Friday, June 8, 2012

Risk of Suicide with Antidepressants Over Estimated

When the US Food and Drug Administration issues a black box warning, it is usually to alert physicians of a serious side effect of a drug.  That warning is highlighted in all of the package material of the pharmaceutical and is a big deal.  For years, the SSRI antidepressants have carried a black box warning that the drug might cause suicide in children and adults.  This warning was there despite the fact that no actual suicides occurred during the drug trials but patients did experience suicidal thoughts and behavior.  I remember hearing about lawsuits against psychiatrists when medication was prescribed and it was thought to have contributed to suicide attempts.

A new meta-analysis study has been published in the Archives General Psychiatry that analyzed 9185 patients who took Fluoxetine (Prozac) and Venlafaxine (Effexor).  These included 7517 adults, 960 geriatric patients and 708 youths.  Contrary to the black box warning, they found that these medications decreased suicidal thoughts and behavior in adults compared to placebo.  No differences were found for youths.  In all age groups, severity of depression improved with medication and was significantly related to suicidal thoughts.  There were no suicides that were attributed to the medication.

This study is important because some clinicians may not prescribe and some patients may be afraid to take antidepressants that could significantly help their quality of life.  Major depressive disorders are life threatening and SSRI medication has been an amazing modern breakthrough to help people get back on track.

If you google this topic you get lots of scary anecdotal information about antidepressants causing suicide and violence along with the usual conspiracy stories and pharmaceutical bashing.  When you consider that 70% of people who commit suicide did not see a psychiatrist within the last year, you realize how serious depression is.

Antidepressants do not cure life problems, but they bring significant relief and save significant lives in millions of humans.


Anonymous said...

Thanks for this important piece. My best friend committed suicide and it was such a surprise to all of us. I keep thinking of how it could have been different if she would have shared her problems and let us get her help. I know others who have been helped by antidepressants and I wish she would have had the chance to try them.
Thank you.

Candida Abrahamson said...

This was an important piece for you post, given the media frenzy after the black-box warning. It is not just the newest research by Gibbons, disproving the connection vis-a-vis prozac. Gibbons also published a piece as early as 2007 showing how youth suicides declined with the prevalence of the new SSRIs--and then increased again after FDA warnings, and as early as 2004, before the second and third warnings, a paper in CNS drugs entitled "Antidepressant Treatment and Risk of Suicide Attempt by Adolescents with Major Depressive Disorder: A Propensity-Adjusted Retrospective Cohort Study" found that "Antidepressant medication use had no statistically significant effect on the likelihood of suicide attempt in a large cohort of adolescents across the US."

[For full information, see the post "'The Reports of My Death Are Greatly Exaggerated': As Is the Correlation of Antidepressants With Suicide" at]

Sometimes things aren't what we believed them to be.

Michael Kirsch, M.D. said...

Sadly and tragically, a small fraction of depressed individuals will commit suicide. This is the far end of the spectrum of this disease. Let's not rush to link this outcome to the drugs prescribed to treat them. While I don't discount a link out of hand, let's not pile on the drug in an effort to find a deep-pocketed scapegoat to blame.

Toni Brayer, MD said...

Michael Kirsch: Agree. This study (along with others) has debunked the SSRI-suicide link. It's now time to remove the black box warning!

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