Study links prescriptions to decrease in suicides ( 2003-10-14 16:31) (NY times)
Suicide remains a leading cause of death for American adolescents, but over
the last decade, the rate of suicide among teenagers has declined. In a new
study, researchers at Columbia University suggest that this drop may be linked
in part to the increasing use of antidepressant drugs in young people.
The researchers examined teenage suicide rates and prescriptions filled by
children ages 10 to 19 in 588 regions of the country from 1990 to 2000. Regions
with higher rates of antidepressant use in 1990 or 2000 had higher suicide
rates. But over time, an increase in the use of antidepressants was associated
with a decrease in suicides.
The inverse relationship between the drugs and suicide held for boys, older
adolescents and lower-income teenagers but not for girls or younger adolescents.
"People have known for some time that over the last years there has been an
increase in the use of antidepressants" among children, said Dr. Mark Olfson, a
professor of clinical psychiatry at Columbia and the lead author of the study,
published this month in The Archives of General Psychiatry. "The question we're
trying to get at here is, `Has that contributed to the decline in suicide?' This
provides some evidence that it may have."
But Dr. Olfson and his colleagues also noted limitations in the research
methods, including its reliance on data from groups rather than individuals.
Other factors, including tougher gun control laws in some regions and reduced
use of alcohol and drugs, may have contributed to the drop in suicides, they
said.
The relationship, if any, between suicide and S.S.R.I.'s, the newer class of
antidepressants that includes Prozac, Zoloft, Paxil and other medications, is a
subject of controversy. Several studies have found correlations between the
increased use of the drugs in adults and decreased suicide rates in Sweden and
other countries. One study, in Italy, found no link.
In recent months, questions also have been raised about whether some drugs
may increase the risk of suicide in some children. British regulators, acting on
the basis of unpublished data that link Paxil with suicidal thoughts and
behavior in children and adolescents, warned doctors not to prescribe the drug
for them. Last month, the regulators also issued a warning about a medication
from Wyeth, Effexor, which they said posed a risk of hostility and suicidal
thoughts in adolescents. In June, the Food and Drug Administration recommended
that doctors refrain from giving Paxil to children while the agency reviews the
issue.
Dr. Olfson noted that most youths who committed suicide received no treatment
at all in the months before they died. He said the new study placed the concerns
about Paxil and other S.S.R.I.'s, selective serotonin reuptake inhibitors, "in a
broader context of a society that has substantial unmet needs for depressed
young people."
Other experts said the study's findings were interesting but far from
conclusive in showing a link between drug treatment and a drop in suicide.
"To me, this is just an impressionistic piece," said Dr. David A. Brent, a
professor of psychiatry, pediatrics and epidemiology at the University of
Pittsburgh and an expert on youth suicide. "It's like a signal. But this type of
study can't prove causality."
Dr. Julie Magno Zito, an associate professor of pharmacy and medicine at the
University of Maryland who has documented striking increases in the use of
antidepressants for children, said she did not find the study convincing.
"It's at best very weak evidence," Dr. Zito said. "I think these findings are
inconsistent with other data that have more rigorous methodology."
The researchers based their analyses on national suicide rates from the
Centers for Disease Control and Prevention, as well as prescription data
provided by AdvancePCS, the largest pharmacy benefit management company in the
nation.
Suicide is the third leading cause of death among teenagers 15 to 19 and the
fourth leading cause of death in adolescents 10 to 14. In 2000, according to the
C.D.C., 4.7 adolescents per 100,000 took their own lives, compared with 6.4 per
100,000 in 1990.
In the study, a 1 percent increase in antidepressant use from 1990 to 2000
was associated with a drop of 0.23 suicides per 100,000 adolescents per year.
The link was found only for S.S.R.I.'s. not for older antidepressants.
The other authors of the study, financed by the Carmel Hill Fund, and the
National Institute of Mental Health, were Dr. David Shaffer and Ted Greenberg,
of Columbia, and Dr. Steven C. Marcus of the University of
Pennsylvania.
