also more likely to receive anti-depressant medication, since the increased risk for suicide has been observed during randomized clinical trials (RTCs). That is, in many RTCs, those clinically depressed kids who are randomly assigned to a medication have been found to be more likely to attempt suicide than their equally depressed peers who happened to be randomly assigned to a placebo. It is indeed the exposure to the active treatment that leads to the increase risk for suicide. Although there are some questions still being debated (e.g., effect of age, type of medication, type of disorder, etc), there is a general agreement that anti-depressant medication use during adolescence leads to a mild but real increase in the risk for suicide. The more pertinent questions are 1) why is this the case? And more importantly… 2) what are the implications for clinical practice ? I’m going to touch on these two questions during the next few weeks. Today, I want to discuss a recent article published in the Journal Pediatrics that examined the risk of suicide among adolescents taking anti-depressant medications in Canada. The main goal of the study was to examine whether the kind of medication (brand or type) resulted in different levels of risk. In other words, are all medications created equal in terms of their effects on suicide risk for adolescents? Read More