A 22% drop in prescriptions for antidepressants for teens and children following government warnings about hazards of the drugs led to a sharp increase in suicides the following year, according to Chicago researchers.
The change in labeling in 2003 warned that use of the drugs could increase suicidal thoughts and behavior among youths, but the labeling seems to have backfired, according to a report in the September issue of the American Journal of Psychiatry.
In the year after the change in labeling, the suicide rate rose 14% among those younger than 19, the largest increase since the government started collecting suicide statistics in 1979, said biostatistician Robert D. Gibbons and his colleagues at the University of Illinois at Chicago.
A similar drop in prescriptions in the Netherlands led to a 49% increase in youth suicides over a two-year period, the team reported. They estimated that every 20% drop in antidepressant use among all ages in the U.S. would lead to a nearly 10% increase in suicides, an additional 3,040 deaths per year.
Gibbons' data is "compelling," Dr. James F. Leckman and Dr. Robert A. King of the Yale University School of Medicine wrote in an editorial accompanying the paper. Unfortunately, they said, Gibbons did not examine data from the previous decade to determine whether the increasing use of antidepressants was linked to a drop in suicides.
Dr. Thomas R. Insel, director of the National Institute of Mental Health, which funded the research, told the Washington Post that "we may have inadvertently created a problem by putting a 'black-box' warning on medications that were useful. If the drugs were doing more harm than good, then the reduction in prescription rates should mean the risk of suicide should go way down, and it hasn't gone down at all -- it has gone up."
The drugs involved are called selective serotonin reuptake inhibitors, or SSRIs, and include Prozac, Zoloft and Paxil. About 16 million Americans take such drugs, according to the Mental Health Assn., an advocacy group.
In 2003 and 2004, the Food and Drug Administration mandated the black-box warning on them after research indicated that youths who took the drugs had an increase in suicidal thinking. The warning applied to patients younger than 19.
Earlier this year, the warning was changed to include adults younger than 25. Many experts had argued against such warnings, contending that it would cause many patients to abandon treatment that they desperately needed. At least 3 million Americans now do not receive any treatment for their depression.
The study, which includes data from the Netherlands, provides the strongest evidence yet that the drugs are useful in preventing suicide, Gibbons said.
"If the intent of the black-box warning was to save lives, the warning failed," the team wrote. " . . . What should be considered instead is better education and training of physicians."