Author’s reply to Dubicka and colleagues and Stone

Dubicka and colleagues say that we are likely to harm young people when we point out that antidepressants increase the risk of suicide.1 2 They consider it harmful that some young people will not start taking antidepressants because they think that these drugs do more harm than good. What is harmful is when these authors and other psychiatrists claim that these drugs protect against suicide despite the solid evidence we have to the contrary and the clear warnings from drug agencies. Dubicka and colleagues say that “It is well established that the undertreatment of depression in children and young people is linked to suicide” and refer to an observational study. There are many such studies, but they are all flawed.3

These authors say that our statement that antidepressants doubled the risk of suicide in children and adolescents is incorrect, and they argue that there is a “hugely important difference” between suicides and suicidal behaviour. There isn’t. A suicide starts with a thought about suicide, which leads to preparations for suicide, a suicide attempt, and suicide. It should surprise no one that the risk factors for serious suicide attempts are similar to those for suicide.4 5

Their other arguments are also invalid. There is no need …