Rethinking Antidepressants and Youth Suicide

Rosa Rodriguez,* now a college student, recalls her suicide attempt at 13 years old: "I decided I couldn't take it anymore, so I took some pills and went to bed early. I threw it all up within 20 minutes, and thinking back, I'm glad it didn't work out."

She goes on: "I share my bed with my sister, and it would have been really selfish of me if I did that knowing that she was lying next to me. I obviously wasn't thinking rationally."

While Rosa looks back with remorse, she does not look back with confusion. She has continued to struggle with depression throughout her life, a disease that affects 5 percent of adolescents and children. According to the Centers for Disease Control (CDC), 90 percent of those who attempt suicide have a significant psychiatric disease. Rosa is not an anomaly.

Two new studies confirm that the suicide rate among young people has increased, particularly among girls between the ages of 10 and 14. The numbers have researchers, health advocates, parents, educators, and teens debating the potential causes -- the most controversial of which is the corresponding drop in antidepressant use among youth after U.S. Food and Drug Administration (FDA) warnings in early 2003.

The first study, conducted by the CDC's National Center for Injury Prevention and Control confirms that between 2003 and 2004, the suicide rate among children and young adults rose 8 percent; the suicide rate for girls ages 10-14 jumped 76 percent. CDC researchers are quick to point out that, though they are interested in the corresponding drop in antidepressant use, the study doesn't prove a causal relationship.

Robert Gibbons of the University of Illinois at Chicago, the head researcher on the other study, believes he has that proof. His study, published in the American Journal of Psychiatry, found that the youth suicide rates in the United States rose 14 percent between 2003 and 2004 and 49 percent in the Netherlands. Youth antidepressant prescriptions fell 22 percent among children aged 0 to 19 in both the United States and the Netherlands after the 2003 warnings were issued.

The study, however, has come under scrutiny recently because two of its eight authors, including Gibbons, have ties to big pharma. Gibbons once served as an expert witness for Wyeth, maker of Effexor; J. John Mann, a neuroscience professor at Columbia University, has received research funding from GlaxoSmithKline, creator of Paxil, and has been an adviser to Eli Lilly, which sells Prozac.

Still, these conflicts of interest do not necessarily mean the study's conclusions are wrong. Any way you slice it, these numbers are alarming and worth a closer look. Especially when you consider that prior to 2003, the suicide rate among youth aged 10 to 24 had fallen by 28.5 percent over a 13-year period. Dr. Ileana Arias, director of the National Center for Injury Prevention and Control told reporters: "We don't yet know if this is a short-lived increase or if it's the beginning of a trend."

Rethinking antidepressants

Though the FDA has never approved Zoloft, Paxil or most similar drugs (with the notable exception of Prozac) for use by younger patients with depression, many doctors prescribe them. According to the Journal of the American Academy of Child and Adolescent Psychiatry approximately 1.4 million pediatric patients are currently taking antidepressants.

In the FDA review, no completed suicides occurred among nearly 2,200 children treated with selective serotonin reuptake inhibitor (SSRI) medications. However, about 4 percent of those on the drugs experienced suicidal thinking or behavior, including suicide attempts -- twice the rate of those taking the placebo.

In 2003, following this review and lengthy hearings, the FDA issued a warning that the use of antidepressants -- particularly the very popular SSRI type, including Prozac and Paxil -- could increase the chances of suicidal thoughts or actions in children and teenagers. The warnings were added in a "black box" on the medications in October 2004.