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Did FDA Teen Suicide Warning Backfire?

After Antidepressant Warning, Youth Prescriptions Down, but Suicides Way Up

Antidepressant Use Dropped, Suicides Soared After Warnings continued...

Then came the warnings:

  • October 2003: The FDA issued a public health advisory warning of reports of children and teens who attempted or committed suicide after taking antidepressants.
  • December 2003: The U.K. and European drug agencies advised doctors not to prescribe most antidepressants for children under age 18.
  • February 2004: The FDA ordered drug makers to put a "black box" warning -- its highest warning level -- on the labels of all antidepressants used in pediatric patients. The label warned of increased risk of "suicidality" in children and teens taking the drugs.
  • December 2006: The FDA extended the black-box warning to young adults.

Here's what happened to antidepressant prescriptions and suicide rates:

  • 1998-2003: U.S. SSRI antidepressant prescription rates went up 91% and suicides dropped 33%.
  • 1998-2003: Netherlands SSRI antidepressant prescription rates went up 120% and suicide rates dropped by 31%.
  • 2003-2004: SSRI antidepressant prescriptions drop 22% in U.S. and Netherlands.
  • 2003-2004: U.S. youth suicides went up 14% (2005 figures not yet available).
  • 2003-2005: Netherlands youth suicides went up 49%.

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 notes.

If the warnings cut adult antidepressant prescriptions by 20%, the researchers predict that there will be 10% more adult suicides.

Kids Not Getting Depression Treatment of Any Kind

Birmaher notes that there's another disturbing trend going on. Since the black-box warnings, fewer children and teens have been diagnosed with major depression.

"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."

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