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A study published in the BMJ claimed that media coverage of safety warnings about suicide risk from antidepressant use affected people’s behaviour and coincided with simultaneous increases in suicide attempts among young people.
Prof Sue Bailey, President of the Royal College of Psychiatrists, said:
“The RCPsych welcomes this study on three levels. One, it serves as a timely reminder that we have an ethical and clinical duty to monitor and reduce any possible ‘unintended side effects’ of regulatory warnings and subsequent media coverage. First practice, least harm.
“Second, what we know is that psychological therapies are the first line treatments for depression in children and young people. Antidepressants continue to play an important part in the management of moderate to severe depression. Treatment should be tailored to individual need taking a multi-modal approach.
“Third, it brings back into the spotlight in England the grim reality of under-resourcing of child mental health services across prevention, early intervention, with, at the present time, a totally unacceptable lack of intensive care, community, and inpatient treatment for young people.
“Young people and families should expect to receive appropriate treatment near to home. Our children deserve better.”
Prof Keith Hawton, Director, Centre for Suicide Research, University of Oxford and Consultant Psychiatrist, Oxford Health NHS Foundation Trust, said:
“The results of this study are important. We also found a decrease in prescribing of antidepressants in adolescents in England following the MRHA warning in 2003 about possible suicidality associated with certain SSRI antidepressant using data from the Multicentre Study of Self-harm in England (Bergen et al, British Journal of Clinical Pharmacology, 2009, 68, 618-629), but no increase in self-harm presentations to general hospitals. Such findings illustrate the powerful impact that such announcements can have on clinician behaviour. Our findings from the UK indicated that this was not just on the targeted antidepressants (certain SSRIs) but also on clinicians’ willingness to prescribe antidepressants in general to adolescents. Until now there has not been convincing evidence that such changes in practice have affected suicidal behaviour. The US study suggests that this may have happened, although fortunately without evidence of an increase in actual suicides.”
Dr Linda Wijlaars, Research Associate in Population, Policy and Practice at UCL, said:
“The paper by Dr Christine Lu and colleagues looks at changes over time in antidepressant dispensing and attempted and completed suicides using health data on 7.5 million Americans. They were interested in the relation between the two as the FDA issued a warning in 2004 stating that antidepressants might increase the risk of ‘suicidality’ – suicidal thoughts and suicide attempts – in adolescents. At around the same time in the UK, the MHRA issued a similar statement for just one type of antidepressants, SSRIs (selective serotonin reuptake inhibitors).
“The authors observe that after the FDA put this warning on patient information leaflets, fewer antidepressants were dispensed. At the same time, suicide attempts started going up, which they suggest might be because of undertreatment of depression.
“Although it is tempting to say this finding means that the two are correlated, this isn’t necessarily the case. The study tried to see whether rates of antidepressant dispensing and suicide attempts started changing at the same time. The fact that they did does not mean that one caused the other. There are many other factors that could have had an influence on both which this type of study cannot correct for. This study provides no evidence that the observed increase in suicide attempts was caused by the decrease in antidepressant prescriptions. The association found by the authors may be a spurious one – this website (http://www.tylervigen.com/) has some nice examples of other spurious correlations.”
Prof Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP), said:
“Recent news stories have suggested that ‘antidepressants do more harm than good’. If that were true, the results of this study should have been the opposite of what they are. In fact, self-poisonings rose by about 20% when prescribing of antidepressants fell by a similar proportion in the second year following FDA black box warnings about antidepressants causing suicidality in young people.
“While these warnings were well intended, they were interpreted in the media as proof that antidepressants caused suicide. This made little sense at the time and makes even less now. Doctors have a particular responsibility not to feed misleading soundbites to journalists: careless talk probably does cost lives”.
Declared interests
Prof Guy Goodwin:
All Financial Involvement with a pharmaceutical or biotechnology company, a company providing clinical assessment, scientific, or medical products or companies over past 2 years (Calendar Years 2013-14 ):
Grants from pharmaceutical or biotechnology company, a company providing clinical assessment, scientific, or medical products directly, or indirectly through a foundation, university, or any other organization (Calendar Years 2013-14 Present):