Wednesday, February 14, 2007

SSRI's and Suicide: Updated Update

I found more information regarding SSRIs and suicide in youth. I'm going to present two sets of statistics from an article and then illustrate how it is impossible to say that decreasing rates of SSRI prescription led to more suicides, contrary to what many "experts" are saying. From the Seattle Times:
The suicide rate climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 deaths to 1,985. Most suicides occurred in older teens, according to the data — the most current to date from the federal Centers for Disease Control and Prevention.

--SNIP--

Data from Verispan, a prescription tracking firm, show that 3 million antidepressant prescriptions were written for kids through age 12 in 2004, down 6.8 percent from 2003. Among 13- to 19-year-olds, the number dropped less than 1 percent to 8.11 million in 2004.
So, SSRI prescriptions were essentially unchanged in 2004 (less than 1% decrease) among older teens, who are much more likely to commit suicide than youger children. Logically, how could a less than one percent decrease in SSRI prescriptions among older teens lead to a significant increase in suicides? Seriously, folks!

I thank the Seattle Times for at least presenting some data, as other sources (such as ABC News) have just taken it as fact that SSRI prescriptions plummeted without presenting any information.

See a prior post on this topic here, which cites somewhat different data, but essentially comes to the same conclusion that there is no scientific data that link the 2004 increase in suicides to decreasing SSRI prescriptions.

Note: Please see the comments. A couple of readers provided some additional information that was very interesting. Note that my conclusion on this matter remains unchanged.

8 comments:

nab said...

AHRP Blog had this info:

According to the American Psychiatric Association:

“In 2003, U.S. physicians wrote 15 million antidepressant prescriptions for patients under age 18, according to FDA data. In the first six months of 2004, antidepressant prescriptions for children increased by almost 8 percent, despite the new drug labeling.”

See: American Psychiatric Association, News & Notes Survey Paints Bleak Picture of Health Insurance Coverage and Premiums, Psychiatric Services October 2004, 55:1192-1193.


CL Psych, this may make you cry.
For depressing irony, please see:

http://medrants.com/index.php/archives/3123

DocJohn said...

I suggest you review:

http://pn.psychiatryonline.org/cgi/content/full/39/20/9

I had similar concerns about there not being a clear link (and truth be told, since nobody has actually done a study researching this issue, we still only have an interesting correlational relationship, not a causal one).

nab said...

Docjohn: already did and already discussed this elsewhere, but briefly:

The partial first quarter Medco "data" is pretty damn worthless - it is such a small sample of overall US adolescent utilization patterns:

"Medco is one of the nation's largest pharmacy benefit managers, providing prescription benefits to some 60 million Americans a year, 3.5 million of whom are under 18."

And even contradicted in the same article.

"During that meeting, FDA officials presented data from IMS Health that appeared to show not a decrease in antidepressant prescriptions, as do the Medco data, but a 7 percent increase in the six months following the February meeting and the subsequent warnings."

So I still have not seen anything that actually supports this "correlation" . . .other than a plausible narrative, which many doctors seem to uncritically accept without the slightest hint of irony.

CL Psych said...

Thanks to both NAB and Dr. John for their research. I followed the link in docjohn's comment and NAB was correct that in the same article, there were contradictory data.

The other information I found (discussed in my post) indicated that the SSRI prescription rate seemed to be flat or only decreasing among those least inclined to commit suicide (the age 12 and under crowd). The article cited in the AHRP blog is interesting though it should be noted that it also did not really cite where its info came from.

The IMS data shows an increase in SSRI prescriptions, so the data are certainly muddy, but there is certainly little to no basis for folks like Nemeroff to say that data support a conclusive link between less SSRI prescription and a jump in suicides.

Again, I thank you both for your contributions.

CL Psych said...

Oh, and the medrants post really made me shake my head, just as NAB predicted.

cs said...

The comments at Medrant are now somewhat robuster. The blogger may also be shaking his head.

nab said...

Try going to DrugWonks if you would like to see a really interesting perspective.

I keep trying to post/ask Goldberg a [non-snarky] question, but I never seem to get "approval" . . . but then again no one really does there from what I can tell.

I am very intrigued by anyone with an excited post, titled "Gottlieb speaks!"

CL Psych said...

I'm glad sites like Drug Wonks are around to present the pro-pharma side of things. Not sure that I can find an area of agreement with them, but it speaks well of the internet to have diverse points of view. If they won't post your comments, however, that does not speak well of their comment policy, in my humble opinion.

NAB, do send me an email sometime. You can set up a hotmail or yahoo account to preserve your anonymity and you can rest assured that I am not interested in "outing" you. I'd be interested in your views on a couple of topics.