Drop in drug use tied to suicides

The antidepressants carry a warning that they may cause suicidal thoughts in youths.

LOS ANGELES TIMES

A 22 percent drop in prescriptions for antidepressants for teens and children after government warnings about hazards of the drugs led to a sharp increase in suicides the following year, according to Chicago researchers.

The change in labeling in 2003 warned that use of the drugs could increase suicidal thoughts and behavior among young people, but the labeling seems to have had the opposite effect, according to a report in the September issue of the American Journal of Psychiatry.

In the year after the change in labeling, the suicide rate rose 14 percent among those younger than 19, the largest increase since the government started collecting suicide statistics in 1979, according to biostatistician Robert D. Gibbons and his colleagues at the University of Illinois at Chicago.

A similar drop in prescriptions in the Netherlands led to a 49 percent increase in youth suicides over a two-year period, the team reported.

They estimated that every 20 percent drop in antidepressant use among all ages in the United States would lead to a nearly 10 percent increase in suicides, an additional 3,040 deaths per year.

Research shortcoming

Gibbons’ data is “compelling,” Dr. James F. Leckman and Dr. Robert A. King of the Yale University School of Medicine wrote in an editorial accompanying the paper. Unfortunately, they said, Gibbons did not examine data from the previous decade to determine whether the increasing use of antidepressants was associated with a decline in suicides.

Dr. Thomas R. Insel, director of the National Institute of Mental Health, which funded the research, told the Washington Post, “We may have inadvertently created a problem by putting a ‘black box’ warning on medications that were useful. If the drugs were doing more harm than good, then the reduction in prescription rates should mean the risk of suicide should go way down, and it hasn’t gone down at all — it has gone up.”

Insel speculated that the drugs might increase suicidal thoughts in only some subgroups of patients, and that the negative effects in those groups are outweighed by the drugs’ positive benefits. He said researchers need to find ways to identify those who might be harmed by the drugs.

The drugs involved are called selective serotonin reuptake inhibitors or SSRIs, and they include Prozac, Zoloft and Paxil. About 16 million Americans take such drugs, according to the Mental Health Association, an advocacy group.

In 2003 and 2004, the Food and Drug Administration mandated the black box warning on them after research that indicated youths who took the drugs had an increase in suicidal thinking. The warning applied to patients under the age of 19.

Earlier this year, the warning was changed to include adults under the age of 25. Many experts had argued against such warnings, contending that it would cause many patients to abandon treatment that they desperately needed. At least 3 million Americans now do not receive any treatment for their depression.

Earlier results had foreshadowed the new findings. A year ago, Gibbons had reported on data from selected counties showing that suicide rates among children were highest in those with the lowest rate of SSRI prescriptions.