Citation

Apter A, Lipschitz A, Fong R, Carpenter DJ, Krulewicz S, Davies JT, Wilkinson C, Perera P, Metz A. J. Child Adolesc. Psychopharmacol. 2006; 16(1-2): 77-90.

Affiliation

Schneiders Childrens Medical Center of Israel, Sackler School of Medicine, Petah Tikva, Israel.

Copyright

(Copyright © 2006, Mary Ann Liebert Publishers)

DOI

10.1089/cap.2006.16.77

PMID

16553530

Abstract

Objective: The aim of this study was to summarize results of a blinded review of potential suicidal events and analyses comparing incidence rates between paroxetine- and placebotreated pediatric patients. Method: One thousand one hundred ninety-one (1191) children and adolescents received paroxetine (n = 642) or placebo (n = 549) during placebo-controlled portions of all acute double-blind trials of paroxetine (n = 5). An expert panel blindly reviewed and categorized all identified cases detected by electronic and manual search of adverse events (AEs), serious AEs, and selected cases as suicidal or nonsuicidal behavior. Incidence rates were calculated for suicide-related events and for rating scale items assessing suicidality. Results: Suicide-related events occurred more often in paroxetine (22 of 642, 3.4%) than placebo groups (5 of 549, 0.9%); odds ratio (OR) 3.86 (95% CI 1.45, 10.26; p = 0.003). All suiciderelated events occurred in adolescents of at least 12 years, except for 1 of 156 paroxetinetreated children. All suicide attempts occurred in major depressive disorder (MDD); few suicide-related events occurred in patients with a primary anxiety disorder. Suicide item analyses did not reveal significant differences between paroxetine and placebo. Conclusions: Adolescents treated with paroxetine showed an increased risk of suiciderelated events. Suicidality rating scales did not show this risk difference. The presence of uncontrolled suicide risk factors, the relatively low incidence of these events, and their predominance in adolescents with MDD make it difficult to identify a single cause for suicidality in these pediatric patients.