More Antidepressant Prescriptions and Lower Suicide Rates: True for Teens, Too

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Summary and Comment

More Antidepressant Prescriptions and Lower Suicide Rates: True for Teens, Too

Although greater antidepressant use has been associated with decreased suicide rates in adults, this issue has not been examined in teenagers despite concerns about a possible relation between certain serotonin reuptake inhibitors (SRIs) and increased agitation and suicidality. For one month in 1990 and one month in 2000, these researchers compared rates of suicide and antidepressant prescriptions for adolescents (age range, 10-19) who resided in 588 different U.S. zip-code regions and who were receiving any medication.

Researchers obtained prescription data from a large pharmacy management company, used federal statistics on suicide rates and regional demographics, and controlled for differences in regional prescription rates by calculating the number of physicians per capita in each zip-code region. From 1990 to 2000, the number of completed suicides decreased, inversely and significantly, with the increase in antidepressant prescriptions overall. Suicide method (firearm versus nonfirearm) did not affect the association. In stratified analyses, the relation remained significant for males, older teens (ages 15-19), and teens with low family incomes. In contrast, a post-hoc analysis revealed that change in prescription rates for tricyclic antidepressants (TCAs) was not associated with change in suicide rate.

Comment: As the authors noted, they could not examine other possible variables, e.g., illicit drug use and access to firearms. Also, diagnostic information was not available. Nevertheless, the findings are consistent with those in older populations and with those from multiple randomized trials that showed no significant effect of TCAs on child and adolescent depression. The greater effect in teens aged 15-19 is consistent with findings of more diagnoses of depression in older than in younger adolescents who have completed suicide. Clinicians who are contemplating pharmacotherapy for depressed children and adolescents need to consider these findings and the possibly agitating adverse effects of SRIs.

— Barbara Geller, MD

Published in Journal Watch Psychiatry November 20, 2003