Depression Drugs, Treatment Reduce Risk of Suicide
> 2/22/2006 10:51:21 AM

There has been a great deal of back and forth over the last couple of years about the efficacy of antidepressants and the potential risk of increased suicide and suicidal ideation. The debate finally came to a head in late 2004 and early 2005 when the FDA released a black box warning, their most serious, for the use of antidepressants by children and adolescents.

Even at the time, there was a strong reaction from the mental health community stating that while the warning was based on scientific research, the link between suicidality and the use of antidepressants was too weak to justify not using them. Depression can, in and of itself, be extremely debilitating and even fatal. Clinicians, researchers and others pointed to the fact that over the last decade an increase in the use of SSRIs has been met with a steady decline in suicides nationwide. Groups even pointed out that "toxicological analyses done during autopsies suggest that suicide is more likely when depressed individuals do not take their medication or when they take the wrong dose rather than when they take it correctly."

Nevertheless, warnings moved forward, and prescriptions immediately began to decline. Mental health professionals fretted, parents and their depressed children struggled, and GPs and other prescribing physicians were often at a loss. But finally, new research published in the American Journal of Psychiatry has provided evidence that earlier warnings may have come on too strong and too soon.

As reported in Clinical Psychiatry News, the greatest danger of suicide actually comes in the month immediately proceeding the start of medication.
In the study of about 60,000 enrollees at Group Health Cooperative (GHC), a nonprofit health care system based in Seattle, the risk of suicide decreased by 60% in the first month after treatment began and continued to decline in the following 5 months of the study. The risk of suicide was highest in the month before treatment.

As Dr. Greg Simon, the study's lead researcher, pointed out it is extremely important to look at suicidality before medication and treatment were started.
“If you didn't look at the months before treatment, the risk after treatment would look very high,” Dr. Simon said. “The idea that there's something especially risky about the time people start taking medications—that's not true” given the study results, but more studies are needed to definitively answer the question, he said.

What is clear at this point is that the initial reaction by the FDA was harsher than the actual threat required and may have, in fact, caused much more harm than good. Dr. William Hapworth said as much a while ago here at Anxiety, Addiction and Depression Treatments. Dr. Simon and team have taken the first steps to restore the place of antidepressants in the treatment process. As they mentioned, only further investigation will undo the damage that has been done. In treating depression, doctors and mental health practitioners need to trust the antidepressants they prescribe and understand the actual risks associated with each. Continued research will achieve both of these aims.

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