Ever since the furor erupted over antidepressants and suicide, psychiatrists worry the media attention and Black Box warnings cause some kids to go undiagnosed and untreated. Now, a new study makes that case after sifting through more than 65,000 patient records in managed care databases between 1998 and 2005.

The study in the American Journal of Psychiatry finds that, from 1999 to 2004, pediatric diagnoses of depression increased from 3 to 5 per 1,000, but after an October 2003 FDA advisory was issued, the national rate fell back to 1999 levels, which the authors describe as a “significant deviation from the historical trend.”

Among patients with depression, the proportion receiving no antidepressant increased to three times the rate predicted by the preadvisory trend, and prescription fills were 58 percent lower than predicted by the trend. And so they conclude the FDA advisory was “associated with significant reductions in aggregate rates of diagnosis and treatment of pediatric depression.”

That’s hardly surprising. Common sense would dictate new warnings would augur caution. Psychiatrists, of course, worry about throwing the baby out with the bath water, which is fair. But the warnings should continue to serve as a reminder for more careful diagnosis and rigorous patient follow-ups, and less knee-jerk prescription writing.

And who paid for the study? Lilly, which brought us Prozac and Cymbalta. In addition, five of the six authors report unrestricted grants from Lilly. One is also a Lilly advisory board member, while another receives research support from Glaxo, of Paxil fame. And another receives support from Pfizer, which sells Zoloft, and J&J’s Janssen, which markets the Risperdal antipsychotic. Only one study author reported no conflicts. The journal claims there was no bias.

Meanwhile, the Psychiatric Times carries a report on an abstract indicating young suicide victims were significantly more likely to have SSRIs in their bloodstream than were young homicide or accident victims.

In an analysis of “unnatural” deaths recorded by the Virginia Medical Examiner’s Office for 1987 through 2003, Antony Fernandez and colleagues found that the SSRI antidepressants and the Effexor SNRI appeared significantly more often in post-mortem toxicology of suicides than of accident or murder victims.

Among the children who committed suicide, these pills weren’t found more often among those whose deaths were ruled suicide by poison than among those who hung or shot themselves, the researchers noted at the American Psychiatric Association meeting. However, the investigators, from the Virginia Commonwealth University in Richmond and the University of Virginia in Roanoke-Salem, cautioned that their data are descriptive only, and do not establish a causal link between the antidepressants and suicide.

The authors noted their study was limited by the retrospective design, and by a lack of information describing the mental state before death of the youths who committed suicide. “Our retrospectively derived data do not reveal whether SSRIs are causally involved in provoking suicidal behavior or suicide. Our report does provide data that may be useful in future meta-analyses addressing this issue,” they wrote.