Antidepressant Scrips & Suicides: Study Was Hasty
18 CommentsBy Ed Silverman // December 11th, 2007 // 9:47 am
You may recall that last September the American Journal of Psychiatry published a study blaming a 14 percent rise in teenage suicides - from 2003 to 2004 - on the widespread publicity given links between antidepressants and suicide. (Here is the abstract). The study also predicted further suicides if scrips continue to decline. Although the Black Box warnings didn’t appear on product labeling until early 2005, the conclusion prompted federal officials to say the warnings may be reviewed, depending upon future suicide data.
Now, though, two prominent physicians say its best to view the conclusions with skepticism, and one of them is David Shaffer, who created Columbia University’s Teen Screen program, which advocates mental health screening. Ironically, the program is controversial because critics of widespread antidepressant usage say Teen Screen has been used around the country as a sort of smokescreen to push the drugs unnecessarily.
Yet, in a letter to the American Journal of Psychiatry, Shaffer and a colleague, Mark Olfson, write that it is “risky to draw conclusions from limited ecologic analyses of isolated year-to-year fluctuations in antidepressant prescriptions and suicides. One promising epidemiological approach involves examining the associations between trends in psychotropic medication use and suicide over time across a large number of small geographic regions. Until the results of more detailed analyses are known, prudence dictates deferring judgment concerning the public health effects of the FDA warnings.”
To back up their assertion, they cite the following figures…
“The authors reported that the national SSRI antidepressant prescription rates declined between 2004 and 2005 for all age groups, except those 60 years (or older). In light of these declines, it is instructive to compare the national number of suicides in 2004 with recently available preliminary figures for 2005, overall and within the relevant age strata,” they write in their letter.
They go on to note that “the total number of suicides declined from 32,439 in 2004 to 31,769 in 2005. More specifically, the number of suicides declined for persons ages 25 to 44 (11,712 to 11,262), ages 15 to 24 (4,316 to 4,139), and ages 5 to 14 (285 to 270). These declines occurred despite decreasing overall SSRI scrips among these age groups reported in the study.
“In terms of rates per 100,000, the suicide rate for all ages declined from 11.0 in 2004) to 10.7 in 2005. For ages 25 to 44, the rate of suicide declined from 13.9 to 13.4, and it declined from 10.3 to 9.8 for ages 15 to 24. For ages 5 to 14, the rate of suicide remained constant at 0.7. The ratio of preliminary-to-final all-age suicides was 0.968 in 2002, 0.973 in 2003, and 0.976 in 2004.
“The focus of (the study) on SSRI scrips may not have captured the full range of effects of the warnings on clinical practice,” they write. “For example, the warnings were associated with an increase in prescriptions of non-SSRI antidepressants to youth as physicians searched for alternative treatments. The effects of the warnings on the use of antipsychotic meds and other psychotropic medications remain poorly defined. Detailed longitudinal analyses of various classes of psychotropic medications and psychotherapy would enrich our understanding of the various effects of the warnings on clinical practice.”
In other words, Shaffer and Olfson say the study jumped to conclusions.
[UPDATE: Robert Gibbons, the study’s lead author, offered a rebuttal in his own letter, which was just sent us. Among other things, he has this to say:
“Drs. Olfson and Shaffer refer to recently released preliminary suicide-rate data for 2005, indicating that suicide rates have not increased further from 2004 to 2005, and suicide rates in some age groups have actually decreased (9). This is an important observation and, if verified in the final CDC data, deviates from our predictions.
However, and perhaps most importantly, the 14% increase in the suicide rate among children ages 5 to 14 seen from 2003 to 2004 is not reversed in the preliminary 2005 data, and therefore remains a serious public health concern. This lack of decrease in suicide rates in younger age groups contrasts with a continuing decline in suicide rates among individuals over age 60, who experienced an ongoing increase in prescription rates during the same time period. These data continue to indicate that the FDA black box warning has not led to a reduction in youth suicide, which would be expected if the risk of antidepressant treatment outweighed the benefit.
“Although antidepressant prescriptions further decreased in this age cohort from 2004 to 2005, the real question is whether the most severely ill children who are at greatest risk of suicide are receiving treatment for their illness. It is possible that changes in the overall population-level antidepressant treatment rate may not accurately reflect the rate of antidepressant treatment among those children at greatest risk for suicide.”
Lisa Van S
Ed,
Medco Health Solutions Report on Psychotropic Drugs in Kids
http://webmd.com/parenting/news/20070517/prescription-drug-use-up-in-teen-girls
James
An excellent reminder that *all* studies must be taken with a grain of salt and a healthy dos of skepticism. Just because it is published in a journal does not make it true–further, many (most?) studies simply find correlation, not causation. Unfortunately, many in the press, and many advocates for a particular position, will jump to conclusions.
This is one of the reasons why nearly every study contains the statement “further research is needed” (the other reason is it justifies their next grant proposal) ;)
Lisa Van S
James
The Spin,..Begins
Amy Gemoules
Shaffer? TeenScreen?
Shaffer is pushing a psychiatric / pharmaceutical plan to “suicide screen” every child in the United States before they graduate from high school. Evidence exists that shows massive pharmaceutical backing that will result in even more overdrugging of kids with psychiatric drugs.
