Over the past decade in the United States youth suicide rates have steadily been declining. Most of this is credited to increased education; more outreach programs, better support systems, as well as more individuals accessing treatments, including prescription drugs, for psychological problems like depression. However, according to the Center for Disease Control and Prevention's Annual Summary of Vital Statistics published last month, the suicide rates sharply rose more than eighteen percent in youths from the ages of one to nineteen years old: from 2.2 per 100,000 in 2003, to 2.6 per 100,000 in 2004, and from 1,737 total suicide deaths in 2003 to 1,985 in 2004. Specifically in those youths from the ages of fifteen to nineteen, the figures reflected more than a twelve percent increase in suicide, from 7.3 per 100,000 in 2003 to 8.2 per 100,000 in 2004. Curiously the rise coincided with the inception of the Food and Drug Administration’s mandated heightened warnings, on the labels of selective serotonin reuptake inhibitors, or SSRIs, a particular kind of antidepressant medication that includes Prozac, Paxil and Zoloft. These “black box” warnings, as they are better known, were added in March 2004 over growing concerns that the drugs led to an increase in suicidal thinking in patients. The prescribing of these medications to children subsequently dropped by over twenty percent.
Since it is well documented that black box warnings can indeed deter some patients from taking certain medication, some mental health professionals are openly criticizing the FDA’s decision to place them on SSRIs. "Patients will be frightened off appropriate treatment," stated Dr. Alex Vuckovic, medical director of The Pavilion at McLean Hospital in Belmont, Massachusetts. "It's already happening to child psychiatrists and their patients. These drugs save lives—end of story, no ambiguity." 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 on February 5th. "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." He added, “This is a disturbing reversal of progress.”
Although there does appear to be a correlative relationship between an increase in youth suicide rates and the reduction of SSRI prescriptions, due to black box warnings, I find it a bit impulsive and irresponsible on the part of critics who hastily point the finger of blame at the FDA. I wholeheartedly agree that the trend is alarming and quite unsettling; however the problem with examining such an immense subject like national youth suicide rates and the explanations of any increase is that it is extremely complicated and difficult, since there are almost an infinite amount of unknown variables that may have an influence on behavior. How can we be sure which one is responsible? Without any solid empirical study examining causative factors in this increase, one simply cannot make factually-based claims, as did Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine, who bluntly said “I have no doubt that there is such a relationship.” That is a bold and unsupported statement that many other scientists completely disagree with. It would be unwise to forget one of the most fundamental principles of good scientific research: correlation is not causation. We must get to the bottom of this tragedy but we can not be so quick as to rush to any conclusion that may possibly alter and have lingering effects on public policy, research and/or treatment decisions, without sufficient data. In the meanwhile we must continue to support existing programs and further educate ourselves and our children about the seriousness of this issue and remain ever so vigilant to any potential problems that may arise and act upon them as soon as possible.