Group Finds No Suicide-Antidepressant Link Depression Called Bigger Danger to Kids Than SSRIs
Jan. 21, 2004 -- The SSRI class of antidepressants don't increase suicide in children and teens, a medical group says.
SSRIs -- selective serotonin reuptake inhibitors -- include the popular antidepressant drugs Prozac, Paxil, Zoloft, and Celexa.
Reports of suicide in young people treated with these drugs last October led to an FDA warning about the drugs. The FDA's warning followed a stronger action by the U.K. Medicines and Healthcare Products Regulatory Agency. The British agency advised doctors not to use the drugs in children and teens.
Both the U.S. and U.K. are currently studying the issue. An FDA advisory panel will consider the issue at a Feb. 2 meeting.
But the American College of Neuropsychopharmacology -- an expert group of psychiatrists and pharmacologists -- convened its own task force on the issue. That task force today released its own findings. It's co-chair, J. John Mann, MD, is professor of psychiatry and radiology at Columbia University and chief of the neuroscience department at New York State Psychiatric Institute.
"Our conclusion is that when you look at the SSRIs as a group, there is evidence they are effective for treating depression in children and adolescents," Mann tells WebMD. "Instead of being a risk for suicidal behavior, they are potentially therapeutic. Doctors must go on treating depression, and SSRIs appear to be a reasonable choice."
"No SSRI/Suicide Report" Still Preliminary
The ACNP task force looked at all available published information. But the panel stresses that it did not have access to "a substantial amount" of unpublished data -- including detailed findings held by drug companies -- that will be made available to the FDA panel.
Mann will be a member of the FDA panel. He says he's keeping an open mind.
"The FDA is examining the data we looked at plus it is examining in more detail the data provided from pharmaceutical companies in terms of the type of suicidal behaviors that have occurred," Mann says. "That is new evidence. Based on how that is assessed, the FDA is attempting to look in a uniform way across seven or eight kinds of antidepressants. That will offer a unique opportunity to look at the data individually and collectively."
Still, Mann says, there's a critical need for more research. People enrolled in clinical trials tend to be less suicidal -- and given much better, much more detailed care -- than those treated in real-world settings.
"What are needed are new studies of the efficacy of SSRIs in depressed kids who are suicidal," Mann says. "Most studies actually excluded kids with suicidal behavior. So we must study the effect of SSRI treatment on those suicidal thoughts and behaviors in a way that's up front in the design of the clinical trials."
Depression More Deadly Than SSRIs
Despite this lack of specific research, Mann argues that SSRIs do vastly more good than harm for depressed young people.
"In the U.S. each year there are 4,000 suicides in young people between ages of 10 and 24 -- it's the third leading cause of death in this age group," he says. "Suicide is a complication of psychiatric illnesses. And the commonest cause of suicide is untreated depression. Identifying effective treatments for depression in kids is very crucial."
Mann says the task force found strong evidence that SSRI treatment helps depressed kids. Moreover, he cites compelling circumstantial evidence: Suicide rates started going down when SSRIs became available.
"There has been a 14-year steady decline in suicide rates in young people," Mann says. "Across 15 countries there has been a 33% decline in suicide rates amongst youths. What is causing that -- what arrested and reversed what had been a steady increase in teen suicide? In most countries that decline began after the introduction of SSRIs."
And there's another bit of circumstantial evidence. Mann cites an unpublished study showing that the vast majority of young people who committed suicide were not treated for their depression. And even in the minority who were prescribed SSRIs, autopsy reports found no sign of the drugs.
"You see a pattern of suicide happening in untreated or noncompliant individuals," Mann says. "So if you thought that antidepressants were somehow triggering suicidal behavior -- well, you just don't see it. All the evidence points to lack of treatment as a factor in suicidal behavior."
Not all mental health experts agree with the ACNP task force's finding that SSRIs are helpful in treating depression in young people.
"There are no compelling data indicating a clinically meaningful benefit for antidepressants over placebo or over alternate treatment approaches," University of Connecticut psychology professor Irving Kirsch, PhD, told WebMD in an August 2003 interview.
All but one member of the 10-member ACNP panel -- including Mann -- has served as a consultant to or has received research support or grants from pharmaceutical companies.
SOURCES: J. John Mann, MD, professor, psychiatry and radiology, Columbia University; chief, department of neuroscience, New York State Psychiatric Institute. Irving Kirsch, PhD, professor, department of psychology, University of Connecticut. Executive Summary: Preliminary Report of the Task Force on SSRIs and Suicidal Behavior in Youth, American College of Neuropsychopharmacology, Jan. 21, 2004. U.K. Medicines and Healthcare Products Regulatory Agency. U.S. Food and Drug Administration.
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