Do antidepressant treatments influence self-harm and aggressive behaviors?

Depression is a frequent disorder with a lifetime prevalence of 25% in women and 12% in men. General practitioners are responsible for the majority of antidepressant prescriptions in France. Antidepressant treatments decrease the suicide risk in adult patients with a depressive disorder or suicidal behavior. However, antidepressant treatment is not recommended in children or adolescents. Indeed, an increase risk of suicide has been reported in this population in previous studies, especially when antidepressant treatment is started. The treatment of adolescents with major depression or suicidal behaviors must be preferentially conducted by a specialized care team. A clinical evaluation must be done very carefully before the onset of antidepressant treatment. In some specific clinical contexts, antidepressant treatments may be used to decrease levels of impulsiveness and aggressiveness. However, the efficacy of antidepressant treatment on violent behaviors is still not clearly determined by scientific literature owing to lack of studies with a high level of evidence. In a few cases of patients, activation syndromes may appear at the beginning of antidepressant treatments, with akathisia, nervousness, anxiety, insomnia and agitation. These reactions may be risk factors for acting out. Alcohol, cocaine or benzodiazepines when concomitantly consumed with antidepressant treatment may increase the risk for acting out. Whenever benzodiazepines are needed in a patient with a high suicide risk, the dosage used must be enough to avoid desinhibition and to obtain anxiolytic and sedative effects.