Antidepressants and Suicide Risk

In 2004, the Food and Drug Administration (FDA) emphasized warnings that antidepressants may cause suicide or suicidal thoughts. But a study from Harvard researchers indicates that people are at a lower risk of suicide after starting on antidepressants than in the week before the treatment began.

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A large new study shows little or no relationship between antidepressant use and suicidal thoughts and actual suicides. That's new information for a contentious debate, and as NPR's Joanne Silberner reports, researchers are likely to argue as much over this study as they have over previous ones.

JOANNE SILBERNER reporting:

The Food and Drug Administration has considered a slew of contradictory and inconclusive studies on antidepressants and suicide. In October 2004, it warned that there could be a connection in children and adolescents. In June of 2005, it issued a warning about adults. Now researchers from Harvard University and Group Health Cooperative, a Seattle-based HMO, have done a new study suggesting little or no relationship. Psychiatrist Gregory Simon of Group Health led the study.

Mr. GREGORY SIMON (Psychiatrist, Group Health Cooperative): We looked at data from Group Health Cooperative and we were able to identify everyone over about a 10-year period who had received a new prescription for an antidepressant, and then we were able to link that information to information about hospitalizations and deaths so that we could identify serious suicide attempts or death by suicide in the people who had received a new prescription for an antidepressant medication.

SILBERNER: Simon and his colleagues published their results in the new issue of The American Journal of Psychiatry.

Mr. SIMON: The overall risk of a serious suicide attempt or death by suicide in people who start taking antidepressant medication is fortunately very low. That risk is less than one in 1,000.

SILBERNER: That's in adults. The risk in adolescents and children was three in a thousand. The data show a clear and obvious decrease in suicidal thoughts and suicides after people start on the antidepressants. Officials from the American Psychiatric Association say with 65,000 people followed over time, there's no reason to question the validity of the study, but others do question it, among them psychiatrist David Healy of Cardiff University in Wales. He's a longtime critic of widespread antidepressant use, though he does prescribe them occasionally in his own practice. He says the current study doesn't prove the lower incidents of suicidal thoughts is due to the drugs.

Mr. DAVID HEALY (Cardiff University): If you have a cold and you go along and seek help for your cold, chances are--almost regardless of what we put you on or do for you, chances are that the symptoms of the cold is actually going to clear up shortly afterwards anyway. I think it's pretty much the same here.

SILBERNER: And he says the drugs could be causing problems in a subgroup of people. Study chief Gregory Simon says that's possible.

Mr. SIMON: What if it were true that, of 100 people who start taking an antidepressant medication, it has a very positive effect in 90 of them and a very negative effect in 10 of them? The overall result would be positive. So it certainly is possible that there are some people for whom these medications have negative effects, even possibly dramatic negative effects, but what our data say is that, on average, the risk of a serious suicide attempt goes down.

SILBERNER: Both Simon and Healy say further studies would be good. Simon says because of the rarity of suicide or suicidal thinking it would take a trial with 300,000 people with depression to see any effect. Healy thinks you could do this study with several hundred people,watching for subtle changes that might lead to suicidal thoughts or actions. Meanwhile, a spokeswoman for the Food & Drug Administration says the agency's studying the available data.

Joanne Silberner, NPR News.

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