Suicide Rate Down in the Era of Prozac

Suicide Rate Down in the Era of Prozac Scientology

Subject: Suicide Rate Down in the Era of Prozac

Numbers have declined since a 1980s peak when such drugs came into use, a study finds. A skeptic says gun laws might be the cause.

By Alan Zarembo, Times Staff Writer

The U.S. suicide rate has fallen steadily since Prozac and related antidepressants came into use in the late 1980s, according to an analysis by researchers worried that evidence linking the drugs to suicide in children could reduce their use.

The suicide rate, which reached a peak in 1988 of nearly 13 deaths per 100,000 people, fell steadily to about 10.5 in 2002.

Most suicides are the result of untreated depression, not adverse reactions to antidepressants, wrote Dr. Julio Licinio and Dr. Ma-Li Wong, psychiatrists at UCLA, in an opinion piece released Wednesday by the journal Nature Reviews: Drug Discovery.

But Vera Sharav, president of the Alliance for Human Research Protection, said the conclusions of the analysis might not be valid because the decline could just as easily be explained by laws introduced around the same time reducing access to firearms — a common means of committing suicide.

The number of people being treated for depression rose more than 50% during the 1990s, an increase largely due to the availability of drugs known as selective serotonin reuptake inhibitors, or SSRIs.

Studies conducted in Denmark and Sweden have shown that fewer than a fifth of suicide victims were taking antidepressants when they killed themselves.

The drugs, however, have recently become the focus of a medical debate after clinical trials data showed that they increased the risk of suicidal thoughts in children and adolescents. Starting this month, the drugs will carry a label warning of the dangers in minors.

Licinio said that he feared that the concern about the use of the drugs in children could deter adults from taking them.

"And then we will have the reverse problem — more people committing suicide because they are not taking antidepressants," he said.

The UCLA professors did not look at the suicide rate in minors. But according to data from the Centers for Disease Control and Prevention, suicides per 100,000 people age 10 to 19 peaked at 6.6 in 1988 and dropped steadily to 4.3 in 2002.

This week, Medco Health Solutions Inc., a pharmacy benefits management company, released data showing that prescriptions of antidepressants for patients under 18 fell sharply after the Food and Drug Administration announced its warning label requirement in October.

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http://www.cbsnews.com/stories/2005/02/02/health/webmd/main671167.shtml

Suicide Rate Down Since Prozac

Feb. 2, 2005

"Our findings strongly suggest that these individuals who committed suicide were not reacting to their SSRI medication. They actually killed themselves due to untreated depression."

Julio Licinio, MD, UCLA

(WebMD) Suicide rates have dropped steadily since Prozac and similar antidepressants hit the market.

The findings challenge recent claims that Prozac, Paxil, Zoloft, and the other drugs in the class known as selective serotonin reuptake inhibitors (SSRIs) increase suicide risk.

As a result of such fears, physicians in the United Kingdom can no longer prescribe the antidepressants to new patients under the age of 18. And in the U.S., the FDA recently ruled that SSRIs and other antidepressants must carry the strongest warning about suicide risk on their package information.

The government actions and the negative press have led to a dramatic drop in SSRI use among children and adolescents. UCLA psychiatry professor Julio Licinio, MD, who conducted the review, argues that the under-treatment of depression poses a much greater threat than the drugs do.

"It is true that in a small number of cases these drugs could make a person more prone to suicide," Licinio tells WebMD. "But by far the biggest cause of suicide is untreated depression. My concern is that when people don't get the treatment they need, the suicide rate is going to start going up again."

Experts Concerned

Licinio is not alone. In a news conference held Tuesday, representatives of the nation's top mental health and suicide prevention organizations expressed similar concerns. They cited recent data showing a 16 percent decline in antidepressant use among children and adolescents in the last quarter of 2004, compared to the same time period a year earlier.

"The general clinical consensus is that when used appropriately, the benefits of SSRI antidepressants far outweigh the potential risks," says child and adolescent psychiatrist and coalition chairman David Fassler, MD, who represented the American Psychiatric Association.

"We really can help most children and adolescents who suffer from psychiatric disorders like depression," he tells WebMD. "The real tragedy is that there are still so many young people who don't get the treatment that they need and deserve."

