SAN FRANCISCO, Aug. 23 (UPI) -- Some studies suggest as antidepressant use goes up, suicide rates among teens come down -- but critics contend this does not prove the medicines save lives.
One review of records dating back to 1960 showed following a 28-year climb that peaked at nearly 13 self-inflicted deaths per 100,000 men and women in 1988 -- the first year of a treatment revolution instigated by the introduction of the antidepressant Prozac -- the suicide rate started descending. It hit rock bottom at 10.5 per 100,000 in 2002, the last year covered by the study.
Numbers may never lie, but they rarely tell the whole truth.
Who's to say, for example, the decline noted in the analysis was not due to some other factor, such as the more-or-less simultaneously enacted legal restrictions on access to guns -- the weapon of choice for suicide, question critics like patient rights advocate Vera Hassner Sharav.
"You can't say they (suicide rates) went down because of antidepressants," Licinio acknowledged, "but it's hard to make a case that antidepressants are causing suicidality because the suicide rate is going down."
Here again, upon closer inspection, uncertainty bedevils any definitive conclusions.
The investigators did not separately examine suicide rates in minors, which do not uniformly reflect the general trends.
Consider the twists and turns the tale takes when you take a look at government statistics broken down by age.
True, the federal figures show between 1980 and 1992, the number of suicides declined in the under-25 demographic as a whole, from 5,381, or 5.7 per 100,000 individuals, to 5,007, or 5.4 per 100,000.
However, during the same period, the rate shot up, by a solid 28.3 percent, from 8.5 to 10.9 per 100,000, among teens 15 to 19 -- and by a mind-blowing 120 percent, from 0.8 to 1.7 per 100,000, among children 10 to 14.
It was not until 1994 that the rate in minors began to dip, reaching 7.4 per 100,000 for those 15 to 19 in 2002, the lowest rate for this age group since the 1970s.
Across college campuses, the number of young people seriously contemplating, attempting or committing suicide appears to be inching up.
In a 2004 poll of 1,865 students at four large universities, 24 percent said they had considered ending it all before graduation. That's a strikingly higher number than the 8.5 percent reported in a similar 2001 study and 9.5 percent noted in a 2000 analysis.
A similar disparity was found in the rates of suicide attempts, reported by 5 percent of the students in the 2004 survey -- disturbingly higher than the 1 percent and 1.5 percent, respectively, so inclined in the two earlier investigations.
"This is one of the most significant findings of this study," lead author John Westefeld, counseling psychology professor at the University of Iowa College of Education, wrote in his conclusion.
However, the findings may simply reflect students' increased willingness to report attempts, he added.
"The reality is we don't know the answer to these questions," said Richard McKeon, the government's special expert on suicide prevention.
"(There are) some people who feel the youth suicide rate peaked in the late 1980s, then plateaued, then began to come down modestly in the 1990s," he noted.
"Some people ... argue this may be due to increased utilization of antidepressants, especially SSRIs. Others disagree," McKeon added. "We don't know for sure what's responsible for those changes in suicide rates."
Whatever the reason, McKeon said, "I think it's prudent clinical practice that children who are put on high-risk kinds of antidepressants need to be carefully followed, especially in the days after they're prescribed."
Key questions remain even after the completion of what many in the field consider the most important report published to date on the treatment of depression in teens, dubbed TADS.
The Treatment of Adolescent Depression Study found among the 439 participants, ages 12 to 17, a type of psychotherapy known as cognitive-behavior therapy combined with Prozac quelled symptoms of depression more effectively than either treatment alone or than a sugar pill.
The strategy teaches problem-solving and helps fight negative thoughts. On its own, neither the drug nor the talk therapy worked better than the placebo. However, all three treatments proved superior to the sugar pill in subverting suicidal notions.
Although the investigators found no close ties between suicide attempts and SSRI use, they did note a much higher rate of "harm-related events" in the Prozac-taking patients than in the other groups.
These included self-cutting, though not necessarily with the intent to die, suicidal ideas and destructive thoughts or acts aimed at people or property.
Another study, a government-sponsored survey of 9,708 men and women 18 to 54 that compared U.S. suicide data between the periods 1990-1992 and 2001-2003, further muddied the picture of the drugs' effectiveness in preventing suicidal behaviors.
The report, published in the Journal of the American Medical Association, provided antidepressant antagonists with ample ammunition to press forward with their questions about the drugs' ability to stop users from considering, planning or attempting suicide.
The authors from Harvard University, Brigham and Women's Hospital, University of Michigan and the Mexican Institute of Psychiatry concluded. "Despite a dramatic increase in treatment, no significant decrease occurred in suicidal thoughts, plans, gestures or attempts in the United States during the 1990s."
They expressed uncertainty about the role, if any, the drugs played in defusing death-inviting despair during the decade studied.
"Completed suicides decreased by about 6 percent during this period," they wrote. "The increase in treatment might have played a part in this trend, although county-level analysis shows no overall association between amount of treatment, as indicated by per-capita number of antidepressant prescriptions, and the suicide rate."
"If increased treatment did play a part in the decrease in the suicide rate, then why did we not see a comparable decrease in suicide-related behaviors?" the study authors wondered.
"Randomized controlled trials find only modest effects of treatment in reducing suicidality, even with optimal regimens," they concluded.
They recommended increasing outreach to untreated suicidal individuals and improving the effectiveness of treatments.
Next: Out-of-bounds treatments.
(Editors' Note: This series on depression is based on a review of hundreds of reports and a survey of more than 200 specialists.)
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UPI Consumer Health welcomes comments on this column. E-mail Lidia Wasowicz at [email protected]
