[Antidepressants and suicidality: primum non nocere]

Since 2003, international health regulatory agencies warned about the use of antidepressants in children and adolescents. These warnings were based upon reports from clinical trials in which there was an increased risk of "suicidality" with these drugs. In 2007, this warning was extended to young adults. Given the widespread use of antidepressants, these warnings have been very controversial. Numerous clinical trials have been made to investigate this subject, finding some difficulties: 1) the lack of consistency of the term "suicidality", 2) the complexity of the differential diagnoses of children depression, given the high rates of bipolarity in this population, 3) the difference between "activation syndrome" and mixed states induced by antidepressants, both with high suicide risk, 4) the methodological difficulties to evaluate suicide.

In treatment with antidepressants there are some reports about an increment in suicide attempts (most at the initial phase of treatment). There is no evidence of an increase of completed suicide rates. It is of utmost importance to make a proper diagnose and a close follow up of depressed patients even if they do not receive pharmacological treatment.