BEYOND THE BLACK BOX WARNING: THE RISK OF SUICIDAL IDEATION FROM SSRIS AND THE DANGERS OF COGNITIVE POLYPHARMACY IN CHILDHOOD

Abstract

Introduction: Child and adolescent psychiatry faces an unprecedented epidemiological crisis in the post-pandemic period, characterized by a substantial increase in diagnoses of internalizing disorders (depression and anxiety) and cognitive deficit complaints. Objective: To synthesize and critically analyze current evidence on the efficacy and safety of Selective Serotonin Reuptake Inhibitors (SSRIs), emphasizing the risk of suicidal ideation, and to investigate the phenomenon of excessive use of psychostimulants and nootropics in polypharmacy regimens. Method: Integrative literature review guided by Evidence-Based Medicine, encompassing randomized clinical trials, meta-analyses, and guidelines published in the last decade in PubMed, PsycINFO, and SciELO databases. Results: SSRIs (notably fluoxetine and sertraline) demonstrate superior efficacy to placebo but require strict surveillance due to the FDA's black box warning for initial suicidal ideation. Simultaneously, there is a growing and often irrational prescription of psychostimulants and nootropics for academic performance optimization, lacking robust evidence for this purpose. Discussion: Infant metabolism alters the pharmacokinetics of these substances, requiring precise dosage adjustments. Polypharmacy combining SSRIs and stimulants elevates cardiovascular and psychiatric risks. Ethically, the pathologization of post-pandemic psychosocial suffering and the urgency of preserving the minor's assent are discussed. Conclusion: It is imperative to prioritize evidence-based psychotherapies as first-line treatments, institute rigorous monitoring protocols in the first weeks of SSRI use, and restrict the use of stimulants to validated clinical diagnoses of ADHD.