Here is a short video on TeenScreen:
http://www.youtube.com/watch?v=RfU9puZQKBY
And here is a petition against TeenScreen:
http://www.petitiononline.com/TScreen/petition.html
Please sign it and pass the word! It was created by Teresa Rhoades. She has filed a federal lawsuit claiming that her child was screened by TeenScreen and diagnosed with two mental “disorders” without Teresa’s knowledge or permission. Her lawsuit is being handled by the Rutherford Institute. See here:
http://www.rutherford.org/articles_db/commentary.asp?record_id=355
And here is a federal bill to ban funding for TeenScreen:
http://thomas.loc.gov/home/gpoxmlc110/h2387_ih.xml
Laurie
“An excellent reminder that *all* studies must be taken with a grain of salt and a healthy dos of skepticism. Just because it is published in a journal does not make it true–further, many (most?) studies simply find correlation, not causation.”
I believe this is what we’ve been saying all along. The rush to judgement on the 2004 data was seen across the board in psychiatry, and held out as “proof” that the black box warnings should be repealed. 2005 at least tells the story of suicide rates in the correct year!
Lisa Van S
Laurie,
Have you noticed the silence!!!
Donna
James,
“Cover My ASSA”………is what it mean’s…..
Truthman
“In other words, Shaffer and Olfson say the study jumped to conclusions”
I think that is indeed the bottom line here…
Both adult and adolescent suicide rates fluctuate all the time, from year to year and decade to decade. Even if this study does provide some evidence of correlation, or a small rise , it doesn’t mean that the black box warnings should be taken off SSRI’s. And im not even sure if this study does show any correlation, never mind causation.
What we have to remember is the black box warnings were put there because of a clinically and statistically proven risk of increased suicdal thoughts and aggression etc…
Should we do a study on thalidomide in pregnant women ?
Should we start prescribing it to pregnant women again based on dubious claims from one dodgy study?…
Of course not..
Big Pharma doesn’t care about suicide rates , correaltion or causation ..
It;s prime modus operandi is maximization of profit..
The human cost of defective medications or dangerous medications is statistical…
I wouldn’t trust the APA’s (American Psychiatric Association) interpretation of any study relating to SSRI’s (or any psychiatric drugs for that matter)..
The APA is by its very nature a biased organisation in favour of the prescription of SSRI’s ..
Most of its members, (those bestowed in the ivory tower of high psychiatry and academic psychiatry ) have conflicts of interests and are affiliated with the drug companies who make the drugs which they in turn prescribe…
Psychiatry woudld not exist were it not for the production of psychiatric drugs..
The pharmas keep the cult alive…
And the psychiatrists who advocate these medications as first line treatments are little more than small time drug pushers…
Laurie
I’m still waiting for the data that shows how many of the suicides were in active treatment with an ssri. That we haven’t seen.
Truthman
Hey Laurie
Is it true you’re gonna be on Fox News soon?..
Atlex
I think we all await more data. Note that Shaffer and Olfson didn’t say they jumped to the wrong conclusion, just that it is too soon to tell.
Truthman
Yes too soon too tell..
But obviously not too soon to spin it in the favour of removing the black box warnings..
And the only interest a travesty like that would serve would be to further line the pockets of drug companies and psychiatrists..
If the APA promotes a study..
There is always an agenda behind it…
Does Paxil study 329 ring a bell?…
Or what about the APA’s recent endorsement of SSRI’s for pregnant women?.. ( despite recent and increasing evidence of birth defects)
The agenda here is for the protection of the psychiatric regime and the pharmaceutical empire which it serves…
Nathan
Truthman, I agree. Psychiatry and psychiatric drugs all a big conspiracy designed get the public hooked on dangerous drugs that don’t do damn thing. The FDA is in on the action too. They approved the drugs, of course, and are getting a big fat paycheck from every pill that’s pushed.
Now, if you’ll excuse me, I think I see a UFO in my backyard….another government cover-up at work.
Monica
Wow!
I love backpeddling! It is so good to see this freight train slow down, and possibly some common sense slip in!!!
Lisa Van S
New Jersey has lower than average suicide rates for all age groups.
Nationall,adolescent suicide rates have declined about twenty percent since 1990.
In 2004 there were 79 suicides in New Jersy among those aged 10-24 years,an increase of over 20% from 2003. Preliminary 2005 data show 77 suicides, a very small decline from 2004.
The number of non-fatal suicide attempts requiring hospitalization also rose in 2004 to 926, an increase of nearly 10%, but in 2005 declined by over 12% to 819.
Approximately 40% of adolescents in New Jersey have some History of Mental Illnes (Antidepressants,SSRI’S,Antopsychotics & ADD/ADHD Drugs increase the risk of suicide); Slightly over 30% are currently being treated for a Mental health problem. This is similar to suicides overall.
(This report doesnt mention the Percentage of Psochotropic drugs prescribed for non Psychiatric conditions, or kids who take it to experiment.. ie, “Pharma Parties”. Toxcology results would help immensely.)
Information was obtained by the CDC…..
Lisa Van S
Ed
The “UPDATE”.
Did Gibbons himself, send you this. His Study didnt hold up to muster earlier this year, so, what makes him think it will today?
Ed Silverman
Hi Lisa,
No, a reader sent this my way, and the right thing to do is post his response, since the Shaffer/Olfson letter is about his study. As to your question, Gibbons will have to answer that one.
cheers
ed
Lisa Van S
News Item–Students O’d on Friend’s Antidepressants:
http://www.newsherald.com/headlines/article.display.php?a=4838
Im sure cases like these were not calculated into Gibbons Study…..