Why Considering SSRI Alternatives For Your LGBTQ Child Or Teen Is Important

alternatives to ssris are important for lgbtq youth holistic pediatrics lgbtq youth depression lgbtq youth suicide ssri alternatives

LGBTQ youth experience higher rates of depression, anxiety, and suicide than their straight peers. A 2018 study examining mental health differences between siblings showed that the LGB sibling was significantly more likely to be in treatment for a mood disorder and use outpatient psychiatric services than their straight sibling. In the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health, 58% reported experiencing symptoms of depression. It’s safe to say that millions of LGBTQ youth are likely taking or considering taking antidepressants. And with 93% of transgender and non-binary youth saying they worry about being denied access to gender-affirming medical care due to state and national laws, it’s no surprise.

Increased Risk of Suicide In Youth Taking SSRIs

Suicide rates, suicidal ideation and attempts are all significantly higher for LGBTQ teens than for their straight peers. 1in 5 trans and non-binary teens attempted suicide in 2022. Starting around 20 years ago, researchers, clinicians, and the FDA started raising serious, life-threatening concerns about pediatric SSRI use and an increased incidence of suicide and suicidal ideation amongst children ages 6 to 17. In 2004, the emerging evidence-base compelled the FDA to begin requiring SSRI, MAOI, and Trycyclic Antidepressant labels to include a warning label about increased risk of suicide or suicidal ideation. The risk appears to highest in the first few months of a child or teen taking the antidepressant or during dosage changes. 

There are several factors that have dampened public awareness of this serious SSRI risk. Pharmaceutical company-funded studies and discrepancies between what is considered a suicide attempt, among other factors, have kept these critical findings from coming to greater light or further studied. As the parent or caregiver of an LGBTQ teen, particularly if your teenage identifies as transgender or non-binary, the potential increased risk of suicide with SSRI use is a considerable risk factor to weigh as you may this choice. Tragically, 14% of LGBTQ youth attempted suicide and 45% of LGBTQ youth “seriously considered suicide” in 2022. 

 

Long-term Side Effects of Antidepressants

We have very limited long-term data on the long-term antidepressant use simply due to how new they are. As such, the increased risks found in studies cited below are considered in contention. Additionally, pharmaceutical companies are the primary funders of pharmaceutical research and have historically not funded studies that might associate serious side effects with medications they manufacture and sell.

Importantly, the decision to start your child or teen on SSRIs for depression might feel like a very here-and-now decision. However, a 2017 study by the CDC’s National Center for Health Statistics found that 25% of antidepressant users have been taking them for a decade or more. 

Two major side effects potentially associated with long-term antidepressant use include:

  1. 14% higher risk of heart attack in people without pre existing heart conditions and a 33% higher risk of death
  2. Higher risk of developing dementia, particularly with Paxil use

 

SSRIs Effectiveness For Depression

A 2022 systematic umbrella review (meaning all available evidence) through December 2020 found that:

The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration."

This calls into question the central rationale for the prescription of SSRIs which explains the fairly low effectiveness rates of SSRIs for depression. One 2008 study showed that antidepressant use increased participants 9.6 points on a depression scale and placebo increased scores by 7.8 points. A negligible different. A decade later, a systematic review of 522 trials comprising 116,477 participants found people taking antidepressants to be only 25% more likely to improve than people taking placebo. Even psychiatrists and champions of SSRI and antidepressant use admit that their effectiveness isn’t what they’ve hoped it would be when the Serotonin Hypothesis came out nearly 50 years ago.

Perhaps it's time to investigate less risky alternatives to SSRIs for depression in LGBTQ youth.

 

SSRI Alternatives For Depression

Now that we’ve established the main risk factors to consider, let’s explore alternatives. Please note: if you are concerned about your child or teen’s mental health, involve your child’s pediatrician, act early, and seek the support of a mental health professional. The recommendations you’ll find here (coming soon!) are only to be used in conjunction with therapy or counseling from a trained mental health professional and not as a substitute for close and consistent mental healthcare.


References
Bränström R, Hatzenbuehler ML, Tinghög P, Pachankis JE. Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings. Eur J Epidemiol. 2018 Jun;33(6):591-599. doi: 10.1007/s10654-018-0411-y. Epub 2018 May 15. PMID: 29766438; PMCID: PMC5995973.

The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health https://www.thetrevorproject.org/survey-2022/

Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007 Jul;164(7):1035-43. doi: 10.1176/ajp.2007.164.7.1035. PMID: 17606655; PMCID: PMC3804920.

Effect of antidepressants on suicide risk in children and adolescents. https://www.uptodate.com/contents/effect-of-antidepressants-on-suicide-risk-in-children-and-adolescents

Maslej MM, Bolker BM, Russell MJ, Eaton K, Durisko Z, Hollon SD, Swanson GM, Thomson JA Jr, Mulsant BH, Andrews PW. The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis. Psychother Psychosom. 2017;86(5):268-282. doi: 10.1159/000477940. Epub 2017 Sep 14. PMID: 28903117.

Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019;179(8):1084–1093. doi:10.1001/jamainternmed.2019.0677

Pratt LA, Brody DJ, Gu Q. Antidepressant use among persons aged 12 and over: United States, 2011–2014. NCHS data brief, no 283. Hyattsville, MD: National Center for Health Statistics. 2017.

Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01661-0

Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLOS Medicine 5(2): e45. https://doi.org/10.1371/journal.pmed.0050045

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