Suicide rates for teens and young adults jumped 8 percent in 2004 as doctors prescribed fewer antidepressants in light of government warnings about the drugs' possible harmful effects on adolescents, according to two new studies.
Among people ages 10 to 24, the number of suicides jumped from 4,258 to 4,599 in 2004, the most significant rise in teen suicides in 14 years, according to a report by the Centers for Disease Control and Prevention. That reverses a 28 percent slide in suicide rates for the age group that began in 1990.
"Our news today is sobering. It raises great concern for us," said Dr. Ileana Arias, director of the CDC's National Center for Injury Prevention and Control. "We don't yet know if this is a short-lived increase or if it's the beginning of a trend."
The biggest increases in the suicide rate were among 15- to 19-year-olds. Among females in the group, deaths jumped from 265 in 2003 to 355 in 2004. Among males the count rose from 1,222 to 1,345.
For girls ages 10 to 14, the suicide numbers were small, rising from 56 to 94, but represented an increase of 68 percent.
Another study found that the number of antidepressant prescriptions doctors write for children and teens has dropped 22 percent since the FDA ordered "black box" warnings for the drugs in 2004.
Arias said too many factors are involved in suicide rates to pin this increase on a downturn in antidepressant use brought on by drug warning labels. "Suicide is a multidimensional and complex problem," she said.
But FDA officials acknowledged yesterday that the suicide numbers deserve close examination. "It is true that antidepressant prescriptions in pediatric patients has come down, and that coincides with this one-year uptick in adolescent suicides. Obviously, that is a concern for us," said Dr. Thomas Laughren, head of the FDA's division of psychiatric products.
In 2004, the FDA ordered manufacturers of antidepressants such as Prozac and Zoloft to print its strictest, "black box" warning to let doctors and patients know the medications could increase the chance of suicidal thoughts or actions in children and teens.
Patients had complained that the medicines, which came on the market in the late 1980s and were not specifically tested on youngsters, sometimes caused those suicidal thoughts. Reports of children committing suicide while on the drugs prompted lawsuits, and the FDA raised safety questions in 2003 when one of its reviewers noticed evidence of suicidal thoughts among patients in a clinical trial.
Independent experts were divided yesterday over whether the black box warnings contributed to the rise in suicides.
"There's been concern that the black box would lead to a reduction in prescribing and therefore an increase in suicides, and my guess is that's what's happening," said Dr. Mark Riddle, director of child and adolescent psychiatry at the Johns Hopkins Children's Center.
Some doctors are reluctant to prescribe an antidepressant to a child if it comes with the FDA's most stringent warning label, Riddle said: "People see it as a potential feeding frenzy for the malpractice lawyers and it's just scared the clinicians off."
The second study, published this week in the American Journal of Psychiatry, found that among youths up to 19, antidepressant use dropped 22 percent in the U.S. and Netherlands after the black box warnings.
In the Netherlands, youth suicide rates rose 49 percent between 2003 and 2005. They rose 14 percent in the United States between 2003 and 2004, according to the report.
"There is a lot of evidence to believe the black box warnings have led to decreases in prescriptions, and there is also evidence that the number of suicides was on the rise as those prescriptions dropped," said Robert Gibbons, director of the Center for Health Statistics at the University of Illinois at Chicago and the study's lead author.
Because the drugs carry such warning labels, doctors are reluctant to prescribe them, which makes treatment more difficult and diagnosis more problematic, he said.
But other outside experts were reluctant to link the black box warnings with a one-year rise in suicides.
"Before you reach that kind of conclusion, you need to take a careful look at the black box warning," said Dr. Mark Ofson, a psychiatrist who studies mental illness issues at the Columbia University Medical Center.
"There are so many social issues that go into suicide rates and how they're reported."