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Youth suicides rose after FDA warnings on antidepressants :

December 1, 2020

Adolescent and young adult suicides rose after federal authorities issued warnings that may have deterred antidepressant use, a study found.

In a 2003 public health advisory, the Food and Drug Administration (FDA) said antidepressants increase the risk of suicidal ideation and behavior in children and adolescents. In 2005, the FDA issued a boxed warning about these risks and in 2007 extended it to include young adults.

Researchers said the intention was to encourage clinicians to be vigilant, but news stories exaggerated the dangers and antidepressant use subsequently declined. To look at the impact of the warnings on suicides, a team studied 1990-2017 death data from a Centers for Disease Control and Prevention database.

The figures showed suicides were declining for adolescents and young adults before the antidepressant warnings and were at 4.2 per 100,000 adolescents in 2002. By 2017, the rate had grown to 7.2 per 100,000 adolescents. Among young adults, there were 12.3 suicides per 100,000 people in 2002, which rose to 17 per 100,000 people in 2017.

Authors estimate the warnings may be linked to 2,365 excess suicide deaths for adolescents from 2005-’10 and 3,593 excess deaths for young adults.

“The FDA antidepressant ‘warning,’ accompanied by exaggerated media coverage, stigmatized depression care for young people, and fostered reluctance by providers to initiate antidepressant treatment,” authors wrote. “Thus, the warnings reduced diagnosis of major depression, and drug and nondrug mental health treatment.”

They acknowledged some have blamed smartphones, cyberbullying, social media and the recession for rising suicide rates. However, they do not believe these factors explain why they saw suicides declining before the warnings and then rising after.

The authors called on the FDA to consider placing less severe warnings on antidepressants and more public education on the risks and benefits.

"Our findings suggest the boxed warnings may have contributed to the very thing the FDA was trying to prevent,” principal investigator Stephen Soumerai, Sc.D., of Harvard Medical School and the Harvard Pilgrim Health Care Institute, said in a press release. “More than two-thirds of depressed teens do not receive any depression care whatsoever, an issue now further exacerbated by COVID-19. We strongly recommend the FDA reexamine the use of these warnings.”

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