11th Leading Cause Of Death

Licinio and colleagues reviewed studies published between 1960 and 2004. They found that suicide rates rose steadily between 1960 and 1988 — the year that Prozac became the first SSRI to be approved for use in the U.S. After 1988, suicide rates began a continuing decline.

In 1988, suicide was the 8th leading cause of death in the U.S., accounting for 12.4 deaths per 100,000 people. By 2002 it was the 11th leading cause of death, with 10.6 suicides for every 100,000 people.

When they reviewed studies in which blood samples from suicide victims were screened, the researchers found that fewer than 20 percent showed evidence of recent antidepressant use. The analysis is reported in the February issue of the journal Nature Reviews Drug Discovery.

"Our findings strongly suggest that these individuals who committed suicide were not reacting to their SSRI medication," Licinio notes. "They actually killed themselves due to untreated depression. This was particularly true in men and in people under 30."

New Users Most Vulnerable

Licinio tells WebMD that antidepressant-related suicide risk can be minimized by monitoring patients closely during the initial phase of drug treatment. That is when they are most vulnerable, he says, because the drugs tend to relieve symptoms of lethargy before they start to improve a patient's sense of well-being.

"The last symptom that tends to improve when a person begins antidepressant treatment is the feeling of despair," he says. "So in this initial period of treatment they may be more at risk because they have more energy to act on their feelings and are still depressed."

He adds that children and teens may be especially vulnerable because they tend to act more impulsively than adults.

Sources: Licinio and Wong, Nature Reviews Drug Discovery, February 2005; vol 4: pp 165-171. Julio Licinio, MD, professor of psychiatry and medicine, UCLA; researcher, UCLA Neuropsychiatric Institute, Los Angeles. David Fassler, MD, child and adolescent psychiatrist, Burlington, Vt.; clinical associate professor of psychiatry, University of Vermont College of Medicine; trustee-at-large, American Psychiatric Association. News release, Medco Health Solutions Inc.

By Salynn Boyles
Reviewed by Michael W. Smith, MD
2005, WebMD Inc. All rights reserved.

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http://www.sun-sentinel.com/features/health/la-sci-suicide3feb03,0,3144870.story?coll=sfla-news-health

Suicide Rate Down in the Era of Prozac

Numbers have declined since a 1980s peak when such drugs came into use, a study finds. A skeptic says gun laws might be the cause.

By Alan Zarembo
Times Staff Writer
Posted February 3 2005

The suicide rate, which reached a peak in 1988 of nearly 13 deaths per 100,000 people, fell steadily to about 10.5 in 2002.

The number of people being treated for depression rose more than 50% during the 1990s, an increase largely due to the availability of drugs known as selective serotonin reuptake inhibitors, or SSRIs.

Studies conducted in Denmark and Sweden have shown that fewer than a fifth of suicide victims were taking antidepressants when they killed themselves.

Licinio said that he feared that the concern about the use of the drugs in children could deter adults from taking them.

"And then we will have the reverse problem — more people committing suicide because they are not taking antidepressants," he said.

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http://www.forbes.com/execpicks/2005/02/03/cx_0203health.html

Health
Happy Pills Can Save Lives
E.J. Mundell for HealthDayNews

Despite recent controversy over the potential effects of antidepressants in young users, the lifesaving benefits of drugs such as Paxil, Prozac and Zoloft far outweigh their risks, a new study suggests.

A comprehensive review of decades of data from Europe and the United States reveals a close correlation between dramatic declines in suicide and the introduction of the selective serotonin reuptake inhibitor (SSRI) family of antidepressants into the marketplace.

"If these drugs were really causing suicide, the reverse should be happening," said study author Dr. Julio Licinio, a professor of psychiatry at the University of California, Los Angeles, School of Medicine.

"It's sometimes hard to see the big picture, but I think the overall effect [of SSRIs] is positive," Licinio added.

The study's publication coincides with the release Monday of pharmacy-industry data showing that prescriptions of SSRIs to children and adolescents in the United States fell by 10% in just the last three months of 2004.

Isolated reports of teens committing or attempting suicide while on antidepressant therapy have sparked Congressional debate and widespread media attention. And late last year, a special U.S. Food and Drug Administration panel ordered that "black box" labeling be placed on all SSRI packaging warning doctors, parents and young users of the potential risk.

But has fear pushed the pendulum too far away from a balanced assessment of these drugs?

