Antidepressants: Higher suicide rates with increased regional antidepressant use

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SSRI-Research@

Wed, 24 Nov 2004 21:11:33 -0500

Subject:[sSRI-Research] Antidepressants: Higher suicide rates with

increased regional antidepressant use among children/adolescents

 

 

This article states: " A reader has to dig deep into the text to

discover that these authors found that in both 1990 and 2000,

increased regional antidepressant medication treatment is linked to

higher suicide rates. "

 

This article was printed in a newspaper in Corning, New York.

 

 

http://www.the-leader.com/articles/2004/11/24/opinion/edit02.txt

 

Consider gradual withdrawal

 

 

Recently there has been a spate of news stories concerning the dangers

of antidepressants, particularly for children and adolescents.

 

This culminated last week when the Food and Drug Administration

ordered that all 32 of these drugs sold in America, from now on, must

come with a " black box warning, " the strongest caution possible.

 

Critics of the FDA have been arguing that the warnings are long

overdue, and the agency only acted because of a barraged of pressure

from outside forces. This pressure prompted FDA officials to review

the relevant research and to hear testimony from experts and witnesses

who spoke of numerous tragic events associated with the use of these

drugs. The agency subsequently concluded that many studies indicate

that the drugs are no more effective than placebos and they

significantly increase the risk of suicidal tendencies. The new black

box warnings are designed to assure that all parents will be notified

of these findings prior to their giving consent for treatment.

 

Given the recent facts that have come to light, people are beginning

to ask why the FDA has not ordered an outright ban on the prescribing

of these drugs to our youth.Some have theorized about the financial

ties between the pharmaceutical companies and FDA officials. But,

according to a recent article published in The Leader, Lester

Crawford, acting FDA commissioner, explains that the drugs shouldn't

be banned because children who are depressed are at an increased risk

of suicide without treatment and suicides among youths decreased by 25

percent in the past decade, as antidepressants prescriptions for

children soared. Here, Crawford seems to be suggesting that the

increased use of the antidepressants is actually reducing the total

number of pediatric suicides.

 

Because of the apparent ties between FDA officials and drug companies,

I decided not to just assume that Crawford's theory is well

documented, and instead, I examined the research for myself. Here's

what I found.

 

According to the Center for Disease Control's publication, Morbidity &

Mortality Weekly (June 11), indeed, in the past decade there has been

a decline in the overall suicide rate among people age 10-19, from 6.2

to 4.6 per 100,000 individuals. But, upon a closer examination of the

data, I became very doubtful that antidepressants had anything to do

with this decline.

 

The first thing I noticed was that the data in the report are broken

down into methods of suicide, e.g., firearms, suffocation, poisoning,

and all other methods. Apparently, during the last decade in which the

overall suicide rate decreased, firearms suicide rates also went down,

but suffocation rates actually increased. In fact, by the end of the

study period, suffocation had surpassed firearms to become the most

common method of suicide among those in the 10 to 14 age-range. The

authors indicate that all other methods of suicide had minimal impact

on the overall reduction in the suicide rate.

 

The authors of this CDC report give absolutely no credit to

antidepressants for reducing the rate of suicide over the past decade.

The writers' best guess after looking at the data, is that there

appears to have been a decrease in the availability of firearms over

the decade and that " some persons without ready access to highly

lethal methods such as firearms might choose not to engage in a

suicide act or, if they do engage in suicide behavior, are likely to

survive the injuries. "

 

My reading of this report is that it looks like the recent high

profile cases of child killings have led to a heightened sense in the

population to be on guard against keeping guns in places accessible to

children. In fact there has been a host of new firearms security

regulations that went into effect during the last decade according to

a report entitled " Adolescent suicide and household access to firearms

in Colorado: results of a case-control study, " published in the

Journal of Adolescent Health (2000, volume 26). Moreover, a link

between firearms in the home and suicide is supported by findings from

epidemiological, case control, and prospective studies. ( " Firearms and

Suicide " , published in Annals of NY Academy of Science, 2001, Volume 932).

 

After my looking at the CDC article, I turned my attention to an

article in the October 2003 issue of the Archives of General

Psychiatry, titled, " Relationship Between Antidepressant Medication

Treatment and Suicide in Adolescents. " The study examined the suicide

rates at two time periods, 1990 and 2000.

 

The first thing I noticed was that the authors all had financial ties

to drug companies. Then I noticed that the summary report on the first

page of the article is completely silent about the major finding of

the authors' study. A reader has to dig deep into the text to discover

that these authors found that in both 1990 and 2000, increased

regional antidepressant medication treatment is linked to higher

suicide rates.

 

The authors admit that, " this relationship may reflect

antidepressant-triggered suicide, " but then they say that they doubt

this interpretation. They, like Crawford, point to the fact that

suicide rates in the general population have dropped as the use of

antidepressants has climbed in the past decade.

 

Their data, however, indicate that this drop in the rate of suicide

has only occurred for older adolescent males living in lower-income

regions, and NOT for younger male adolescents regardless of whether

they were living in lower or middle-income regions. Rates of suicide

for older and younger female adolescents, regardless of their living

in either a low, or middle-income region also have NOT changed over

the past decade.

 

Now, in light of these findings, I ask you, is it likely that the

decreased suicide rate in only the older lower-income male adolescents

over that decade is due to an increase in antidepressant use? It just

doesn't seem plausible to me that a drug would affect differently

males living in lower-income regions than those living in

middle-income regions. My best guess for explaining this pattern of

results is that the economy improved during the period that was

studied, and this improvement especially affected males of that age

range in lower-income regions. This, combined with recent gun control

measures, I theorize, is why low-income, older adolescent males were

less likely to commit suicide in 2000 then in 1990. I fear that

low-income, older adolescent males would have even been less likely to

commit suicide in 2000 then in 1990 if so many of them were not

ingesting these antidepressant drugs.

 

In any case, even if we interpret the data in the best possible way

for drug companies, it seems that at the very least, Crawford should

be calling for a ban on the drugs for all female adolescents, and for

all younger adolescents, and for all adolescents living in

middle-class regions. These groups did NOT show any reduction in

suicide rates in the past decade as antidepressant use climbed, and

regions that had higher rates of antidepressant use per hundred

thousand adolescents had a significantly HIGHER suicide rate. When all

of this is combined with the research indicating that in randomized

controlled studies, youth taking antidepressants, when compared to

those taking a placebo, have significantly higher rates of suicidal

behavior, Crawford's argument for not banning the drugs looks highly

suspect.

 

This said, I must caution readers who have children already taking

these drugs. The above discussion may lead them to conclude that they

should immediately stop giving these drugs to their children.

Immediate withdrawal from these drugs, however, can be dangerous, and

should not be done without careful supervision of a physician.

Gradually weaning children off these drugs is increasingly being

considered best practice because some children experience very

uncomfortable withdrawal reactions that are far more severe than the

depression that led to the initial prescription.

 

Jeffrey Rubin, PhD., lives in Corning.