Suicides rise as SSRI use falls

Anyone who takes care of children and adolescents remembers the big bruhaha about the use of antidepressant medications and their association with suicides. This was in the context of a huge drug recall at the time (I don't remember which one) and the FDA getting politically killed in the press for (at the time) not being able to protect America's children. (image credit)

Now, we're starting to see the unintended consequences of the black box FDA warning that was placed on these SSRI medications. According to this article from today's Washington Post, as use of the SSRI medications decreased, there was actually and INCREASE in suicides in children.

From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

The data suggest that for every 20 percent decline in antidepressant use among patients of all ages in the United States, an additional 3,040 suicides per year would occur, said Robert Gibbons, a professor of biostatistics and psychiatry at the University of Illinois at Chicago, who did the study. About 32,000 Americans commit suicide each year.

Now, I admit that I'm not the smartest dude, but even I can connect the dots here. Many docs are afraid to prescribe these SSRI meds, especially to adolescents, because of the huge black box warning - which basically tells docs that they are taking their legal life into their own hands if they prescribe this drug.

Now, some out there are not willing to admit this association. In fact, there are some out there who are aiming the blame at another set of medications as the cause of the increase in suicides.

David Healy, a British psychiatrist who has been critical of the drugs, disagrees. He said that the increase in suicides was more likely caused by the growing use of antipsychotic drugs among children rather than a decline in antidepressant use. "I would be absolutely certain that the increase is not because kids are not being treated," he said. "They may not be getting SSRIs, but they are getting psychotropics."
Of course these kids are not being treated. People like this are making docs think twice about using the best medications (in my opinion) for children and adolesents. I'll be curious to see other reactions to these findings.

Update: Roy from My Three Shrinks just posted on this topic.