SSRI's help increase levels of serotonin in the brain. Serotonin is a neurotransmitter that is widely believed to play a key role in regulating mood. Although the first SSRI's hit the market in 1987, researchers still don't know how they work.
And since suicidal people are generally not allowed to participate in clinical trials of the drugs, it is quite difficult to judge exactly how or when antidepressants might affect a suicidal person.
"These studies don't take people with severe depression or those who are acutely suicidal. Since FDA trials involve half the group taking placebo it is unlikely we will ever conduct a definitive trial of an antidepressant in acutely suicidal people," said Dr. P. Murali Doraiswamy, professor of psychiatry at the Duke University Medical Center in Durham, N.C.
In other words, it would be unethical to give a placebo to someone who is in danger of killing themselves. So doctors have a hard time proving antidepressants hurt or help.
In addition, DePaulo pointed out that drug trials, which rarely last more than a year and have a few thousand people at best, is a hard model to track suicide risk since it is such a rare event.
From experience and a few studies, psychiatrists say antidepressants do help suicidal people.
"We're able to save a lot of lives with medications," Dr. Andrew Leuchter, a psychiatry professor at the University of California Los Angeles.
Yet doctors do know that "Starting and stopping medication is a time when things are a little uncertain," DePaulo said. He pointed out that while some studies have shown increased suicide ideation in young people when starting medication; other studies have shown both a jump in positive feelings and negative feelings after stopping antidepressants.
In terms of pharmacology, "it takes two months to really know whether someone's going to respond or not," DePaulo said.
"It's the decision to stop that may be as important the pharmacology itself," said DePaulo.
In many cases, DePaulo said people who have given up hope in life will then also give up treatment -- including doctor's visits and antidepressants.
"Sometimes, people who are treated for depression feel hopeless and they may throw up their hands and say 'what's the use?' They may stop going to therapy, and they may stop taking medicines," he said.
Unlike Koenig, the public statements by friends and families of McQueen and Osmond's son, leave few details about a struggle with depression before suicide.
However the scant details share a common theme of those who take their life: a recent, very personal blow.
"The biggest predictors of suicide in young adults are persistent depression symptoms and life stressors such as family conflict, relationship problems rather than a side effect of the medication," said Doraiswamy.
"My family and I are devastated and in deep shock by the tragic loss of our dear Michael and ask that everyone respect our privacy during this difficult time," Osmond said in the statement following Blosil's death on Feb. 26.
InTouch Weekly reports that Blosil jumped from the 15th floor apartment he shared with roommate Sean Srnik. Blosil was enrolled at the Fashion Institute of Design & Merchandising in Los Angeles.