The Reality of Antidepressants

An antidepressant is a psychiatric medication or other substance (nutrient or herb) used for alleviating depression or dysthymia (’milder’ depression). Drug groups known as MAOIs, tricyclics, and SSRIs are particularly associated with the term. These medications are now amongst the drugs most commonly prescribed by psychiatrists and as well as other physicians, and their effectiveness and adverse effects are the subject of many studies and competing claims. Nutrients for which there are claims of antidepressant activity include phenylalanine, tyrosine, tryptophan, 5-Hydroxytryptophan, and choline.

A new study has revealed that the use of antidepressants among teens has considerably reduced the risk of suicides.

The earlier studies suggested a link between antidepressants and suicidal thinking and behavior in youth, which led to an investigation by researchers at the University of South Florida and University of Illinois.

After the investigation, Hendricks Brown, professor and director of the Prevention Science and Methodology Group, USF College of Public Health along with his colleague Robert Gibbons from the University of Illinois at Chicago found the report findings contrary to earlier studies.

The study was published in the September 2007 issue of the American Journal of Psychiatry.

“The overall effect of these newer antidepressants is very likely that they reduce suicide risk considerably. Overall, the new antidepressants provide a large protective benefit. If there is any group of people who are adversely affected by taking these antidepressants, it has to be a very small group,” Brown said.

“People need to know if the antidepressant medication they are taking is increasing or decreasing their risk for suicide. It would be bad if antidepressants were causing an increase in suicides, in which case the appropriate policy would be to restrict their use in adolescents. It would be even worse if FDA policies led to less treatment of depression and more suicides,” Brown said.

Brown and his group examined different statistical approaches that might assess whether a widely used class of antidepressants known as selective serotonin reuptake inhibitors (i.e., Prozac, Zoloft, Paxil, Celexa) were causing more or less suicides in the teenage population.

The analysis was problematic because suicide occurs in one person out of 10,000 youth, but there were only a few thousand youth enrolled in all the clinical trials of antidepressants. And in none of these trials was there a suicide, either among those given an antidepressant, or those given an inactive placebo. There was no ability to compare rates because the number of subjects in the clinical trials was too small.

Given those limitations, Brown used several data sources where depressed individuals were treated differently with different classes of antidepressants or no medication, and he examined the rates of suicide along with the rates of antidepressant prescriptions at the county level. He also looked at the reports of suicide detailed by U.S. doctors after medication use.

The results showed that suicide attempts were dramatically lowered once antidepressant medication began, indicating an overall benefit of these newer medications. Also, very few people who died from suicide had been taking antidepressants.

He also found consistent reductions in suicide across counties as well as across countries during the time when there was increased use of antidepressants. Now that the overall level of antidepressants has decreased since the FDA warnings, there is very early evidence of an upturn in youth suicides.

“With the FDA warnings there has been a rapid lowering of antidepressant prescriptions, and there has been a corresponding increase in youth suicides. We found similar results in the Netherlands once the warning was broadcast there as well,” Brown said.

Brown said sometimes health policy decisions are made on limited information, and it may be that the FDA warnings about suicide in youth treated with antidepressants could have unintended consequences of placing more youth at risk. The FDA is now reviewing policy decisions in the light of these data and at some point may withdraw or revise its warning.

Read more about Understanding the Global Pharmaceutical Market