Warnings that antidepressant medications might prompt suicidal thinking in some young people may have backfired, resulting in more suicide attempts, new research suggests.
The study, published Wednesday in the BMJ medical journal, is not the first to show that antidepressant use by young people fell sharply after warnings from the Food and Drug Administration and subsequent media coverage in 2003-04. But it is the first to link the change to an increase in suicide attempts among teens and young adults, researchers say.
The researchers suspect many troubled young people too scared to try the pills (or not offered them by scared parents and doctors) ended up getting no depression treatment at all.
The study "is a good reminder for the media, the FDA, clinicians and parents not just to think about the risks of drugs, but the risk of under-treatment," says lead author Christine Lu, an instructor in population medicine at Harvard Medical School.
As Lu and colleagues note in the study, the FDA modified the antidepressant warning in 2007 to emphasize that depression and other psychiatric disorders are the most important causes of suicide.
For the study, the researchers looked at insurance records for 7.5 million people ages 10 to 64 for several years before and after the initial warnings. Just before the warnings, the medications were used by about 2% of teens and 4% of young adults in the study.
Two years later, antidepressant use was down 31% in teens, 24% in young adults and 14.5% in adults not even targeted by the warnings.
In the same period, likely suicide attempts involving overdoses with tranquilizers and other psychotropic drugs rose 21.7% for teens and 33.7% for young adults. There was no significant rise in adults.
That fits with other studies that show depressed older adults are more likely than young people to get psychotherapy or other treatment when they don't take antidepressant medications, Lu says.
The study found no rise in completed suicides in any age group. Those would be statistically harder to detect, Lu says, because they are much rarer than attempts.
Antidepressant use started to rise again by 2008, the study shows.
Today, use among young people probably is about as high as it was in 2000 but not as high as the peak years just before the warning, says David Brent, a professor of psychiatry at the University of Pittsburgh.
Brent, who was not involved in the new study, says "it supports the view that the benefit of using anti-depressants in kids outweigh the risks." He says "there may be kids for whom that's not true," but clinical studies suggest the medications are 11 times more likely to help a depressed young person than to trigger suicidal thoughts or actions.
The reasons for any link between antidepressants and self-harm in young people remain unclear. One theory is that the medications give some young sufferers new energy to carry out suicide plans; another is that unpleasant side effects trigger suicidal thoughts. No link between the medications and increased suicidal thoughts and behavior have been found in people older than 24, the FDA says.
The FDA says young people starting the drugs should be carefully monitored by their doctors and families.