Fewer antidepressant prescriptions a factor in trend, expert says
THURSDAY, Sept. 6 (HealthDay News) -- Youth suicide rates rose 8 percent from 2003 to 2004, the largest annual increase in 15 years and a reversal of a decade of declines, a new government report shows.
"Our news today is sobering and raises a great concern for us," Ileana Arias, director of the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention, said during a teleconference Thursday. "Suicide is the third leading cause of death among people ages 10 to 24, surpassed only by car crashes and homicides."
The suicide rates for these age groups had been trending downward, falling 28 percent from 1990 to 2003. However, between 2003 and 2004, there was a 75.9 percent increase in the suicide rate among 10- to 14-year-old girls, a 32.3 percent increase among 15- to 19-year-old girls, and a 9 percent increase among 15- to 19-year-old boys, Arias said.
"This is a dramatic and huge increase," Arias noted.
While the CDC won't speculate on the causes for the increase in suicides among teens, one expert thinks it correlates with the warnings issued a few years ago by the U.S. Food and Drug Administration that antidepressants called SSRIs can increase the risk of suicide among teens.
In fact, prescriptions for these drugs for teenagers have dropped by 20 percent since then, according to Dr. Benjamin N. Shain, an associate professor of psychiatry at Northwestern University and a liaison to the American Academy of Child and Adolescent Psychiatry.
Shain believes the years of decline that preceded this sharp increase were due to the increased prescribing of antidepressants. "One major factor that changed was the prescribing of antidepressant medications," Shain said. "Most likely, that's [what was] responsible for the decrease in suicide rates."
But after several studies pointed to a possible increased risk of suicide among teens taking antidepressants, the FDA in 2004 mandated a black box warning on the labels of antidepressants, Shain noted. "There is a correlation between decreased antidepressant prescribing among teenagers and the increased rate of suicide, and other studies show this," he said.
"It is true that antidepressant prescribing in pediatric patients has gone down, and that coincides with this one-year uptick in adolescent suicide, and that is a concern for us," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products, Center for Drug Evaluation and Research, said during the teleconference. "But we do have an obligation to alert prescribers and patients of risks we find with drugs -- it's a dilemma for us, but clearly, it's a concern."
Arias noted that there are many causes of suicide, and the reduction in antidepressant prescribing may be only one reason for the increased rate.
"Suicide is a multidimensional and complex problem," Arias said. "As much as we would like to be able to attribute suicide to any single source that we can fix quickly, unfortunately, we can't do that."
Shain, who wrote a paper on teen suicide that was published in the September issue of Pediatrics, used the same data as the CDC but found an 18 percent increase in the teen suicide rate.
The difference in the rate of increase was due to Shain's inclusion of suicides among people aged 0 to 24, Arias said.
In the CDC report, researchers collected data from the CDC's National Vital Statistics System. They looked specifically at the trends of suicide over 15 years, according to the report in the Sept. 7 issue of Morbidity and Mortality Weekly Report, a CDC publication.
The researchers also found the methods used to commit suicide had changed among girls over time. In 1990, guns were the most common method used by both girls and boys. But by 2004, hanging/suffocation was the most common method for females, accounting for 71.4 percent of the suicides among 10- to 14-year-old girls and 49 percent among 15- to 19-year-old girls.
There was a 119 percent increase in hanging/suffocation suicides among 10- to 14-year-old girls, according to the report. However, for boys, guns were still the most common method.
In 2004, 161,000 youths between the ages of 10 and 24 showed up in emergency rooms across the country with self-inflicted injuries, the report added.
"Today's findings alert us that [the] CDC, along with others in the field of suicide prevention, need to work harder to prevent the underlying causes of suicide," Arias said. "We believe that there is urgent need for broader prevention measures that address the needs of youth."
For more on teen suicide, visit Safe Youth.
SOURCES: Sept. 6, 2007, teleconference with: Ileana Arias, Ph.D., director, U.S. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Thomas Laughren, M.D., director, Division of Psychiatry Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration; Benjamin N. Shain, M.D., Ph.D., associate professor, psychiatry, Northwestern University, Evanston, Ill., and liaison, American Academy of Child and Adolescent Psychiatry; Sept. 7, 2007, Morbidity and Mortality Weekly Report
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