Researchers have found that U.S. Food and Drug Administration safety warnings about a potential increase in risk for suicide associated with the therapeutic use of antidepressants among young people may have inadvertently led to an increase in suicide attempts by teens and young adults.
The 2003 warnings generated widespread media coverage that precipitated a sudden steep decline in the number of prescriptions for antidepressants without any offsetting increases in other effective treatments. In a study reported online June 18 in BMJ, researchers at the HMS Department of Population Medicine and the Harvard Pilgrim Health Care Institute write that in the second year after the warnings, antidepressant use fell by more than 30 percent among adolescents, coupled with a relative increase of approximately 22 percent in the use of psychotropic drugs to attempt suicide. Among young adults, the decrease in antidepressant use two years after the warnings was slightly more than 24 percent, while the relative increase in suicide attempts approached 34 percent in this group.
The researchers used overdose with psychotropic drugs as a conservative measure of suicide attempts. The number of completed suicides, however, did not change for any age group studied.
In 2003, an analysis that combed through existing clinical trials noted that approximately 1 percent of adolescents and young adults taking antidepressants experienced an increase in suicidal ideation. The original warning mentioned only this potential risk without noting the potential risk of undertreating depression. According to the researchers, the warnings alarmed clinicians, parents, and young people, and many prominent media outlets mentioned that these drugs raised the risk of suicide.
The FDA later revised the warning to recommend that physicians weigh the risk of prescribing the medication against the risk of not prescribing the medication, and that doctors monitor patients for thoughts of suicide and treat them as needed.
“This study is one of the first to directly measure a health outcome driven by the interaction of public policy and mass media,” says Christine Lu, an HMS instructor in population medicine at Harvard Pilgrim Health Care Institute and study leader.
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