Government warnings that antidepressants may be risky for adolescents, and the ensuing media coverage, appear to have caused an increase in suicide attempts among young people, researchers reported Wednesday. Warnings Against Antidepressants for Teens May Have Backfired, NPR Morning Edition, June 14, 2014. (Listen here).
I have been saying for a long time that too much media hype has surrounded the FDA warnings regarding the suicide risk of antidepressants for young people. The recommendations were exaggerated and magnified to the point that parents were afraid to treat their children. The reality is this, the drugs do help.
What the FDA was recommending at the time were that medical professionals, parents and school staff watch for signs that might be worrisome. All the time, the FDA has said increased suicidal ideas are a rare side effect. So how did this warning from the FDA get so out of control? I think that fear is what drove much of it.
“This was a huge worldwide event in terms of the mass media,” said Stephen Soumerai of the Harvard Medical School, a co-author of the study, which was published in the journal BMJ, on NPR Morning Edition this week. “Many of the media reports emphasized an exaggeration of the warnings.”
Having treated children and teens for more than 30 years, I know how difficult it is for parents to process their child’s disorder or illness, and, often, it is even more difficult to make treatment decisions that that they think could endanger their child further. Even with a doctor’s reassurance this is a trying time for parents, but it should not be scary.
Look, the FDA warnings were well intended, but what happened is that the media hype made some doctors and more parents reluctant to medicate leading to a drop in antidepressant prescriptions. According to the study, antidepressant use nationally fell 31 percent among adolescents and 24 percent among young adults, the researchers reported. Suicide attempts increased by almost 22 percent among adolescents and 33 percent among young adults, they said.
The bottom line is that the drugs do help. This leaves parents and doctors having to weigh the positive effects of the drugs against, what are in many cases, the rare side effects. Interestingly there are two new developments. I have heard that there has been consideration of removing the suicide warnings, and also, most recently, there was a report that it was only high dosing in young people that was associated with increased suicidal phenomena. So, in summary we got a report that antidepressants can lead to suicidal thinking in young people, and, as a result, many prescribing doctors stopped prescribing them to depressed young people whose untreated depression itself could lead to suicide. For some reason, as yet unproven, the depression rate and suicide rate went up chronologically coincident with these developments. And now, at a time when there has been consideration of taking off the warning, a new study implies there might be a danger, but only when too high a dose is given at the initiation of treatment.
So what now? I prescribe these medications as needed. As usual, I routinely do follow ups on a frequent basis to check for all aspects of the response, including a detailed suicide assessment. I have yet to see any signs of increased suicidal fantasies that I can attribute to these drugs. I suggest that all parents develop a constructive relationship with the prescribing psychiatrist and not rely solely on social media or other sources of information.
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.