Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 18:348:g3596.
doi: 10.1136/bmj.g3596.

Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

Christine Y Lu  1 , Fang Zhang  2 , Matthew D Lakoma  2 , Jeanne M Madden  2 , Donna Rusinak  2 , Robert B Penfold  3 , Gregory Simon  4 , Brian K Ahmedani  5 , Gregory Clarke  6 , Enid M Hunkeler  7 , Beth Waitzfelder  8 , Ashli Owen-Smith  9 , Marsha A Raebel  10 , Rebecca Rossom  11 , Karen J Coleman  12 , Laurel A Copeland  13 , Stephen B Soumerai  2
Affiliations

Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

Christine Y Lu et al. BMJ. .

Abstract

Objective: To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people.

Design: Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends.

Setting: Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network.

Participants: Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million).

Main outcome measures: Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides.

Results: Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were -31.0% (95% confidence interval -33.0% to -29.0%) among adolescents, -24.3% (-25.4% to -23.2%) among young adults, and -14.5% (-16.0% to -12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100,000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, -6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100,000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group.

Conclusions: Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that all authors have support from the National Institute of Mental Health for the submitted work. FZ received personal fees from Policy Analysis outside the submitted work. RBP received research funding from Bristol-Meyers Squibb for a study regarding antipsychotic augmentation therapy for major depression in adults only. GS reports grants from Bristol-Myers Squibb outside this work. EH has two pending patents, “Individualized health care management system” (patent application No 11/155 967 publication No US20050283385. Enid Hunkeler, et al. The Permanente Medical Group will own the patent if granted), and “System and method for assisting a care partner in monitoring a patient with chronic disease” (patent application No 11/155 821 publication No US20050283384. Enid Hunkeler, et al. The Permanente Medical Group will own the patent if granted). Other authors declared no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adolescents enrolled in 11 health plans in nationwide Mental Health Research Network
None
Fig 2 Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among young adults enrolled in 11 health plans in nationwide Mental Health Research Network
None
Fig 3 Rates of antidepressant use, psychotropic drug poisonings, and completed suicides per quarter before and after the warnings among adults enrolled in 11 health plans in nationwide Mental Health Research Network
See this image and copyright information in PMC

Comment in

References

    1. Kaizar EE, Greenhouse JB, Seltman H, Kelleher K. Do antidepressants cause suicidality in children? A Bayesian meta-analysis. Clin Trials 2006;3:73-90; discussion 91-78. - PubMed
    1. Leckman JF, King RA. A developmental perspective on the controversy surrounding the use of SSRIs to treat pediatric depression. Am J Psychiatry 2007;164:1304-6. - PubMed
    1. Simon GE. The antidepressant quandary—considering suicide risk when treating adolescent depression. N Engl J Med 2006;355:2722-3. - PubMed
    1. Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006;63:332-9. - PubMed
    1. Olfson M, Marcus SC. A case-control study of antidepressants and attempted suicide during early phase treatment of major depressive episodes. J Clin Psychiatry 2008;69:425-32. - PubMed

Publication types

Substances