From the Guidelines
The most important question to ask during a one-week telephone follow-up after starting SSRI treatment is "Have you had any suicidal thoughts?" This question directly addresses the most serious potential adverse effect of SSRIs, particularly during the initial treatment period, as highlighted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. SSRIs carry an FDA black box warning regarding increased risk of suicidal thoughts and behaviors, especially in young adults and adolescents during the first few weeks of treatment, with pooled absolute rates for suicidal ideation reported to be 1% for youths treated with an antidepressant and 0.2% for youths treated with a placebo 1. While other questions about symptom improvement, general adverse effects, and panic attacks are important for comprehensive care, assessing suicidal ideation is critical for patient safety and should be prioritized during early follow-up. Key points to consider in this context include:
- The potential for suicidal thinking and behavior is a significant concern with SSRI use, particularly in the first months of treatment and following dosage adjustments 1.
- Close monitoring for suicidality is recommended by the FDA, especially in the first months of treatment and following dosage adjustments 1.
- If suicidal thoughts are reported, immediate intervention is necessary, which may include more frequent monitoring, adjusting the treatment plan, or arranging emergency psychiatric evaluation depending on the severity of the ideation. Other considerations in the management of patients on SSRIs include:
- Monitoring for behavioral activation/agitation, which may occur early in SSRI treatment, with dose increases, or with concomitant administration of drugs that inhibit the metabolism of SSRIs 1.
- Being aware of the potential for rare but serious adverse effects such as mania/hypomania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome 1. However, the question of suicidal thoughts takes precedence due to its immediate impact on patient safety and the necessity for prompt intervention.
From the FDA Drug Label
WARNING: SUICIDAL THOUGHTS AND BEHAVIORS 5.1 Suicidal Thoughts and Behaviors in Pediatric and Young Adult Patients
The most important question to ask is: “Have you had any suicidal thoughts?” 2
From the Research
Most Important Question to Ask
When following up with a patient one week after starting SSRI treatment, the most important question to ask is related to their safety and potential adverse effects. Considering the potential risks associated with SSRI treatment, particularly in the initial stages, it is crucial to monitor the patient's mental state closely.
- The question "Have you had any suicidal thoughts?" is particularly relevant in this context, as studies have shown that SSRIs may increase the risk of suicidal behavior, especially in children and adolescents 3.
- While the study found that SSRI treatment may reduce the risk of suicidal behavior over time, the initial period after treatment initiation is critical, and close monitoring is necessary.
- Other questions, such as "Have you noticed any improvement in your anxiety symptoms?" or "Have you experienced any panic attacks?" are also important, but they are secondary to assessing the patient's safety and potential adverse effects.
- The question "Are you experiencing any new adverse effects?" is also crucial, as it can help identify any potential issues related to the treatment and ensure the patient's safety 4, 5, 6, 7.