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Education Reporter

Debate Over Antidepressants and Youth Suicide
A study on youth suicide published in the American Journal of Psychiatry drew widespread public and media attention in September, but in the end wasn't what it seemed.

The study showed that the suicide rate for Americans under the age of 19 increased 14% between 2003 and 2004. The authors claimed this coincided with a decrease in antidepressant prescriptions to minors.

While some of the study's authors were more cautious about claiming that suicides rose because prescription rates fell, Dr. J. John Mann of Columbia University expressed the conclusion most media coverage also presented. "The most plausible explanation is a cause and effect relationship: prescription rates change, therefore suicides change," he told the New York Times (9-14-07).

Concerns about antidepressants' side effects in young people have risen in recent years, and the Food and Drug Administration called in late 2004 for a "black box" warning on antidepressant labels. The black box warns that children on these drugs may be at higher risk for suicide. Trials by Glaxo Smith Kline and other drug makers have shown that children and teens who take antidepressants are two to three times more likely to report suicidal thoughts or attempts than those on placebos. This is especially remarkable since doctors prescribe these drugs assuming that they will have the opposite effect.

About a week after the study hit the news, outside experts administered a reality check. Antidepressant prescription rates for under-19s did not in fact fall significantly in 2004, even according to the study's own data. A change in prescription rates could not have caused the suicide increase, because prescription rates did not change between 2003 and 2004.

Until 2005, prescription rates for children and teens had been rising for years. Between 1994 and 2001, prescriptions of psychotropic drugs for American teens rose 250%. By 2001, one in every ten teenage boys who visited the doctor left with a prescription for a psychotropic drug.

Most other western countries saw the same trend; for example, in the U.K., prescriptions for mind-altering drugs more than quadrupled in a single decade. British child psychiatrist Mike Shooter expressed concern over this phenomenon. "One factor is the pharmaceutical companies marketing these drugs as happiness in the form of a pill," he told the Independent (8-14-07). "In the process they have concealed the fact that they don't actually bring happiness. There is also controversy at the moment about drug companies concealing lack of effectiveness." He also expressed frank skepticism about the long-term effects of such drugs. "Some may appear to be helpful in the short-term, but I don't know that we have long-term knowledge of what these drugs can do to the mind."

Other psychiatrists insist that antidepressants do prevent youth suicide, even though this particular study, in the American Journal of Psychiatry, could not prove a connection. Another study, from Columbia University, detected that for every 20% increase in teen antidepressant use, there were five fewer suicides a year per 100,000 people. Studies in Sweden, Japan and Finland have found similar rates among various age groups.

Child psychiatrist Sami Timimi, author of Mis-Understanding ADHD, argues strongly against using these drugs for children and teens. "Antidepressants do not work in this age group. There have been several double-blind placebo trials which uniformly show that sugar pills worked just as well as Selective Serotonin Reuptake Inhibitors or SSRIs." SSRIs are the class of antidepressants that includes Prozac, Zoloft and Paxil.

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