Anti Depression Medications Lower Suicide Rate, Study Shows
I was immeasurably relieved to see a study last week in the American Journal of Psychiatry that indicated that suicide rates dropped among depressed people soon after they started treatment with antidepressants or psychotherapy.
You might wonder why I say I was relieved instead of just pleased. Mainly because SSRI antidepressants have been taking it on the chin since 2004, especially when it comes to adolescents or children being treated with them. It was in 2004 that studies came out that indicated that younger patients on SSRI antidepressants had a higher rate of suicide. This, combined with a suit by a publicity-seeking state attorney general against GlaxoSmithKline, led the FDA to institute a "black box" warning on all SSRI antidepressants except Prozac.
Although very few in the medical community disputed the findings or disagreed with the action the FDA took, many were worried that all the publicity and media frenzy would drive young people (and their doctors) away from antidepressant treatment altogether.
It turned out that this concern was well-founded. The number of pediatric antidepressant prescriptions plunged by 52% in the next year and teenage suicides rose by 18%, after having been in decline for a decade. Unfortunately, the media chose not to publicize the second set of figures. I'm not sure why. It seems pretty irresponsible to make a big hoo-ha over the FDA's decision, but not subsequently report on findings that in all likelihood were a result of that decision.
Let me say right now that I am not an apologist for the drug companies. For years, I've expounded the virtues of psychotherapy as well as, or instead of, antidepressants in depression treatment. I think the tactics the drug companies use to push their drugs can be downright appalling. I think it's also true that medical insurers in general make it harder for you to get non-medication depression treatment approved, since medication is generally cheaper than therapy (in the short run). However, I also think that antidepressants saved my life, or at least made it a lot more enjoyable. I know that they've done the same for thousands of people.
Anyway, back to the study. A team led by Dr. Gregory Simon of the Center for Health Studies in Seattle, analyzed the records of over 100,000 people being treated for depression. They divided the patients into three groups. The first group was composed of people who received their antidepressant prescription from their primary care physician. The second group received their prescription from their psychiatrist. The third group was treated with psychotherapy only.
The team looked at the rate of suicide attempts in each group from 90 days before to 180 days after beginning treatment. They found a clear pattern in the incidence of suicide attempts over time, and it was consistent across all three groups. The rate of suicide attempts was highest in the month before starting treatment, next highest in the first month of treatment, and still lower as treatment continued.
In other words, the groups that were treated with antidepressants did not have a higher rate of suicide than the group treated with therapy.
There are three things that I feel are important to note. One is that the study did find a higher incidence of suicide attempts in adolescents and young adults, which is consistent with previous findings. The second is that the incidence of suicide attempts was lowest among the group of people that received their antidepressant prescriptions from their primary care physicians and highest among people in the group who received their prescriptions from their psychiatrists. The group of people who received only psychotherapy fell in the middle.
I find this interesting, although a bit perplexing. I would have assumed that psychiatrists were better at follow-up and spotting potential suicidal behavior than primary care physicians, but maybe since the primary care physicians were more involved with the patient's overall care, this translated into more time spent with the patient.
One other thing I feel that it's important to note. There is a period soon after an antidepressant regimen is begun that can be dangerous for some people. It's an odd paradox. People who were too sunk in depression to plan and execute a suicide before they started antidepressant therapy start to improve enough on the antidepressant to actually attempt suicide, because they are not yet feeling well enough that they are not experiencing suicidal ideation.
Suicide Findings Question Link to Antidepressants
Antidepressants and Suicidal Acts
Published On: July 14, 2007