Back in 2003, the U.S. Food and Drug Administration (FDA) required that a particular class of antidepressants called selective serotonin reuptake inhibitors (SSRI) carry a “black box” warning that for children and teens, side effects may include an increased risk of suicidal thoughts. Sounds perfectly reasonable, doesn’t it?
But then, along comes the Law of Unintended Consequences, which revealed that since that FDA mandate came out, doctors wrote 20 percent fewer prescriptions for SSRIs (which include Prozac, Zoloft, Paxil, and Celexa) for their teen patients. (Adult use of SSRI antidepressants went down by 14 perent—and they weren’t even covered by the FDA warnings). At the same time, teen suicide attempts rose by about the same amount—21.7 percent for teens, 33.7 percent for young adults under 25.
They study’s lead author, Christine Lu, has some interesting thoughts on why this happened. “To a certain extent, the FDA’s black box warning was legitimate, but the media emphasis was really on suicide without noting the potential risk of undertreatment of depression, says Lu, an instructor in population medicine at the Harvard Pilgrim Health Care Institute in Boston, “Because of that, there has been an overreaction, and that overreaction has sent alarming messages to parents and young people.”
As a result of the FDA warnings, doctors began to prescribe fewer SSRIs,, which left a huge number of depressed teens and young adults untreated.
The message here is that the FDA and the medical community need to do a better job of assessing the risks and benefits of various treatments. Yes, the SSRIS may have been associated with an increase in suicidal thoughts in some young people, but not receiving any treatment at all may have led to the increase in suicide attempts. Interestingly, the study noted an increase in the number of attempts. Completed suicides did not increase.
More on this topic here.
