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David Baxter

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Effect of antidepressant warnings moderate: U.S. study
Mon Jan 7, 2008
By Julie Steenhuysen

CHICAGO (Reuters) - Warnings that antidepressants might increase the risk of suicidal behavior in youth curbed rapid growth of these drugs but did not eliminate access to them among young people as some had feared, U.S. researchers said on Monday.

They said that while antidepressants had been growing at an annualized rate of 36 percent before regulators made the warnings in 2003, that growth flattened out after the warnings were issued.

Doctors have assumed that a spike in teen suicide in 2004 resulted from a sharp fall in use of antidepressants among children and youth.

That was not the case, according to Dr. Mark Olfson of Columbia University Medical Center.

"When the warnings first appeared, there was a great deal of concern among psychiatrists and other mental health professionals that these warnings would result in a precipitous decline in antidepressant use by young people, and as a result, youth with depression would have less access to treatment," said Olfson, whose study appears in the Archives of General Psychiatry.

"What we found is the FDA warnings had a relatively moderate and targeted effect in slowing the growth of antidepressant use by children," Olfson said in a telephone interview.

Recent studies have suggested the drug warnings triggered an 8 percent rise in suicide among youth and teens in 2004, the biggest one-year gain in 15 years.

U.S. and European regulators sent out a series of public health warnings on use of the drugs beginning in 2003 after clinical trials showed the drugs increased the risk of suicidal thoughts and behaviors in children and teens.

In 2004, the U.S. Food and Drug Administration issued its strongest warning, a so-called "black box," on the use of all antidepressants in children and teens to draw attention to the possible risks of these medications.

Olfson and colleagues wanted to see the overall impact of the public health warnings and of the FDA's black box warning.

MONITORING SUICIDE RATES
They reviewed U.S. prescription data from before a June 2003 warning by FDA to monitor adolescents taking GlaxoSmithKline's antidepressant Paxil, known generically as paroxetine hydrochloride, for signs of worsening depression and suicidal thoughts.

The researchers also studied antidepressant use in the period leading up to the strict black box warning on all antidepressants, and the period 15 months after the warnings.

They found that prior to the public health warnings, antidepressant use in youth -- those aged 6 to 17 -- had been rising at an annualized rate of 36 percent. But use of these drugs in this age group flattened after the initial warnings in 2003 and that rate did not change significantly after the black box warning was issued in late 2004.

Olfson said the changes in antidepressant use have been confined to youth and young adults, and that adults continued to take the drugs.

The American Foundation for Suicide Prevention said the FDA black box warnings and the drop in antidepressant prescriptions were the most likely cause of the higher suicide rates in young people in 2004.

But Olfson said preliminary figures suggest teen suicide rates in 2005 actually declined from 2004. "This suggests that we need to look more carefully at this issue," he said.

Olfson said his study should address some concerns among physicians that the black box warning went too far.

"There are still a number of physicians who feel the FDA overshot and that these warnings had a dramatic chilling effect," Olfson said.

"I think this study will provide evidence that ... it was not as profound as some physicians have imagined," he added.

The FDA has said it will continue to monitor suicide rates in youth and teens to see if rates continue to rise.

Depression is the leading cause of suicide, which is the third-biggest killer of children and young adults between the ages of 10 and 24.
 

lallieth

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Here's what I honestly think

I don't really believe that anti-depressants cause teen suicide.I think that kids do not have the coping skills to deal with anxiety/depression and the stigma of these two things prevent young adults from asking for help

I was told when I started taking meds,that often things can get worst before they get better,but that they WILL GET BETTER.

Anxiety/depression coupled with side effects can be overwhelming even for well adjusted adults,so I imagine for a young adult,it can seem hopeless and pointless.

Parent/kid communication is so much more important in this day and age,kids have to feel that they can trust their parents to listen to their problems and help them work it out..teach their kids good coping skills.


The media loves to blow everything out of proportion and I think that we need to take what is being said with a grain of salt
 

David Baxter

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The combined evidence I have seen leads me to the same conclusion: SSRIs do not increase suicidal thinking or suicide attempts at any age. The anectdotal evidence suggesting the claim that they do is, I think, based on lack of information given to patients about what to expect from SSRIs - they do NOT act in a way that provides immediate relief for most patients, something that many patients do not understand. If therfe is any correlation between starting SSRIs and increased despair and suicidal thinking at all, I would suggest it occurs in patients who are expecting the medication to provide immediate relief - when that doesn't happen, they may believe their depression is "incurable".

What that should tell us is that follow-up of patients who start any SSRI - or indeed any new medication at all - should be standard practice.

The article, however, is primarily about the observation and previous reports that suicide rates in young people seemed to climb right about the time that the SSRI warnings were issued in the US, Canada, and the UK. This study goes against previous studies in concluding there was no such rise in suicide rates. It's hard to know which to believe but in any case a simple correlation does not imply cause and effect regardless of which "camp" one is in.
 

David Baxter

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Latest Report on SSRI Prescriptions Tempers Concern with Caution

Latest Report on SSRI Prescriptions Tempers Concern with Caution
Wednesday, January 09, 2008

The latest report on the effects of the FDA's antidepressant warnings, published in this month's edition of the Archives of General Psychiatry, concluded that the warnings did result in a leveling-off of SSRI prescriptions, but that this shift occurred mainly among the targeted population. To arrive at this conclusion, researchers from Columbia University's Department of Psychiatry examined prescription data from three distinct periods: data occurring before any warnings were announced, during an initial warning period, and after the black box warnings were issued. The pre-warning period was characterized by increasing prescriptions of all types of antidepressants, while those prescriptions began to level out after news of possible warning labels began to make the rounds.

The researchers make no speculation about the results of declining prescription rates, but we had harsh words regarding the effects of the FDA's warnings on antidepressants. This new evidence simply confirms what we already knew: prescription rates decreased. The decreases occurred in what these researchers called the targeted area, which was that of adolescents and young adults. Unfortunately, we can only fully understand the implications of these actions as they play out over time.

The most important observation drawn from this study may be that the change in prescription rates preceded the actual warnings, which shows that physicians and psychiatrists are keenly aware of the debate that rages about the safety of SSRI medications. This could mean that just as prescribers appeared to take more caution before the warnings, they may become more comfortable and judicious with their scrips now that time has passed and the initial shock of the warnings has abated. This could lead to more effective use of SSRIs, especially in combination with therapy, which would improve overall treatment, and ideally, counteract any initial negative responses to the warnings.

The wild card in this situation is research into the genetic basis for poor SSRI response. With a greater understanding and appreciation for how and why different medications affect different individuals in unique ways, we should be able to greatly improve current outcomes for psychopharmacological approaches to depression. Any news out of this research sector could greatly alter the landscape of the SSRI warnings debate. We'll continue to keep an eye out.
 

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