A report by the US government shows a sudden sharp rise in youth suicide rate. The year 2003 to 2004 (the latest data does not show anything more recent) shows a sudden 18 per cent rise for suicides among the under 20s, from 1,737 to 1,985. The rise is largely driven by increases in deaths among older teenagers.
This is a sudden reversal in a trend that has shown a steady decline in the 10 years before that.
The figures appear in a government Annual Statistics report for 2005 produced by the Centers for Disease Control and Prevention (CDC) and summarised in the February issue of the journal Pediatrics.
Various media reports describe interviews with alarmed health experts who point to the coincidence with the year when the Food and Drug Administration (FDA) brought in the black box warning rule. This required that all packaging on prescription antidepressants display a warning about the risk that taking the drug could induce suicidal behaviour in the younger patient.
They are suggesting that young people who might have been saved from suicide by taking the drugs could have been put off by the warning.
A psychiatry professor at the University of Vermont, Dr David Fassler is very concerned by the news. He told the FDA to be careful about introducing the black box label at a hearing just before they introduced the warning regulation.
Other health professionals at the time said that the media interpretations of the evidence that led to the FDA black box label ruling were misleading and may have put undue pressure on them to make a decision. An article by Sally Satel, MD, for the Manhattan Institute reviewed the evidence in 2004 and said it was not sufficient to support the ruling.
The CDC will be issuing a more detailed report later in the year, and in the meantime are urging people not to jump to conclusions about the cause of this sudden “spike” in the data. Nobody knows yet whether this sudden rise is concentrated in certain parts of the population, for instance ethnically or geographically that might lead to other explanations.
Evidence linking antidepressants with suicide risk is conflicting. In November last year, the National Institute of Mental Health (NIMH) published a report showing that areas of the US with higher rates of antidepressant prescriptions correlated significantly with lower suicide rates in the 5 to 14 year olds from 1996 to 1998. Yet in a landmark study by the NIMH, antidepressants have been linked to increased risk of suicidal intentions but psychotherapeutic interventions compensated for it.
“Annual Summary of Vital Statistics: 2005.”
Brady E. Hamilton, Arialdi M. Miniño, Joyce A. Martin, Kenneth D. Kochanek, Donna M. Strobino, and Bernard Guyer.
Pediatrics 2007; 119: 345-360.
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The rush to black label (or blackball) SSRIs (Sally Satel MD, Manhattan Institute, 2004).
Written by: Catharine Paddock
Writer: Medical News Today