Substance Abuse

Translational Research

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A recent report issued by British drug authorities and endorsed by the FDA said that unpublished studies show the antidepressant Paxil carries a risk of prompting some teen-agers and children to consider suicide. Because the studies also found that Paxil was no more effective than a placebo in treating young people's depression, the U.S. regulators recommended that doctors write no new Paxil prescriptions for patients under 18. However, earlier in the year, the FDA approved Prozac, another SSRI, for the treatment of major depressive disorder in young people ages 7 to 17.

Although millions of people have taken the drugs, and many experts believe that SSRIs like Paxil have prevented far more suicides by teen-agers and children than they have caused, fears about antidepressants' effects on teen behavior have still taken hold in the public consciousness.

Now, in a new study, Columbia researchers have found a correlation between the increased use of SSRIs and a decline in suicides among adolescents in the decade from 1990 to 2000.

In findings published in the October 2003 issue of the Archives of General Psychiatry, the team – Dr. Mark Olfson, professor of clinical psychiatry; Dr. David Shaffer, professor of psychiatry and pediatrics; Dr. Steven Marcus, research assistant professor at the University of Pennsylvania; and Ted Greenberg, MPH, research associate at Columbia – raises the possibility of a role for antidepressants in youth suicide prevention efforts, especially for males, older adolescents, and adolescents who live in low-income areas. Young people in low-income areas often tend to be in greater need of treatment than those in higher income areas, according to Dr. Olfson.

Although adolescent suicides have steadily declined in the United States during the past several years, youth suicide is still the third-leading cause of death among adolescents age 15 to 19 and the fourth-leading cause among children age 10 to 14.

The current findings are based on a study of antidepressant use and suicide rates among teens in 588 zip code regions in the United States. The researchers looked at data from a major pharmacy benefit program, national suicide mortality files, regional sociodemographic data from the 1990 and 2000 U.S. censuses and regional data on physicians per capita. The researchers found that overall, a 1 percent rise in antidepressant use by teen-agers correlated with a decrease of .23 suicides per 100,000 teens. This inverse relationship was not seen with the older tricyclic antidepressants such as Elavil or Tofranil. The authors state that the earlier findings from randomized controlled trials with tricyclic antidepressants in youth have been "disappointing." Compared with tricyclic antidepressants, SSRIs are associated with greater medication adherence, less danger when taken in overdose, and greater efficacy in young people.

In the current study, the inverse relationship between antidepressant medication and suicide was seen in older adolescents and males but not in younger adolescents and females.

"The relationship between antidepressants and suicide risk is not clear-cut," Dr. Olfson says. "Simply giving teen-agers more antidepressant medications will probably not guarantee continued declines in the rate of youth suicide. At the same time, our findings are consistent with suicide risk reduction policies that aggressively seek to identify and treat young people with major depression and other psychiatric disorders that are responsive to antidepressants."

—Anna Sobkowski Lachter