Although a recent study from the United Kingdom found no relationship between the use of SSRIs in adolescents and self-harm events, nevertheless, other studies have shown that as high as 15% of patients who are prescribed antidepressants can experience emerging or worsening suicidal thinking. A study in Acta Psychiatr Scand 2008 Apr; 117:271 was able to determine which patients may be more at risk for developing suicidal thinking on antidepressants. This study was reviewed in Journal Watch Psychiatry, volume 14, Number 6. EEGs were performed on 82 patients before treatment and after treatment with a variety of different SSRIs and Effexor. Eight patients who had no prior suicidal thinking developed suicidal thinking four weeks after treatment. These patients showed significant differences in the results of their EEG as compared to the patients whose suicidal thinking stayed the same or decreased. “This difference remained significant after adjustments for sex, baseline suicidal ideation, specific antidepressant mediation taken, and interactions among these features”. The results of this study were interesting but the study was funded a manufacturer of EEG equipment, thereby, raising the possibility of bias in the study. This study does, nevertheless, raise interesting questions. Will at some point in the future a more quantitative measurement of vulnerability to worsening suicidal thinking in patients receiving antidepressant medication emerge that is practical, convenient, and inexpensive enough to be used in a busy clinical practice? And, are there clinical techniques that are currently available that can predict a negative response to antidepressant medication?
The Bottom Line: The results of this study suggest that there may be a subgroup of patients who are at risk for the development of emerging or worsening suicidal thinking when prescribed antidepressant medications whose vulnerability may be discovered by EEG.
Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com