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Antidepressants and Self Harm Risk in Children and Young Adults

Antidepressants and Self Harm Risk in Children and Young Adults

BCC Staff Note: This blog was first posted at Dr. Hodges’ site, Good Mood Bad Mood and is reposted at the BCC’s Grace & Truth blog site with Dr. Hodges’ permission. You can also read the original post here.

A recent article published in JAMA Internal medicine is a reminder that current antidepressant drugs are not free of side effects or risks.[i] Researchers found that individuals age 10 to 24 treated with higher than normal starting doses were twice has likely to have suicidal thinking as compared to those treated with placebo. (A pill that looked like but did not contain the active ingredient) In this same age group those treated with the higher starting doses were twice as likely to harm themselves.[ii] [iii]

This is very important information for lots of reasons. The first is that no one should think that the selective serotonin reuptake inhibitors such as Prozac, Zoloft, Celexa and Lexapro are as safe as taking Tylenol or a couple of aspirin. These are serious medicines that bring with them significant side effects. Patients who are offered these medicines should be asking their doctors to carefully inform them about the possible side effects.

Second, it is vitally important to be certain that the individual being treated is actually struggling with depression. This is a real problem today because since 1980 normal sadness has been turned into depression. Individuals who are struggling with normal grieving over loss do not have a disease. When they are treated with medication that is meant for a disease they will often simply be sad and then have the side effects of the medicine.

Third, it is important to note that younger individuals seem to have more trouble with this side effect of the SSRI antidepressant than older ones. As the researchers noted, “…the efficacy of antidepressant therapy for youth seems to be modest.” With that being said, taking medicine that has significant side effects and risks should be a last resort, not the first thing we reach for.

In Good Mood Bad Mood, I outline the research that deals with the importance of dealing with people grieving over loss differently than with those who cannot tell us why they are sad.[iv] The latter has been described for years as disordered sadness and used to be the one of the main criteria for making a diagnosis of depression.

Up to 90% of individuals who carry the label of depression today can tell us when it started and what they lost. They are far more likely to be struggling with normal sadness than a disease.  And at the same time, it appears that that nearly 90% of people who take the currently available antidepressant do not benefit from them any more than they would from taking a placebo pill.[v]

The first principle of medicine that all physicians must learn is “first do no harm.” Few of us in medicine would be satisfied with just leaving it at that. I would say that most of us in medicine are always looking for better ways to help and yes, to cure. But, the benefit of taking medicine must be worth the risk.

When we add in the significant problem of side effects, most of these strugglers would probably do better just talking to anyone with training, compassion and skill. And, many could profit greatly from counseling from the Bible that deals with how God wants to love and help them in the middle of their sorrow.

[i]The JAMA Network Journals. “High doses of antidepressants appear to increase risk of self-harm in children young adult.” Science Daily, 28 April 2014. <>.

[ii]Matthew Miller, Sonja A. Swanson, Deborah Azrael, Virginia Pate, Til Stürmer. “Antidepressant Dose, Age, and the Risk of Deliberate Self-harm.” JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2014.1053

[iii]David A. Brent, Robert Gibbons. “Initial Dose of Antidepressant and Suicidal Behavior in Youth.” JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2013.14016

[iv]Charles Hodges, Good Mood Bad Mood, Shepherd Press, Chapter 5.

[v]Ibid., 49.

This entry was posted in Cutting and Self-Harm, Depression, Medication, People in Need of Care, People Who Offer Care, People Who Train Caregivers and tagged , , , . Bookmark the permalink.
  • Dick Gautraud, MD

    While I agree with your conclusion, medication is at best a two edged sword particularly in young people, the study used “deliberate self-harm” as the outcome. I believe they have erroneously equated self harm with “risk of suicidal behavior” (their term).

    In my long years as an emergency physician almost all deliberate self harm was motivated (in my assessment and many others) by anger and was not an indicator, for example, that admission for suicide potential was necessary.

    I would offer that unless the study found increased suicide in the high dose group there is no finding of increased suicidality.

  • Debra R. Cornacchia

    This is interesting, as a crisis care advocates for teens who struggle with cutting, I have seen an increase in depression for those teens under 18 on anti depression medication. Self-injury is fueled by anger, shame and depression.Can medication increase the desire to self harm? I think more research needs to be done on this before we draw any conclusions.

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