Warnings About Suicide and Antidepressant Use Backfired

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Antidepressant prescriptions decreased and suicide attempts increased in young people after FDA warnings

June 22, 2014 / Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

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(dailyRx News) In 2003, the Food and Drug Administration (FDA) issued several warnings about a possible increased risk of suicide among young people who were prescribed antidepressants. However, these warnings may have had the opposite effect than intended.

A recent study found that extreme and exaggerated media coverage of the statements made by the FDA in 2003 led to a significant decrease in the amount of antidepressant prescriptions among young people.

The researchers discovered that the decline in antidepressant prescriptions was accompanied by an increase in suicide attempts among young people.

"Discuss the risks and benefits of antidepressant use with your psychiatrist."

The lead author of this study was Christine Y. Lu, MSc, PhD, from the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, Massachusetts.

The study used the U.S. Mental Health Research Network to get claims data for 7.5 million people enrolled in 11 different health plans across 12 states between 2000 and 2010.

There were 1.1 million youths aged 10 to 17 years old, 1.4 million young adults aged 18 to 29 years old, and 5.0 million adults aged 30 to 64 years old.

The adults were used as the control group because the 2003 warnings did not target them.

The researchers identified cases of psychotropic drug overdose as an indication of a suicide attempt.

Psychotropic drugs are medications that are used to treat mental health conditions, such as antidepressants.

The findings showed that in the second year after the warnings, there was a 31 percent decrease in antidepressant use among youths aged 10 to 17 years old, reflecting a reduction of 696 antidepressant prescriptions per 100,000 youths.

Among the young adults aged 18 to 29 years old, there was a 24 percent decrease in antidepressant use in the second year after the warnings, reflecting a reduction of 1,216 antidepressant prescriptions per 100,000 young adults.

There was a 15 percent decrease in antidepressant use among adults aged 30 to 64 years old in the second year after the warnings. This equals a reduction of 1,621 antidepressant prescriptions per 100,000 adults.

The researchers found that a significant increase in suicide attempts with psychotropic drugs happened at the same time as these decreases in antidepressant prescriptions.

Among the youths aged 10 to 17 years old, there was a 22 percent increase in suicide attempts with psychotropic drugs, reflecting an increase of 2 suicide attempts per 100,000 youths.

There was a 34 percent increase in suicide attempts with psychotropic drugs among the young adults aged 18 to 29 years old, equaling an increase of 4 suicide attempts per 100,000 youths.

There was not a significant increase of suicide attempts with psychotropic drugs among the adults.

The researchers noted that the studies that the FDA warnings were based off found that approximately 1 percent of young people taking antidepressants had experienced an increase in suicidal thinking.

The warnings were overly publicized without much explanation of the specifics, and did not mention the potential risks associated with the undertreatment of depression.

"This study is a one of the first to directly measure a health outcome driven by the interaction of public policy and mass media," said Dr. Lu. "The FDA, the media and physicians need to find better ways to work together to ensure that patients get the medication that they need, while still being protected from potential risks."

The FDA later changed the warnings and recommended that doctors consider the risk of prescribing the medication versus the risk of not prescribing the medication, and then monitoring patients for thoughts of suicide and treating them as needed.

"We need to do a better job of understanding and communicating the risks of taking—and not taking—medications," Dr. Lu concluded.

This study was published on June 18 in BMJ.

The US National Institute of Mental Health provided funding.