Review ArticlePractice

Approach to adolescent suicide prevention

Marcia Kostenuik and Mohana Ratnapalan
Canadian Family Physician August 2010; 56 (8) 755-760;

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  • The following should be considered when prescribing antidepressants for youth:

    • Inform the patient and family about the risks and benefits of selective serotonin reuptake inhibitors

    • Be sure to inform family members specifically about the risk of suicidal behaviour

    • Therapy should be started at a low dose (equivalent of 5–10 mg of fluoxetine)

    • If needed, dose increases should be considered every 2 weeks

    • The Food and Drug Administration recommends weekly monitoring for the first 4 weeks of antidepressant therapy and after any dose adjustment

    • Adapted from Cheung et al.13

  • The following are some common warning signs of adolescent suicide:

    • Sudden change in behaviour

    • Apathy

    • Withdrawal

    • Change in eating patterns

    • Unusual preoccupation with death or dying

    • The giving away of valued personal possessions

    • Signs of depression

    • Moodiness

    • Hopelessness

    • Adapted from the Canadian Mental Health Association.33

    • For mental health resources in your area: www.ementalhealth.ca

    • For social services available in your area: dial 211 on your telephone (in the greater Toronto area in Ontario and Edmonton and Calgary in Alberta)

    • Mental Health Service Information Ontario (MHSIO): www.mhsio.on.ca or 866 531-2600 (available 24 hours)

    • Canadian Mental Health Association (for services and education): www.cmha.ca or 613 745-7750

    • Kids Help Phone (hot-line crisis services): 800 668-6868 or www.kidshelpphone.ca

    • Mind Your Mind (resources and support for youth): www.mindyourmind.ca

    • Greenberger D, Padesky C. Mind Over Mood: Change How You Feel by Changing the Way You Think (cognitive behavioural therapy workbook for patients and physicians)

    • Children’s Hospital of Eastern Ontario (academic pediatric hospital affiliated with the University of Ottawa) mental health intake services: 866 737-2496

    • Guidelines for Adolescent Depression—Primary Care (GLAD-PC): www.glad-pc.org

    • Collaborative Mental Health Network (mentoring program for physicians through the Ontario College of Family Physicians): www.cfpc.ca/English/OCFP/CME/CMHCN/default.asp?s=1

    • Diagnostic criteria for mental illness: Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision

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Approach to adolescent suicide prevention
Marcia Kostenuik, Mohana Ratnapalan
Canadian Family Physician Aug 2010, 56 (8) 755-760;
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