SSRIs May Increase the Risk of Violent Behavior in Young People

Selective serotonin reuptake inhibitors, or SSRIs, are among the most commonly prescribed antidepressants. These drugs are not generally used in adolescents and young adults as several studies have suggested that SSRIs increase the risk of suicidal ideation in these age groups, but not in adults. SSRIs are also believed by some to cause violent behavior, particularly in adolescents and young adults, although the data on this is much more inconclusive. Therefore, one group of researchers in Sweden designed a study to try and determine a possible correlation between SSRI use and violence in adolescents. The researchers used records available from the Swedish Prescribed Drug Register to identify 856,493 patients over the age of 15 who had been prescribed SSRIs in the period between January 1, 2006 and December 31, 2009. The researchers then examined the arrest records of these patients and compared individual patient records when they were on SSRI treatment to when they were not on an SSRI treatment.

Of the entire patient population studied, 9.9% were between the ages of 15 and 24, and these individuals were considered adolescents or young adults. Upon examining the arrest and conviction records of this population, it was determined that this group was more likely to be convicted of a violent crime while on SSRI treatment, although only low doses of SSRIs produced this result. Patients in this age group on moderate or high doses of SSRIs and patients in other age groups on any dose of SSRI did not show a significant increase in violent crime. Within the 15 to 24 age group, the use of medications that could serve as an alternative to SSRIs, such as venlafaxine, was also associated with an increase in violent crime. The study could not determine the cause of this association, and recommended that further studies should be conducted to corroborate their findings.

Given their potential to increase suicidal ideation and possibly the rate of violent crime among adolescents and young adults, is there any case for using SSRIs in adolescents? Would giving a young person large doses of an SSRI really be the most effective treatment option?  With this study’s suggestion that other antidepressant treatments may also increase violent behavior in adolescents, is it possible that antidepressant medication as a whole may not be appropriate for adolescents or young adults?

 

 

Molero Y, Lichtenstein P, Zetterqvist J. Selective serotonin reuptake inhibitors and violent crime: a cohort study. PLoS Med. DOI: 10.1371/journal.pmed.1001875 (published 15 September 2015)

3 thoughts on “SSRIs May Increase the Risk of Violent Behavior in Young People”

  1. There are surely a lot of factors involved in this association between SSRI use and arrest records in youth populations. I appreciate that this article articulates that this is simply an association, that more research has to be done, and that there may be many confounding factors. I also thought the study was strengthened by using a “within-individual” design. One possible confounding factor/ flaw may be the fact that just because a patient is prescribed a medication does not mean they actually take it and take it properly.
    I’d be curious to see if large doses of SSRIs are also associated with suicidal ideation. If not, it may be a better treatment option to give younger people larger doses. In any case, adolescents and young adults with depression need some kind of treatment nonetheless. With all mediations, there are going to be some potential adverse effects that need to be weighed against the benefits.

  2. I believe that this article in and of itself does not offer sufficient evidence to stop prescribing or dispensing SSRIs to adolescents and young adults on the premise of increasing violent behavior. For one thing, both a diagnoses of depression and committing violent crimes have many underlying and overlapping causal factors. Attempting to separate which string of the underwoven fabric contributes to depression and which contributes to violent thoughts or behaviors is, in my opinion, an exercise which would be both pedantic and futile. Unless there is a clear and causal relationship between SSRI regimens and violent behavior, I believe that SSRIs should continue to be prescribed to young people. SSRIs are the first line of anti-depressant treatment for a reason – they are effective treatments for many patients without causing many adverse effects. Removing them from the line of treatment for an entire demographic based on the associative findings of a single paper is, I believe, a step backwards in the treatment of mental illness.

  3. One thought I have about this article is comparing the behavior of these young adults on SSRIs to other young adults not receiving any treatment. Is it possible that violent behavior is just more likely in young adults and adolescents? Additionally, I would like to compare their behavior to young adults with untreated depression. I think its important to determine whether or not the behavior can be directly attributed to the use of SSRIs. Certainly more studies need to be conducted before prescribing practice is affected.

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