WARNING SIGNS:

Depression and Suicide

According to the American Academy of Pediatrics (AAP) revised clinical report, "Suicide and Suicide Attempts in Adolescents," more than 90 percent of adolescent suicide victims met criteria for a psychiatric disorder before their death, increasing the importance of timely evaluation and referral of teenage patients when mental illness is suspected. The report includes a new section on antidepressant medications and suicide. Since the FDA directed pharmaceutical companies to include a black-box warning on all antidepressant medications in 2004, there has been a decrease in prescriptions. Concern has been expressed that this reduction of antidepressant prescribing may be related to an 18 percent increase in U.S. youth suicides from 2003 to 2004 after a decade of steady declines. Regardless of whether the use of antidepressant medications changes the risk of suicide, depression is an important suicide risk factor, and careful monitoring of adolescents’ mental health and behavioral status is critically important, particularly when initiating or changing treatment. Warning signs for family members to contact the physician include:

New or more frequent thoughts of wanting to die

• Self-destructive behavior
• Signs of increased anxiety/panic/agitation, aggressiveness, impulsivity, insomnia or irritability
• New or more involuntary restlessness, such as pacing or fidgeting
• Extreme degree of elation or energy
• Fast, driven speech
• New onset of unrealistic plans or goals

Additional risk factors for suicide include intoxication, agitation, and a recent stressful life event. Teens are also at a much greater risk than adults of being influenced by the media, and may imitate suicidal behavior seen on television.