Some Experts Blame FDA Labeling for Child Suicide Increase

Child and teen suicide rates rose for the first time in more than a decade in 2004 -- and many psychological experts said the stronger warning labels that led to a drop in the number of prescriptions for antidepressant drugs may be to blame.

According to the Center for Disease Control and Prevention's Annual Summary of Vital Statistics released Monday, the suicide rate rose more than 18 percent in those 1 to 19 years old, from 2.2 per 100,000 in 2003 to 2.6 per 100,000 in 2004.

In those 15 to 19 years old, the figures reflected a more than 12 percent rise in suicide, from 7.3 per 100,000 in 2003 to 8.2 per 100,000 in 2004.

The rise occurred at the same time that the Food and Drug Administration mandated heightened warnings on the labels of selective serotonin reuptake inhibitors (SSRIs), a particular class of antidepressant medications that includes Prozac, Paxil and Zoloft.

The "black box" warnings were added in March 2004 over concerns that the medications led an increase in suicidal thinking in patients. The prescribing of these medications to children subsequently dropped by 20 percent.

Not all experts said there was a clear link between the warning labels and the increase in suicide rates, but many believe the association is too dramatic to ignore.

"I have no doubt that there is such a relationship," said Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine.

"The concerns about antidepressant use in children and adolescents has paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates."

"This is very disturbing news," said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine. "The adolescent suicide rate has been declining steadily since the early 1990s.

"The sudden increase in the adolescent suicide rate," Fassler continued, "corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group."

The nonprofit group Mental Health America has also called for a further look into the FDA's decision to strengthen warnings on SSRIs.

"As a result of the agency's activities, dramatic decreases in the use of SSRIs in the adolescent population were noted," said David Shern, president of Mental Health America in a statement issued Monday. "Other research has indicated a general relationship between the use of SSRIs and decreasing suicide rates in the general population.

"We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants have caused an increase in youth suicide."

Warning Labels May Scare Doctors, Parents

Some doctors say the additional black box warnings may have led medical professionals to be less confident in prescribing antidepressants.

"In the state of Michigan, we have found that our colleagues in pediatrics have become increasingly uncomfortable with the prescription of SSRIs following the institution of the black box warning," said Dr. Sheila Marcus of the section of child and adolescent psychiatry at the University of Michigan Hospitals.

"The past history of such FDA warnings has revealed that they create barriers to care and unnecessarily frighten families away from seeking treatment," Nemeroff said.

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