Will SSRI suicide fear curtail appropriate use?

Some worry that proposed expansions for label warnings could undermine treatment of depression.

By Susan J. Landers, AMNews staff. Jan. 22, 2007.

Washington -- A move last month to broaden the age range for label warnings on risks of suicidal thoughts and behaviors associated with antidepressant use reignited concern about the impact such cautions may have on the continued proper use of these drugs.

The controversy has been raging in recent years, and alarms have been set off again by new data showing that prescribing rates for antidepressants -- including the popular selective serotonin reuptake inhibitors -- have declined, especially for children, while suicide rates may be climbing.

U.S. suicide rates in children up to 18 increased from 1.76 per 100,000 in 2003, when this issue first surfaced, to 2.01 per 100,000 in 2004, according to the Centers for Disease Control and Prevention. Suicides also increased in the Netherlands after a similar controversy over the drugs' side effects, according to testimony at a Food and Drug Administration hearing last month.

Such data lead some experts to say that heightened warnings of possible side effects among children and teens, which were added to SSRI labels in 2004, have made increasing numbers of doctors reluctant to prescribe the drugs. This outcome, they add, is causing patients more harm than good.

The FDA advisory committee also heard testimony in mid-December 2006 about the risks and benefits of antidepressant use for adult patients. There were numerous, deeply affecting stories about the suicides of loved ones who were taking the drugs. But there also were pleas from physicians that the use of these medications, which have been shown to be effective, should not be discouraged.