Thursday, September 06, 2007

Suicides rise as SSRI use falls

Anyone who takes care of children and adolescents remembers the big bruhaha about the use of antidepressant medications and their association with suicides. This was in the context of a huge drug recall at the time (I don't remember which one) and the FDA getting politically killed in the press for (at the time) not being able to protect America's children. (image credit)

Now, we're starting to see the unintended consequences of the black box FDA warning that was placed on these SSRI medications. According to this article from today's Washington Post, as use of the SSRI medications decreased, there was actually and INCREASE in suicides in children.
From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

The data suggest that for every 20 percent decline in antidepressant use among patients of all ages in the United States, an additional 3,040 suicides per year would occur, said Robert Gibbons, a professor of biostatistics and psychiatry at the University of Illinois at Chicago, who did the study. About 32,000 Americans commit suicide each year.
Now, I admit that I'm not the smartest dude, but even I can connect the dots here. Many docs are afraid to prescribe these SSRI meds, especially to adolescents, because of the huge black box warning - which basically tells docs that they are taking their legal life into their own hands if they prescribe this drug.

Now, some out there are not willing to admit this association. In fact, there are some out there who are aiming the blame at another set of medications as the cause of the increase in suicides.
David Healy, a British psychiatrist who has been critical of the drugs, disagrees. He said that the increase in suicides was more likely caused by the growing use of antipsychotic drugs among children rather than a decline in antidepressant use. "I would be absolutely certain that the increase is not because kids are not being treated," he said. "They may not be getting SSRIs, but they are getting psychotropics."
Of course these kids are not being treated. People like this are making docs think twice about using the best medications (in my opinion) for children and adolesents. I'll be curious to see other reactions to these findings.

Update: Roy from My Three Shrinks just posted on this topic.


Anonymous said...

Soon there will be black box warnings on all drugs... at least it seems that way.

Like my hubby says (not a doc, but has stayed at a Holiday Inn Express), "When you put a substance in your body there are risks no matter what it is -- prescription drugs and all."

Anonymous said...

IMO, why wouldn't teens be depressed? A recent article in Psychology Today lamented the infantilization of our young adults. We keep taking things from them, not allowing them to do 'adult' things, keep raising the legal ages of privileges. We've created a sub-culture of adolescence, where you basically hang out, because you can't move on in life. Your life is rigidly controlled. That totally sucks.

Who wouldn't be depressed?? I'd blame society before I'd blame lack of antidepressant therapy.

Gerbil said...

I have to wonder how many parents decided not to seek treatment for their depressed children because they feared that their kids would be prescribed medication that would make them suicidal... and then their children attempted or completed suicide because they weren't treated.

Incidentally, I used this story to explain to Mrs. Gerbil the difference between clinical significance and statistical significance. She was wondering why, if the statistical effect of SSRIs on suicidal behavior is so small, is there a black box warning in the first place. So I said, "Well, any time someone attempts suicide, it's clinically significant."

Visionary & Medium Extraordinaire said...

I find this topic highly interesting to say the least, and I have a few points I'd like to address.

Firstly, Pfizer is behind the study even though it's ran by the federal government, their funding puts their fingerprint on it.
Then I'd like to know, was the study done on people that had been taking, and stopped taking ssri's. Or was this study done on teens that had never taken the drug. This would change the results dramatically.
David Healy UK, says that psychotropics are much more easily accessible amongst teens. This I agree with completely.

On the other hand, there is another huge issue in North-America which I've seen repeatedly. Young teens and people are given ssri's but they're often not given the chance to be treated with behavioral therapy with a professional psychotherapist, psychologist or a psychiatrist.

My last point here has to do with the young and the old, or mixing TCM (Chinese Traditional Medicine) which has existed for over 3000 years, with Western Medicine.
In TCM, there is a connection with food, and mood. You are what you eat! And with the connection of food and mood, if 'an organ' is malnourished it will affect the body physically or emotionally. 5 element acupuncture focuses on emotions more than anything else.
Depression often has to do with blood deficiency, and what would treat that but proper diet. Long term treatment with western medicine (psychiatrist/psychologist/therapist) and eastern medicine can be highly affective alongside good healthy nutrition.

Nobody knows the long term affect on the brain or other organs when eating dyes that are completely unnatural.

Rach said...

Then again... My bias would point me in the direction of saying that since more Docs are diagnosing kids with
Bipolar Disorder
and since SSRIs and other antidepressants are catalysts for mania, prescription of these drugs has dropped off. On the other hand, I would say that it's safe to bet the prescriptions for drugs like Respiradol, Seroquel, Lithium, Depakote, Gabapentin and Lamictal have sky-rocketed.

Mauigirl said...

Good points, Rach.

I personally think it makes total sense that lowering the prescribing of SSRIs could make suicides go up in teens.

Personally, I am all for SSRIs since I am now on Prozac and much happier than I've been for most of my life - especially my teen years! Obviously each case needs to be taken individually and care must be used to ensure that the teen in question is followed up regularly by a therapist and the parents keep on top of what the kid is up to.