Gail Griffiths, a member of the FDA panel who voted "yes" to the black box warning last year, said she would vote differently now.

"If I would have known how sharply prescription rates were falling, I would not have voted in favor of the 'black box' warning," Griffiths, a parent whose son attempted suicide while on antidepressants, said in a prepared statement Tuesday. She was endorsing the launch Tuesday of a new online help site to guide parents with pediatric SSRI use.

In her statement, Griffiths added, "I hoped the FDA could help to inform parents, but it seems many parents have simply become fearful of antidepressants, which are so often the life jacket preventing us from being sucked under by depression's powerful undertow."

The results of the UCLA study, published in the February issue of Nature Reviews: Drug Discovery, appear to support Griffiths' view that SSRIs do far more good than harm.

In their study, Licinio's team pored over U.S. and European data on depression and suicide, stretching back to the 1960s. Included in that data were FDA statistics on U.S. suicide rates, as well as studies reporting on the percentage of suicide victims found with traces of antidepressants in their bloodstream.

"To my surprise, I found that the suicide rate goes up in a straight line, year by year, from the 1960s on--right up until 1988, which is exactly the year Prozac was introduced," Licinio said. "From then on, it goes down substantially."

In fact, according to recent figures from the U.S. Centers for Disease Control and Prevention, suicide fell from the 8th leading cause of death in 1998 to the 11th in 2002.

"Also, we find antidepressants in the blood of less than 20% of people who died of suicide--80% had no antidepressants on board at all," Licinio added, which he said might suggest that a majority of victims might have killed themselves because of untreated depression.

Dr. David Fassler, a child and adolescent psychiatrist and spokesman for the American Psychiatric Association, said the latest findings "support the growing consensus that, when used appropriately, the benefits of these medications far outweigh the potential risks."

Fassler believes there's now "a real concern in the medical community that the public is getting confused by contradictory media reports [on this issue]. As a result, people may be less likely to get treatment. That would be a real tragedy, because the good news is that we can help most people who suffer from psychiatric disorders, including depression."

Any reaffirmation of the benefits of SSRIs shouldn't obscure the fact that a minority of users, especially young people, may experience some increase in suicide risk while on these medications. As Licinio explained, that's mainly due to the way the drugs work, with the drugs boosting energy before they ease feelings of gloom.

"Many people who are depressed think, 'Oh, the world would be better off without me.' But they simply lack the energy to act upon that feeling," he said. "At the beginning [of SSRI use], they begin to get that energy, however."

Licinio said that initial period is when parents and doctors should monitor young users most closely, although he stressed that monitoring must continue as long as therapy continues.

Still, available data suggests SSRIs have saved the lives of thousands of people--children and adults alike--so reductions in their use against depression are troubling, he said.

"Of course, suicide is always tragic on an individual level, but I look upon these drugs as I would a vaccine, another intervention that saves lot of lives," Licinio said. "We should be alert here not to throw the baby out with the bathwater."

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http://washingtontimes.com/upi-breaking/20050202-062333-9054r.htm

Study: Antidepressants save lives

Los Angeles, CA, Feb. 2 (UPI) -- U.S. suicide rates have dropped since Prozac and similar drugs were introduced, which researchers say challenges links between antidepressants and suicide.

The study by the University of California at Los Angeles said government action to limit the use of serotonin reuptake inhibitor, or SSRI, drugs might actually increase deaths from depression, the nation's top cause of suicide.

"The vast majority of people who commit suicide suffer from untreated depression," said lead researcher Julio Licinio. "This was particularly true in men and in people under 30."

Licinio worked with fellow psychiatrist Ma-Ling Wong in what was described as an exhaustive search of studies published between 1960 and 2004 on antidepressants and suicide. The results were a surprise.

"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," Licinio said. "Since then, suicide rates have dropped precipitously, sliding from the eighth to the 11th leading cause of death in the United States."

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http://www.eurekalert.org/pub_releases/2005-02/uoc--nus012705.php

New UCLA study disputes antidepressant/suicide link Scientists fear rise in deaths from untreated depression

Challenging recent claims linking antidepressant use to suicidal behavior, a new UCLA study shows that American suicide rates have dropped steadily since the introduction of Prozac and other serotonin reuptake inhibitor (SSRI) drugs. Published in the February edition of the journal Nature Reviews Drug Discovery, the authors caution that regulatory actions to limit SSRI prescriptions may actually increase death rates from untreated depression, the No. 1 cause of suicide.

