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David Baxter PhD

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Teen Suicide, Antidepressant Link Questioned
Wednesday, December 15, 2004
By Daniel DeNoon, WebMD Medical News

Close Look Casts Doubt on Depression Drugs as Teen Suicide Cause

Dec. 15, 2004 -- Suicide attempts in depressed teens aren't due to antidepressant drug use, a new study suggests.

Depressed teens who take antidepressants do attempt suicide more often than teens whose depression isn't treated with drugs, find researchers at the University of Colorado Health Science Center. But a closer look at the data - taking into account severity of depression and other factors that influence suicidal behavior - shows that the drugs don't increase teen suicide attempts.

In fact, kids who take the drugs for six months or more are less likely to attempt suicide, report Robert J. Valuck, PhD, RPh, director of pharmaceutical outcomes research at the UCHSC, and colleagues. Their analysis of insurance claims for more than 24,000 depressed 12- to 18-year-olds appears in the current issue of CNS Drugs.

"People see that crude relationship between antidepressants and suicide attempts and say antidepressants are bad," Valuck tells WebMD. "But what if we adjust for all these factors that may contribute to the person's likelihood of attempting suicide? When we do that, the relationship goes away. There are a lot of things going on in teens who attempt suicide. It is not just the antidepressant drugs."

The new report comes on the heels of a recent study that found an increase in suicidal behavior in the days immediately after patients start antidepressant therapy. One of the leaders of that study is James A. Kaye, MD, DrPH, senior epidemiologist for the Boston Collaborative Drug Surveillance Program and associate professor at Boston University School of Public Health.

"They have found essentially the same thing we did: that suicidal attempts are more likely soon after someone is getting treated," Kaye tells WebMD. "It is still controversial whether the drugs are doing something to stimulate suicide or whether it is just that people are at their worst when starting therapy. We sort of favor the latter. This study is supportive of that view -- that it is not the drugs themselves."

Fewer Teen Suicides With Successful Antidepressant Treatment
More and more teens are getting prescriptions for antidepressant drugs. But the study shows that health professionals prescribe antidepressants for only about a third of depressed teens, says study co-author Alexis A. Giese, MD, professor of psychiatry and medical director for acute care and inpatient services at UCHSC.

"The idea that patients are being prescribed these drugs willy-nilly across the board is not accurate," Giese tells WebMD. "Doctors are being circumspect in prescribing these drugs for people who are more severely mentally ill."

The best treatment for depression, Giese says, is combining drug treatment with psychotherapy, family therapy, and/or social therapy.

"Antidepressants by themselves are not a treatment plan," she notes. "Children, especially in early treatment, need to be monitored and to get specific treatment, not just medications alone. We know that treatment has to be individualized. The individual's psychological issues and social situation need to be factored in."

Study co-researcher Anne M. Libby, PhD, assistant professor of psychiatry at UCHSC, stresses the finding that depressed teens who complete antidepressant therapy are less likely to attempt suicide than depressed teens who don't receive antidepressants.

"In our study, the kids who stayed on antidepressant therapy for at least six months -- a complete course -- had a 66% reduced risk of suicide," Libby tells WebMD. "In other words, statistically speaking, antidepressants alone don't seem to increase the risk of suicide attempts. But if you are on the drug and stay on it, you actually have a protective effect."

SOURCES: Valuck, R.J. CNS Drugs, 2004; vol 18: pp 1119-1132. Robert J. Valuck, PhD, RPh, associate professor of pharmacy and director of pharmaceutical outcomes research, University of Colorado Health Science Center, Denver. Anne M. Libby, PhD, assistant professor, University of Colorado Health Science Center, Denver. Alexis A. Giese, MD, professor of psychiatry and medical director, acute care and inpatient services, University of Colorado Health Sciences Center, Denver. James A. Kaye, MD, DrPH, senior epidemiologist, Boston Collaborative Drug Surveillance Program; associate professor, Boston University School of Public Health.
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