When the FDA put a black box warning on SSRIs a few years ago, I was a bit concerned. Yes, the increase in suicide rates in teens on SSRIs was cause for concern, but the truth is that no drug works 100% of the time, and teens with depression are going to be at risk for suicide no matter what drug they're on. In the meantime, parents and doctors would be scared off of getting help for children who need it. Now, four years later, we have evidence that my concern was warranted:
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.
No drug is perfect. And there may well be a link between SSRIs and suicide in some patients. But it's very clear that if we're playing the odds, that someone dealing with depression is better off seeking treatment for it than not, and better off on an SSRI than off it.
That doesn't mean that we should just give kids drugs and forget 'em. Therapy is vitally important in helping to manage depression. And it's best if depression is diagnosed by a therapist, rather than a general practitioner -- as GPs are necessarily going to be less able to distinguish between organic and situational depression.
But I hope that this study puts to rest the notion that we're somehow drugging our children and ruining everyone's free-thinking with happy pills. Depression is a real disease, and it's a deadly disease if left untreated. I'm not advocating getting everyone on medication. But those that need it should get it.
