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
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.
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
2003-2004: U.S. youth suicides went up 14% (2005 figures not yet
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
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
"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."