"The recent debate has focused solely on a possible link between antidepressant use and suicide risk without examining the question within a broader historical and medical context," explained Dr. Julio Licinio, a professor of psychiatry and endocrinology at the David Geffen School of Medicine and a researcher at the UCLA Neuropsychiatric Institute. "We feared that the absence of treatment may prove more harmful to depressed individuals than the effects of the drugs themselves."

"The vast majority of people who commit suicide suffer from untreated depression," he added. "We wanted to explore a possible SSRI-suicide link while ensuring that effective treatment and drug development for depression were not halted without cause."

Licinio worked with fellow psychiatrist Dr. Ma-Ling Wong to conduct an exhaustive database search of studies published between 1960 and 2004 on antidepressants and suicide. The team reviewed each piece of research in great detail and created a timeline of key regulatory events related to antidepressants. Then they generated charts tracking antidepressant use and suicide rates in the United States.

What they found surprised them.

"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," said Licinio. "Since then, suicide rates have dropped precipitously, sliding from the 8th to the 11th leading cause of death in the United States."

Several large-scale studies in the United States and Europe also screened blood samples from suicide victims and found no association between antidepressant use and suicide.

"Researchers found blood antidepressant levels in less than 20 percent of suicide cases," said Licinio. "This implies that the vast majority of suicide victims never received treatment for their depression."

"Our findings strongly suggest that these individuals who committed suicide were not reacting to their SSRI medication," he added. "They actually killed themselves due to untreated depression. This was particularly true in men and in people under 30."

Licinio and Wong fear that overzealous regulatory and medical reaction, public confusion and widespread media coverage may persuade people to stop taking antidepressants altogether. They warn that this would result in a far worse situation by causing a drop in treatment for people who actually need it.

The UCLA study also looked at other reasons that may contribute to suicidal behavior by people taking SSRIs for depression.

Before the introduction of SSRIs, patients taking early drug treatments for depression were susceptible to overdoses and serious side effects, such as irregular heart rates and blood pressure increases. As a result, doctors prescribed the drugs in small doses and followed patients closely.

In contrast, toxic side effects are rare in SSRIs. Physicians often prescribe the drugs in larger doses and may not see the patient again for up to two months. This scenario, Licinio warns, can set the stage for suicide risk.

"When people start antidepressant therapy, the first symptom to be alleviated is low energy, but the feeling that life isn't worth living is the last to go," he said. "Prior to taking SSRIs, depressed people may not have committed suicide due to their extreme lethargy. As they begin drug therapy, they experience more energy, but still feel that life isn't worth living. That's when a depressed person is most in danger of committing suicide."

Licinio stresses the need for even closer monitoring of SSRI use by children.

"The only antidepressant proven to be effective for treating children with depression is Prozac," he said. "Children should receive Prozac only and should be followed very closely by their physicians during treatment."

### Funding from the National Institute of General Medical Sciences and an award from the Dana Foundation supported the research.

Depression is a complex disorder that affects some 10 percent of men and 20 percent of women in the United States during their lifetime. Ten to 15 percent of depressed people commit suicide. Depression plays a role in at least half of all adult suicides and in 76 percent of suicides committed by children. Suicide is the most common cause of death in children age 5 to 14, the third most common cause of death in people age 15 to 24, and the fourth most common cause in people age 25 to 44.

The UCLA Neuropsychiatric Institute is an interdisciplinary research and education institute devoted to the understanding of complex human behavior, and the causes and consequences of neuropsychiatric disorders. See www.npi.ucla.edu for more information.

-UCLA-

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http://www.newkerala.com/news-daily/news/features.php?action=fullnews&id=68063

Antidepressants save lives:

[World News]: LOS ANGELES, Feb. 2 : U.S. suicide rates have dropped since Prozac and similar drugs were introduced, which researchers say challenges links between antidepressants and suicide.

"The vast majority of people who commit suicide suffer from untreated depression," said lead researcher Julio Licinio. "This was particularly true in men and in people under 30."

"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," Licinio said. "Since then, suicide rates have dropped precipitously, sliding from the 8th to the 11th leading cause of death in the United States."

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