Data on Antidepressants and Suicide2
Black Box Warning
August 4, 2015
I hope you enjoyed the first part, which introduced concepts necessary to appreciate the relationship, between Antidepressants and Suicide.
It is important to learn about the events as they unfolded, including the decisions of the FDA, as well as other parties, and the consequences of those actions.
Intended, and unintended.
The value lies in enhancing our understanding of these complex issues, which will help us, for the next ones, life throws our way.
Throughout the late 90’s, and early 21st Century, Family Physicians and Pediatricians became more comfortable assessing, and treating, Depression in Children and Teenagers.
Because of their effectiveness, with low side effect profiles, compared to earlier versions, these Doctors began prescribing Antidepressants to more teenage patients.
The Antidepressants, recommended by 4 out of 5 Doctors, were the SSRI’s.
The ‘SSRI’s’, is an acronym for the ‘Selective Serotonin Reuptake Inhibitors’.
S S R I
There are several different ways that medications can target Depression, and most Antidepressants increase Serotonin, which is a chemical in the brain.
Other Antidepressant medications, which increase a handful of other chemicals, have also been found to be effective. An example would be medications increasing brain NOREPINEPHRINE.
Depending on the type of Antidepressant we are talking about, different letters are used in the first 2 positions of the acronym.
Examples of SSRI’s, with their Generic Name listed first, followed in brackets by their Trade Name, include:
Other examples include the SNRI’s, where the first ‘S’ stands for Serotonin, and the next letter ‘N’, stands for NorEpinephrine.
S N R I
An example of an SNRI is:
Due to this growing familiarity, and effectiveness, Antidepressants prescriptions to Teenagers essentially doubled, in the years spanning 1996-2005.
The FDA first began learning about Depressed Teenagers developing Suicidal Ideation, while being treated, in 2003.
Upon the FDA reviewing case reports, involving teens with depression, they rightly grew concerned.
They reacted, by issuing a statement to Doctors, that there were reports of Suicidal Ideation, occurring in association with the first several weeks, of an Antidepressant trial.
Their warnings, were an effort to ensure that the kids taking these medications for Depression, would be closely monitored, during their treatment.
The FDA continued to gather data.
Guided by fear, instead of firm evidence, in 2004, the FDA placed a BLACK BOX WARNING, on Antidepressants prescribed to Children and Teenagers.
A Black Box warning is printed in a black box, on the side of a medication box or bottle. Inside the Black Box is specific information related to the possible adverse event.
Now, if you are a concerned parent, educated teen, or conservative doctor, Black Box warnings are pretty serious business. Concerned parents tried their best to understand all the information and controversy, swirling around this issue. Some of them, justifiably, sought other types of treatments, such as focusing on talk therapy, or family counselling.
Since you have hopefully already read Data on Antidepressants and Suicide1, I will not rehash the rebel occupation of the teen.
If I was an educated Teenager, with Depression, feeling like Crap, who was told the medication offered to me, may cause me to become suicidal?
For some Parents and Teenagers, decisions were also made to stop Antidepressant Medications. Even though the teen may have been taking them for months, and was not displaying Suicidal thinking.
And as for Doctors, it is in their very professional makeup, to be conservative.
That was by no means a political statement, given recent events.
Doctors are in a profession that truly deals with life, and death. And there are many controversial edges, along the Field Of Medicine’s, best intentions. Abortion, Euthanasia, and DNR, are but a few examples, alongside Mental Health.
Any Doctor, who becomes aware of a Black Box warning, has a Knee Jerk Reflex, and immediately considers never prescribing that medication again. As time passes, patient suffering softens resolve, and Doctors begin to prescribe them again. Sometimes less frequently, or perhaps in only the more serious cases.
The media did not help much, spreading the message quickly, and using attention grabbing scare tactics, gluing viewers to screens.
Unfortunately, in some cases, due to the Media Sensationalist Distortion Effect, some reports actually exaggerated the warnings.
In the Big Picture, many people interpreted the main message to be that starting an Antidepressant medication, increased their risk of committing Suicide.
Then end result of this WARNING, was that the Antidepressant prescribing rates, for Teens with Depression, DROPPED BY 30%, as well as 25% in Young Adults.
What the FDA failed to properly explain, as history has proven, is that Antidepressant medications were not associated, with any increase in fatal SUICIDE ATTEMPTS.
Unfortunately, in this case, the Black Box warning seems to have had the opposite effect.
The public became less safe.
And the irony, of using an image similar to a coffin, in this case; was tragic.
Tune in for Part 3, The Data.
Simon Trepel, MD
Simon Trepel, MD FRCPC, is a practicing Child and Adolescent Psychiatrist, in Winnipeg, Canada. He is an Assistant Professor, at the University Of Manitoba, in the Faculty of Medicine, and the Co-founder of the GDAAY Clinic. He is, more importantly, the proud Father of 2 beautiful Daughters. He writes in his spare time about things he knows something about, and occasionally about things he doesn’t; like Yoga, and Italian flavored coffees. He was not referring to coffee that tastes like an Italian person.
Check out his Blog, called Simon Says Psych Stuff, at