Why Increased Suicidal Ideation?

One of my doctors told me about a new anti-depressant called Viibryd (vilazodone HCI). I went onto their site to check it out and at the top of their professional site it provided a safety information state that went as follows:

“Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of VIIBRYD or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Important Safety Information continued below.”

The question popped into my head, “Why would anti-depressants increase the likelihood of suicide?” And then, “And why would this occur only in children/adolescents/young adults?”

I don’t have a scientific answer to that, but let me throw out a hypothesis. Suicide and suicidal thinking oftentimes reach their peak during recovery. That is, when an individual is severely depressed they oftentimes lack even the energy to commit suicide AND they oftentimes feel that there is some light at the end of the tunnel, somewhere. When an individual begins to recover they gain the capacity for committing suicide BUT perhaps more importantly, they experience relapses – e.g. there is no “straight up out of depression” road, one invariably experiences good days and bad days – and it is at these times of relapse that folks oftentimes become suicidal. Before there was light – but now they have found the light and the light has been extinguished and they are dashed back into depression.

So why would this increase the suicidal ideation and behavior in children/adolescents but not in adults? Simple – younger individuals are still developing their ability for various types of mature thinking (this is especially true of children) and as such they may see a situation as hopeless whereas an adult may be able to understand that there is yet hope – thinking more abstractly about their situation.

I’m sure there are also numerous other variables involved – including brain chemistry and the ongoing development of the body/brain at these ages – but I ponder if this could explain a significant amount of the difference of response between children and adults.

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