NEW YORK (Reuters Health) -
A move by U.S. health officials to warn the public of an
increased risk of suicidal thoughts among young people
taking antidepressants was actually associated with an
increase in suicide attempts, suggests a new study.
It could be that doctors avoided prescribing those medications after
media reports of the warnings and children and teens with depression
went untreated, researchers suggest in the medical journal BMJ.
“In this case, we think we’re seeing the decreased use of the
medication in kids who had appropriate use of the medications,” said
Stephen Soumerai, the study’s senior author from the Harvard Pilgrim
Health Care Institute in Boston.
Between 2003 and 2004 the U.S. Food and Drug Administration (FDA)
issued warnings that antidepressants were tied to an increased risk
of suicidal thoughts and behaviors in about one percent of children
and teens. The agency required the warning to be printed on
antidepressant drug labels in October 2004.
The warnings were expanded to include young adults in 2007.
About seven percent of Americans have depression, according to the
Centers for Disease Control and Prevention.
Previous studies had found that antidepressant use fell after the
warnings were issued but that use of other treatments for
depression, such as therapy, did not increase. There was also a
decline in the number of people being diagnosed with depression.
To look at how suicidal behavior might have been affected, Soumerai
and his colleagues analyzed data from 11 healthcare organizations
that provide care to about 10 million people in 12 states.
They found that antidepressant use decreased by 31 percent among
adolescents, about 24 percent among young adults and about 15
percent among adults after the warnings were issued.
At the same time, there were increases in the number of adolescents
and young adults receiving medical attention for overdosing on
psychiatric medicines, which the authors say is an accurate way to
measure suicide attempts.
Those poisoning increased by about 22 percent among adolescents and
about 34 percent among young adults after the warnings. That
translates to two additional poisoning per 100,000 adolescents and
four more poisoning per 100,000 young adults, the researchers write.
There was no change in poisoning among adults, they found.
There was also no change in completed suicides. Soumerai said the
study may not have been large enough to detect an increase because
completed suicides are relatively rare.
Dr. Mark Olfson, a professor of psychiatry at Columbia University
Medical Center in New York, cautioned that poisoning from
psychiatric drugs may not be an accurate representation of suicide
attempts, however.
“Their analyses are undermined by the selection of psychotropic drug
poisoning for suicide attempts because these events are only weakly
associated with suicide,” Olfson, who was not involved with the
study, said.
However, Soumerai said poisoning were a better predictor of
attempted suicide than other measures that are sometimes used, such
as reports of self-harm.
The study “suggests that the warning had the intended effect (of
reducing antidepressant prescribing for young people) but it remains
an open question of whether the warnings were beneficial or not,”
Olfson added.
A press officer for the FDA also told Reuters Health in an email
that “nothing indicates a need for change in the Boxed Warning on
these drugs, which urges attention to patients starting treatment,
which the FDA feels is still good advice.”
“The FDA has not tried to discourage use of antidepressant drugs in
people who may benefit from them,” the email continued. “And, the
current labeling and patient Medication Guides remind physicians and
caregivers of the monitoring that is needed for patients taking
these medications.”
It added that the agency has “tried to balance the suicidality
warning language with a reminder that depression is a serious
illness that itself is the major risk factor for suicidal thoughts
and actions.”
“I think it is incumbent that we all have to do a better job at
gauging the risk and benefits of these medications,” Soumerai said.
