Warning about antidepressants, suicide risk leads to unintended consequences

  • Article by: JEREMY OLSONHEALTH
  • Updated: August 9, 2014 - 2:00 PM

The trend following the 2004 black-box warning about antidepressants and suicide risk was predictable — many adolescents simply stopped taking these drugs.

After all, what parent wants to give potent psychiatric meds to kids if it makes them more likely to think about and even attempt suicide?

Trouble is, the public response to the warning from the U.S. Food and Drug Administration might have gone too far, leaving depressed teens with less treatment.

Now a University of Minnesota researcher is among the first to document the effect — not just on symptoms, but on how depressed teens did in school following the warning and whether they were prone to drug use and delinquency.

“Those are all things that have lifelong consequences,” said Ezra Golberstein, a U assistant professor of public health.

In the three years following the FDA warning, antidepressant use in adolescents dropped 20 to 30 percent, research has shown. There was no compensating increase in other forms of such therapy as counseling, though, meaning depressed teens simply received less treatment.

Over that same time frame, Golberstein found the grade-point average of depressed teen girls dropped from a B to a B-. Depressed adolescents also became more likely to abuse illicit and prescription drugs, and to fight and steal, according to his research, which was based on more than 100,000 responses to the National ­Survey on Drug Use and Health from 2001 through 2007.

Teens who weren’t depressed didn’t exhibit the same decline.

Researchers were surprised to find more significant behavioral changes among girls with depression. Grades dropped for girls, not boys, in the years after the black box warning. Overall, the rate of stealing increased by 4.6 percentage points among depressed adolescents after the warning, but that trend was entirely driven by girls.

It’s unclear why girls with depression were affected more after the black box warning on antidepressants.

“At the end of the day for us,” Golberstein said, “it really is a mystery.”

No evidence

All of these trends might seem lamentable, but acceptable, if the trade-off was fewer adolescents dying by suicide. But there is no evidence of that. Earlier this summer, a study in the British Medical Journal — co-authored by a researcher from Bloomington-based HealthPartners — actually found an increase in attempted suicide by drug overdoses in the years following the black box warning. However, that study found no statistically significant change in teen ­suicides.

Golberstein said his research shows the need for more caution and better communication whenever the FDA alters warnings about existing medications. His conclusions also demonstrate the need, he argued, to consider social measures such as academic performance when weighing whether to approve medications for youth or publish warnings about their usage.

“These are really huge implications that have lifelong consequences,” Golberstein said. “Maybe we should be finding ways to factor that into the risk-benefit calculus more explicitly.”

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