WebMD Health News
Daniel J. DeNoon
Louise Chang, MD
Sept. 13, 2007 - Warnings that antidepressants may increase teen suicides
appear to have backfired, a new study suggests.
The study shows that a steep drop in antidepressant prescriptions for
children and teens followed the FDA and European drug authority warnings. At
the same time, there was an unprecedented spike in child and teen suicides.
The study isn't proof that the antidepressant warnings caused the increase
in suicides. But the circumstantial evidence -- from both the U.S. and the
Netherlands -- is very compelling, says study researcher Hendricks Brown, PhD,
director of the prevention science and methodology group at the University of
South Florida College of Public Health, Tampa.
"The FDA actions look like they had very serious unintended
consequences," Brown tells WebMD. "Our analyses show that the FDA
actions, which should have reduced or at least not changed the number of
suicides for youth, had just the opposite effect."
On the advice of an expert panel, the FDA in 2004 put a "black-box"
warning -- its highest warning level -- on antidepressants for pediatric use.
The panel's advice was based not on actual suicides, but on indications that
suicidal thoughts and behaviors increased in some children and teens taking
newer SSRI-type antidepressants.
It looks as though the FDA effort backfired, says Boris Birmaher, MD,
director of the child and adolescent mood and anxiety program at the University
of Pittsburgh's Western Psychiatric Institute. Birmaher was not involved in the
"Years ago we speculated that suicides -- not suicidal thoughts or
suicide attempts but real deaths -- were going down because a lot of doctors,
not just psychiatrists, were prescribing SSRI antidepressants," Birmaher
tells WebMD. "Then comes the black box, and without any other specific
reason there was a huge increase in the number of kids dying from suicide. This
is not proof, just a statistical association. But it is suspicious."
Researcher Robert D. Gibbons, PhD, of the University of Illinois, Chicago,
was a member of the FDA panel. He voted against the black-box warning.
"The FDA has overestimated the effect of antidepressant medications on
suicidality and dramatically underestimated the efficacy of antidepressants in
the treatment of childhood depression," Gibbons told WebMD in April
The study by Gibbons, Brown, and colleagues, appears in the September issue
of the American Journal of Psychiatry.
(Have you held off putting your teen on antidepressants because of black
box warnings? Talk about it on the Depressed and Bipolar Kids: Family
Support message board.)
Brown and colleagues looked at antidepressant prescription data in a large
sample of American and Dutch pharmacies. They also obtained data on suicide
rates from the CDC and from the Netherlands Central Bureau of Statistics.
They found that from 2002 to 2003, prescription rates for SSRI
antidepressants went up for all age groups -- continuing a steady increase
since 1987. After 2003, prescription rates dropped for all ages under 60.
Then came the warnings:
Here's what happened to antidepressant prescriptions and suicide rates:
The one-year 14% increase in suicides among American 5- to 19-year-olds is
highly unusual. Since 1988, suicides in this age group went up only twice: a 1%
bump in 1994 and a 3% increase in 2000.
If there really is a link between fewer antidepressant prescriptions and
child and teen suicides, Brown and colleagues predict that the CDC's statistics
will show a 44% increase in child and teen suicides from 2003 to 2005.
The effects aren't limited to kids.
"There is a spillover effect: SSRI prescriptions in the U.S. for all
other age groups have been decreasing for everyone under age 60," Brown
If the warnings cut adult antidepressant prescriptions by 20%, the
researchers predict that there will be 10% more adult suicides.
Birmaher notes that there's another disturbing trend going on. Since the
black-box warnings, fewer children and teens have been diagnosed with major
"The fact that diagnosis of major depression has decreased means these
kids are going untreated. Nobody is offering them anything, neither
antidepressants nor psychotherapy," Birmaher says. "This can be linked
to the increase in suicides. And unfortunately, this looks like a side effect
of the FDA warning."
Birmaher says that depressed kids are at highest risk of suicide in the
month before they seek treatment.
"Depression in kids and in grown-ups goes together with suicide, just as
strep throat goes together with high fever," he says. "Kids at high
risk of suicide are the ones seeking treatment. Once treatment begins,
suicidality begins to decrease. This is an important message for the public. If
you are not aware of this, you can mix up the cause of suicide -- depression --
with the effect of treatment."
Brown says the findings underscore how important it is for parents to know
when their children need support for mental health issues.
"It is important for parents to be able to talk with their children and
to learn if their children are feeling like killing themselves," he says.
"A conversation like that can be a lifesaver. There is no way to help these
kids if they suffer in silence. Asking kids if they are suicidal does not
increase their risk of killing themselves, and may actually give them the
opportunity to talk about how they are actually feeling."
Both Brown and Birmaher stress that antidepressants and psychotherapy are
both effective treatments for depression. They say untreated depression -- not
treated depression -- is the true cause of suicide.
SOURCES: Gibbons, R.D. American Journal of Psychiatry, September
2007; vol: 164 pp 1356-1363. C. Hendricks Brown, PhD, professor and director,
prevention science and methodology group, University of South Florida
College of Public Health, Tampa. Boris Birmaher, MD, director, child and
adolescent mood and anxiety program and co-director, child and adolescent
bipolar disorders service, Western Psychiatric Institute and clinic, University
of Pittsburgh. Robert Gibbons, PhD, professor of psychiatry and director,
center for health statistics, University of Illinois at Chicago.
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