antidepressants and adolescent suicide ?
Q.What about alcohol? Binge drinking is a significant predictor of adolescent suicide.(6) But is depression the cause of binge drinking and suicide, or does drinking drive depression and suicide? The answer seems to depend on gender. Modelling of drinking and suicidal behaviours in an adolescent population showed that suicidality precedes drinking in females, whereas drinking problems precede suicidality in males.(7) In either case, self-medication is an explanatory component of the behaviour. Do we want our children drinking to seek relief, or might antidepressants be a better idea?
A.In over 5,000 suicides in Sweden, blood analyses showed that 16.5% had detectable antidepressants in their blood, although epidemiological evidence suggests that up to 85% of suicides are depressed.The same dataset appears to have been reported in a different way, showing gender and age differentials in the use of antidepressants comcommittant with suicide. Men and youth are undertreated, especially. A similar study based on U.S. data (particularly that for Mobile Alabama) found rates (15%) and gender imbalances that seem to be very similar to those findings from Sweden, for a similar period of time. What about alcohol? I'm not going to belabour the point, as alcohol consumption is well known to be the most significant risk factor for suicide (after depression itself), but here's a sample of the literature. Alcohol was consumed just prior to suicide in between 40-50% of all suicides in Sweden. That's about three times as often as antidepressants. Still, though, what do we know about the rate of suicide in untreated depressives versus those treated with antidepressants? The fear-mongering literature makes scary comparisons between rates of suicide in antidepressant-treated depressives and normal people. But surely, that comparison is like comparing chalk to cheese. What do we know about the relative suicide rates of the depressed population, medicated vs. unmedicated? I can't say it any better than this, from reference 12, "The calculated risk for suicide among depressed patients who were treated with antidepressants was 141 per 100,000 person years and, among the untreated, 259 per 100,000 person years (i.e., 1.8 times higher among the untreated). This supports the hypothesis that antidepressant medication decreases the risk for suicide in depressed patients. The reason this has not been obvious in the general suicide statistics seems to be that so few depressed people are treated with antidepressants." A decade of increasing antidepressant medication treatment for adolescents and corresponding declines in suicide rates raise the possibility that antidepressants have helped prevent youth suicide. To evaluate the relationship between regional changes in antidepressant medication treatment and suicide in adolescents from 1990 to 2000. DESIGN: Analysis of prescription data from the nation's largest pharmacy benefit management organization, national suicide mortality files, regional sociodemographic data from the 1990 and 2000 US Census, and regional data on physicians per capita. PARTICIPANTS: Youth aged 10 to 19 years who filled a prescription for antidepressant medication and same-aged completed suicides from 588 three-digit ZIP code regions in the United States. MAIN OUTCOME MEASURES: The relationship between regional change in antidepressant medication treatment and suicide rate stratified by sex, age group, ...
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