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Antidepressant warnings increase suicides, claims study

By Lilian Anekwe

Warnings over use of antidepressants in young people have been accompanied by a leap in their number of suicides, researchers are warning.

A series of warnings have been issued in the UK and internationally, advising GPs to avoid prescribing antidepressants to children and adolescents, because of suggestions that the drugs are associated with a raised risk of suicidal behaviour.

Those warnings have prompted falls in use of antidepressants in young people – but new evidence suggests the effect may have been the opposite of that intended.

A team of Canadian researchers found that suicide rates among depressed children and adolescents jumped by 25% after warnings on the use of antidepressants from Health Canada – the country's regulatory body.

The study, based on records of more than 265,000 children, adolescents and young adults, found the prescription rate of antidepressant fell by 14% in children and adolescents and 10% in young adults aged 19-24 in the two years after a regulatory warning was issued in Canada in June 2004.

During the same period, the suicide rate in children and adolescents rose by 25%, although the effect seemed restricted to adolescents, whose crude prevalence of suicide rose from three per 1,000 in 2002/3 to eight per 1,000 in 2005/6.

The authors, whose study was published in concluded in the Canadian Medical Association Journal, said their results ‘raise several question about the impact of warnings from regulatory bodies', and suggested warnings about antidepressants in the young could lead to vulnerable patients receiving less care.

Lead research Dr Laurence Katz, a researcher at the department of psychiatry at the University of Manitoba, said: ‘Our findings suggest the warning not only affected prescribing patterns of the drugs mentioned but that it also had spillover effects on the provision of care.'

Dr Stephen Pilling, a consultant clinical psychologist at University College London and a member of the NICE depression group, said: ‘Anything that comes out of research like this is borne out of what are genuine concerns about the safety of antidepressants. But it is dangerous to draw conclusions from studies in isolation.

‘It's unfortunate when one thing dominates public health messages in this way. Simplistic conclusions like this are often not helpful. NICE has pressed very strongly for improved detection and better identification of depressed kids.'

Suicide fears Suicide fears

Regulatory warning issued in 2004 on use of antidepressants in children and adolescents

Prescription rates fell by 14% in children and adolescents and 10% in young adults – with particular falls in use of SSRIs other than fluoxetine

Suicide rate rises by 25% in children and adolescents, with a big leap in adolescent suicides in particular

Source: CMAJ;178:1005-11

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