Researchers report an inverse relationship between antidepressant prescriptions and the rates of suicide in children and adolescents -- a finding that contradicts the Food and Drug Administration's "black box" warning for selective serotonin reuptake inhibitor medications, also known as SSRI drugs.
The University of Illinois at Chicago epidemiologic study appears in the November issue of the American Journal of Psychiatry.
The researchers examined suicide rates of children ages 5-14 in each county of the United States from 1996 to 1998 and county-level data on SSRI prescriptions. The results were adjusted for sex, race, income, access to quality mental health care and variations in county-to-county suicide rates.
"We found that counties with the highest prescription rates for SSRI drugs had the lowest suicide rates in children and adolescents," said the lead author Robert Gibbons, director of the Center for Health Statistics and professor of biostatistics and psychiatry at UIC. "This is just the opposite of what you would predict if SSRI's were producing suicide."
There were 933 suicides among children ages 5-14 from 1996 to 1998, or an overall annual rate of 0.8 per 100,000. The researchers found that in counties with low antidepressant prescription rates, the suicide rate was as high as 1.7 per 100,000. In counties with high antidepressant prescription rates, the suicide rate was as low as 0.7 per 100,000.
The study predicts that if there were no SSRI prescriptions, there would be 253 more suicides per year among children and adolescents in the United States.
According to Gibbons, who was a member of the 2004 FDA advisory panel that voted 15-8 in favor of placing a black box warning on SSRI prescriptions, some experts fear that "doctors, particularly general practitioners, would be terrified of prescribing SSRI drugs for children" because the antidepressants are believed to cause suicidal thoughts and behavior.
Since the black box warning was issued, the rate of antidepressant prescriptions in children has decreased by approximately 30 percent, said Gibbons.
"The big concern is that the rate of suicide will increase, not only in the United States, but in the world," Gibbons said. "What our study shows is support for that idea."
The study also found that adjusted suicide rates were highest in less densely populated areas of the western United States, which often include areas with Indian reservations. The adjusted suicide rates were lowest in large cities such as Chicago, New York, Boston, Los Angeles, San Diego, Seattle and Miami.
"It is very important that we develop better tools and a greater interest in this country in post-marketing surveillance of drugs," said Gibbons, who suggests a systematic and rigorous follow-up of prescription drugs to discover adverse event associations as early as possible to avoid making decisions about drugs based on very preliminary, or biased, data.
Gibbons was also a member of the Institute of Medicine Committee on U.S. Drug Safety, whose recent report "The Future of Drug Safety: Promoting and Protecting the Health of the Public" was critical of the FDA's lack of regulatory authority, chronic underfunding, organizational problems, and scarcity of post-approval drug data.
Co-authors of the study include Kwan Hur and Dulal Bhaumik of the UIC Center for Health Statistics and J. John Mann of the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons.
Funding for the study was provided by the National Institute of Mental Health.
UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.
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