Which class of antidepressants carries a black box warning for increased suicidal ideation?

• A. TCAs
• B. SSRIs
• C. SNRIs
• D. RIMAs

Answer: (B)

The main point is that antidepressants can trigger or worsen suicidal thoughts in younger people, especially when treatment is started or the dose is changed. The class most closely associated with a black box warning for this risk is the selective serotonin reuptake inhibitors. This warning arose from data showing a small but real increase in suicidal ideation and behavior among children, adolescents, and young adults during early treatment or dose adjustments, so clinicians are advised to monitor closely, start at low doses, and adjust gradually. While other antidepressant classes have important safety considerations (such as different side effects or interactions), the prominent safety alert about suicidality in youth is tied to the SSRI class, making it the best choice here.