Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital-Huddinge, M59, 141 86, Stockholm, Sweden,
Paediatr Drugs. 2014 Apr;16(2):115-22. doi: 10.1007/s40272-013-0061-1.
Government agencies have issued warnings about the use of antidepressant medications in children, adolescents, and young adults since 2003. The statements warn that such medications may cause de novo 'suicidality' in some people. This review explores the data on the treatment of depression that led to these warnings and subsequent data that are relevant to the warnings. It also addresses the effectiveness of antidepressant treatment in general and the relationship of suicide rates to antidepressant treatment. It concludes that the decisions for the 'black box' warnings were based on biased data and invalid assumptions. Furthermore, the decisions were unsupported by the observational data regarding suicide in young people that existed in 2003. The following recommendations would seem to follow from these observations. First, drug authorities should re-evaluate the basis for their imposed warnings on antidepressant medicines, and analyze the actual public health consequences the warnings have had. In the absence of substantial evidence supporting the warnings, they should be removed. Second, physicians and other providers with prescription privileges should continue to be educated regarding the importance of aggressively treating depression in young people, using antidepressants when indicated. Third, physicians and other professionals who treat depressed young people must always be aware of the risk of suicide (albeit quite low) and observe them closely for any signs of increased risk of suicide. This is necessary regardless of the type of treatment being provided.
自 2003 年以来，政府机构发布了有关在儿童、青少年和年轻成年人中使用抗抑郁药物的警告。这些声明警告说，此类药物可能会导致某些人出现新的“自杀意念”。本综述探讨了导致这些警告的抑郁症治疗数据以及随后与这些警告相关的数据。它还讨论了抗抑郁治疗的总体效果以及自杀率与抗抑郁治疗的关系。它得出的结论是，“黑框”警告的决定是基于有偏见的数据和无效的假设。此外，这些决定也没有得到 2003 年已经存在的有关年轻人自杀的观察数据的支持。从这些观察中似乎可以得出以下建议。首先，药物监管机构应重新评估其对抗抑郁药物实施警告的依据，并分析这些警告对公众健康的实际影响。在没有充分证据支持这些警告的情况下，应将其撤销。其次，具有处方权的医生和其他提供者应继续接受有关积极治疗年轻人抑郁症的教育，在需要时使用抗抑郁药。第三，治疗抑郁的年轻患者的医生和其他专业人员必须始终意识到自杀的风险（尽管很低），并密切观察他们是否有自杀风险增加的迹象。无论提供何种类型的治疗，这都是必要的。
