Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care

• Published in: Psychiatric research and clinical practice Vol. 2; no. 2; pp. 43 - 52
• Main Authors: Lu, Christine Y., Penfold, Robert B., Wallace, Jamie, Lupton, Caitlin, Libby, Anne M., Soumerai, Stephen B.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.12.2020; John Wiley and Sons Inc; Wiley
• Subjects: Antidepressants; Mental depression; Mortality; Psychotherapy; Psychotropic drugs; Suicidal ideation; Suicides & suicide attempts; Teenagers; Trends; Young adults; United States > US
• ISSN: 2575-5609; 2575-5609
• DOI: 10.1176/appi.prcp.20200012

Objective Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether suicide deaths increased following the warnings and declines in depression care. Methods We conducted an interrupted time series study of validated death data (1990–2017) to estimate changes in trends of US suicide deaths per 100,000 adolescents (ages 10–19) and young adults (ages 20–24) after the warnings, controlling for baseline trends. Results Before the warnings (1990–2002), suicide deaths decreased markedly. After the warnings (2005–2017) and abrupt declines in treatment, this downward trend reversed. There was an immediate increase of 0.49 suicides per 100,000 adolescents, 95% confidence interval [CI]: 0.12, 0.86) and a trend increase of 0.03 suicides per 100,000 adolescents per year (95% CI: 0.026, 0.031). Similarly, there was an immediate increase of 2.07 suicides per 100,000 young adults (95% CI: 1.04, 3.10) and a trend increase of 0.05 suicides per 100,000 young adults per year (95% CI: 0.04, 0.06). Assuming baseline trends continued, there may have been 5958 excess suicides nationally by 2010 among yearly cohorts of 43 million adolescents and 21 million young adults. Conclusions We observed increases in suicide deaths among youth following the warnings and declines in depression care. Alternative explanations were explored, including substance use, economic recessions, smart phone use, and unintentional injury deaths. Additional factors may have contributed to continued increases in youth suicide during the last decade. Combined with previous research on declining treatment, these results call for re‐evaluation of the antidepressant warnings. HIGHLIGHTS Previous research showed that depression care declined following the US FDA antidepressant warnings regarding suicidality for adolescents and young adults. In this interrupted time series analysis using 28 years of nationwide death certificates, we found youth suicide deaths increased after the FDA antidepressant warnings and reductions in depression care. We recommend that the FDA err on the side of caution and consider replacing the boxed warning with less severe warnings that still communicate information on possible drug risks without endangering essential, first‐line treatments of depression in youth.