Did FDA Teen Suicide Warning Backfire?
After Antidepressant Warning, Youth Prescriptions Down, but Suicides Way Up
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.)
Antidepressant Use Dropped, Suicides Soared After Warnings
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.