Wednesday, September 3, 2008

Antidepressants and Suicide Rates: Another Salvo in the Debate

Remember all those dire warnings from the psychiatric community that youth suicides would rise after the FDA put black box warnings on antidepressants in late 2004? The argument was that physicians would be scared away from prescribing these drugs for depressed youth, leading to a rise in suicide rates.

Well, guess what? The opposite seems to have happened.

Not only did the number of antidepressant prescriptions actually rise in 2005, according to a report from the U.S. Agency for Healthcare Research and Quality this summer. But a new analysis published this week in the Journal of the American Medical Association found that the rate of suicides among youth aged 10 to 19 years actually fell by 5.3 percent between 2004 and 2005 -- to 4.49 per 100,000 kids.

The authors of the JAMA research letter did note that overall youth suicide rates for both 2004 and 2005 were still greater than the rates in earlier years. But they declined to attribute the bump solely to the FDA boxed warnings. Indeed, they noted that a lot of other factors could be at work here -- alcohol use, access to firearms, the influence of online social networks and even suicides among U.S. troops.

And that is precisely what I concluded in an opinion piece I wrote for The Boston Globe a year ago. In that op-ed, I also noted that suicide rates have long been trotted out as a public relations tool by drug companies intent on selling antidepressants. Yet there is no evidence that the use of drugs such as Prozac, Paxil, Zoloft and Celexa contributed to a decline in youth suicide rates from 1995 to 2003. Indeed, as a number of epidemiologists have pointed out, suicide rates among children (and adults) were going down well before the new class of antidepressants (SSRIs) hit the market.

Conversely, there is no evidence of a link between the FDA black box warnings and the uptick in youth suicide rates in 2004 (which, as it turns out, occurred before the black warnings went into effect).

In the end, of course, such statistical navel-gazing doesn't mean much. As Julie Zito, associate professor of pharmacy and psychiatry at the University of Maryland, said in my book, Side Effects, "People who are specialists in statistics know you have to look at trends over years and years."

So until we have some long-term data to work with, we should take any new salvos in the debate over antidepressants and suicide rates -- pro or con -- with a healthy dose of skepticism. Especially since several authors of the latest analysis have received resesrch funding or consulting income from companies that make antidepressants.

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