Beginning in 2003, the Food and Drug Administration (FDA) started issuing warnings regarding the potential suicide risk for young people taking antidepressants. Researchers from Harvard Medical School's Department of Population Medicine and the Harvard Pilgrim Health Care Institute have reported that these FDA antidepressant warnings may have backfired, causing more suicide attempts among teens and young people.
"This study is a one of the first to directly measure a health outcome driven by the interaction of public policy and mass media," Christine Lu, HMS instructor in population medicine at Harvard Pilgrim Health Care Institute and lead author of the study, said in a statement. "The FDA, the media and physicians need to find better ways to work together to ensure that patients get the medication that they need, while still being protected from potential risks. We need to do a better job of understanding and communicating the risks of taking—and not taking—medications.”
Lu and her colleagues used a “virtual data warehouse” comprised of anonymous patient data that allowed them to compare insurance claims between 2000 and 2010 from 11 health plans under the U.S. Mental Health Research Network. Overall, the research included 1.1 million adolescents, 1.4 million young adults, and 5 million adults. Suicide attempts were measured by overdoses with psychotropic drugs, which in some cases resulted in long-term hospitalization and a notable disruption of the lives of both the patients and their families.
Researchers were not surprised to find a lack of change among completed suicides, however, the number of suicide attempts saw a dramatic increase. After the start of FDA drug warnings in 2003, the number of antidepressants prescriptions being filled had dropped by 20 percent in the following year. In the same year the number of suicide attempts by overdose with psychotropic drugs increased by 21.7 among teenagers and 33.7 percent among young adults.
"This is an extraordinarily difficult public health problem, and if we don't get it right, it can backfire in serious ways," said co-author Stephen Soumerai, HMS professor of population medicine at Harvard Pilgrim Health Care Institute. "These drugs can save lives. The media concentrated more on the relatively small risk than on the significant upside."
The research team also noted that in the years prior to the FDA issuing these warnings the number of reported suicide attempts among young people was stable. Research cited by the FDA concerning the potential suicide risk only reported a one percent increase in the risk of suicidal thoughts among adolescents and young people who were prescribed antidepressants, not completed suicides and suicide attempts.
Source: Zhang F, Lakoma M, Lu C, et al. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ. 2014.