Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents.
OBJECTIVE
In 2003 and 2004, U.S. and European regulators issued public health warnings about a possible association between antidepressants and suicidal thinking and behavior. The authors assessed whether these warnings discouraged use of antidepressants in children and adolescents and whether they led to increases in suicide rates as a result of untreated depression.


METHODS
The authors examined U.S. and Dutch data on prescription rates for selective serotonin reuptake inhibitors (SSRIs) from 2003 to 2005 in children and adolescents (patients up to age 19), as well as suicide rates for children and adolescents, using available data (through 2004 in the United States and through 2005 in the Netherlands). They used Poisson regression analyses to determine the overall association between antidepressant prescription rates and suicide rates, adjusted for sex and age, during the periods preceding and immediately following the public health warnings.


RESULTS
SSRI prescriptions for youths decreased by approximately 22% in both the United States and the Netherlands after the warnings were issued. In the Netherlands, the youth suicide rate increased by 49% between 2003 and 2005 and shows a significant inverse association with SSRI prescriptions. In the United States, youth suicide rates increased by 14% between 2003 and 2004, which is the largest year-to-year change in suicide rates in this population since the Centers for Disease Control and Prevention began systematically collecting suicide data in 1979.


CONCLUSIONS
In both the United States and the Netherlands, SSRI prescriptions for children and adolescents decreased after U.S. and European regulatory agencies issued warnings about a possible suicide risk with antidepressant use in pediatric patients, and these decreases were associated with increases in suicide rates in children and adolescents.
Gibbons
Robert D
RD
Center for Health Statistics, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60614, USA. rdgib@uic.edu
Brown
C Hendricks
CH
Hur
Kwan
K
Marcus
Sue M
SM
Bhaumik
Dulal K
DK
Erkens
Joëlle A
JA
Herings
Ron M C
RM
Mann
J John
JJ
D000293:Adolescent; D000367:Age Factors; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004348:Drug Labeling / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012044:Regression Analysis; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D012737:Sex Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration / Q000706:statistics & numerical data
D017367:Selective Serotonin Reuptake Inhibitors