Antidepressant Warning for Kids Did Not Increase Teen Suicide Rate..

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Antidepressant Warning for Kids Did Not Increase Teen

Suicide Rate

Date Published: Tuesday, January 8th, 2008

A caution against the use of antidepressants in

children and adolescents did not have the dire

consequences some feared. Doctors assumed a rise in

teen suicide resulted from a sharp fall in

antidepressant use among children and youth.

Depression is the leading cause of suicide, the

third-largest killer of children and young adults,

between those aged 10 and 24.

In 2004, the U.S. Food and Drug Administration (FDA)

issued its strongest warning—a black box—on all

antidepressant use in children and teens to draw

attention to these medications’ possible risks.

Researchers at Columbia University wanted to see the

overall impact of the public health warnings and of

the FDA’s black box warning. They reviewed U.S.

prescription data from before the FDA’s June 2003

warning to monitor adolescents taking

GlaxoKline’s antidepressant Paxil—the generic

paroxetine hydrochloride—for signs of worsening

depression and suicidal thoughts. Researchers also

studied antidepressant use in the period leading up to

the black box and the period 15 months following the

warnings.

According to Dr. Mark Olfson of Columbia University

Medical Center, the assumption that suicide spiked

from reduced antidepressant use were mistaken.

Warnings that antidepressants might increase suicidal

behavior in youth slowed rapid growth of these drugs

but did not eliminate young people’s access, U.S.

researchers said Monday, adding that while

antidepressant use grew at an annualized rate of 36

percent before regulators’ 2003 warnings, growth

flattened after warnings were issued. “When the

warnings first appeared, there was a great deal of

concern among psychiatrists and other mental health

professionals that these warnings would result in a

precipitous decline in antidepressant use by young

people, and as a result, youth with depression would

have less access to treatment,” said Olfson, whose

study appears in the Archives of General Psychiatry.

“What we found is the FDA warnings had a relatively

moderate and targeted effect in slowing the growth of

antidepressant use by children,” Olfson said. Recent

studies suggest the drug warnings triggered an eight

percent rise in suicide among youth and teens in 2004,

the biggest one-year gain in 15 years. U.S. and

European regulators sent out a series of public health

warnings in 2003 after clinical trials showed the

drugs increased the risk of suicidal thoughts and

behaviors in children and teens.

What they found was that antidepressant use in

youth—aged six to 17—rose at an annualized rate of 36

percent; however, drug use in this group flattened

following the 2003 warnings and did not significantly

change following the black box in late 2004. Olfson

said changes in antidepressant use have been confined

to youth and young adults.

The American Foundation for Suicide Prevention said

the FDA black box warnings and the drop in

antidepressant prescriptions were what likely

triggered higher suicide rates in young people in

2004. Olfson argued that preliminary figures suggest

teen suicide rates in 2005 actually declined from

2004. “This suggests that we need to look more

carefully at this issue,” he said, adding that his

study should address some concerns among physicians

that the black box went too far. “There are still a

number of physicians who feel the FDA overshot and

that these warnings had a dramatic chilling effect,”

Olfson said.

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