Pharma Spin and Child Suicide Rates

According to the Center for Disease Control and Prevention’s Annual
Summary of Vital Statistics, the suicide rate rose more than 18 percent
in those 1 to 19 years old from 2.2 per 100,000 in 2003, to 2.6 per
100,000 in 2004. In those 15 to 19 years old, the figures reflected a
more than 12 percent rise in suicide, from 7.3 per 100,000 in 2003 to
8.2 per 100,000 in 2004.

“The rise occurred at the same time that the Food and Drug
Administration mandated heightened warnings on the labels of selective
serotonin reuptake inhibitors (SSRIs), a particular class of
antidepressant medications that includes Prozac, Paxil and Zoloft.”

The linkage between the increased suicide rate and warnings on SSRI
labels was manufactured by antidepressant drug companies and their PR
firms who have embarked on a campaign to keep physicians and parents
uninformed about the risks posed by the drugs prescribed.

The claimed causal linkage is negated by the facts: In October 2004, the
American Psychiatric Association published the following:

“In 2003, U.S. physicians wrote 15 million antidepressant prescriptions for patients under age 18, according to FDA data. In the first six months of 2004, antidepressant prescriptions for children increased by almost 8 percent, despite the new drug labeling.”

See: American Psychiatric Association, News & Notes Survey Paints Bleak
Picture of Health Insurance Coverage and Premiums, Psychiatric Services
October 2004,  55:1192-1193 online at:
http://www.psychservices.psychiatryonline.org/cgi/content/full/55/10/1192

So, if antidepressant prescriptions for children INCREASED by almost 8% in the first six months of 2004, how could an INCREASED suicide rate the same year be blamed on reduced use of antidepressants???

The “authorities” quoted in today’s media reports make bald, unsubstantiated pronouncements asserting causal links between the black box warnings and the finding of increased suicide rates. This is known
as an ecological fallacy.
Those who present themselves as “authorities”– Dr. Charles Nemeroff and Dr. David Fassler–should be more judicious about making scientifically invalid claims.

Dr. Charles Nemeroff’s financial ties to manufacturers are legendary. He has even been found to have put his name to a ghostwritten article and published it in a journal that he previously was the editor in chief of.
(See, for example: Wall Street Journal; New York Times editorial, and more:
www.ahrp.org/cms/content/view/295/27 and  www.ahrp.org/cms/content/view/301/27 .

And Dr. David Fassler, a spokesman for the American Psychiatric Association and the American Academy of Child & Adolescent Psychiatry, has never found fault with prescribing any psychotropic drug or drug combination for children.

The media fell for an industry planted “news” item inappropriately linking suicide rates and antidepressant use. The media had fallen for industry’s manufactured myths before. For
example, the mythological “chemical imbalance” in the brain of depressed persons who, it was claimed, needed an SSRI antidepressant to increase serotonin levels.

When will medical news reporters and science editors adopt of a bit of skepticism rather than disseminate Big Pharma’s planted spins?

Contact: Vera Hassner Sharav
212-595-8974
veracare@ahrp.org
http://abclocal.go.com/wpvi/story?section=nation_world&id=5006104
ABC News:  Child Suicide Rate Spikes Nearly 20 Percent ABC News Medical Unit

Feb. 5, 2007 – February 5, 2007 – Child and teen suicide rates rose for
the first time in more than a decade in 2004 – and many psychological
experts said the stronger warning labels that led to a drop in the
number of prescriptions for antidepressant drugs may be to blame.

According to the Center for Disease Control and Prevention’s Annual
Summary of Vital Statistics released Monday, the suicide rate rose more
than 18 percent in those 1 to 19 years old, from 2.2 per 100,000 in 2003
to 2.6 per 100,000 in 2004.

In those 15 to 19 years old, the figures reflected a more than 12
percent rise in suicide, from 7.3 per 100,000 in 2003 to 8.2 per 100,000
in 2004.

The rise occurred at the same time that the Food and Drug Administration
mandated heightened warnings on the labels of selective serotonin
reuptake inhibitors (SSRIs), a particular class of antidepressant
medications that includes Prozac, Paxil and Zoloft.

The “black box” warnings were added in March 2004 over concerns that the
medications led an increase in suicidal thinking in patients. The
prescribing of these medications to children subsequently dropped by 20
percent.

Not all experts said there was a clear link between the warning labels
and the increase in suicide rates, but many believe the association is
too dramatic to ignore.

“I have no doubt that there is such a relationship,” said Dr. Charles
Nemeroff, chairman of the department of psychiatry and behavioral
sciences at the Emory University School of Medicine. “The concerns about
antidepressant use in children and adolescents has paradoxically
resulted in a reduction in their use, and this has contributed to
increased suicide rates.”

“This is very disturbing news,” said Dr. David Fassler, clinical
professor of psychiatry at the University of Vermont College of
Medicine. “The adolescent suicide rate has been declining steadily since
the early 1990s.
“The sudden increase in the adolescent suicide rate,” Fassler continued,
“corresponds to the significant and precipitous decrease in the use of
SSRI antidepressants in this age group.”

The nonprofit group Mental Health America has also called for a further
look into the FDA’s decision to strengthen warnings on SSRIs.
“As a result of the agency’s activities, dramatic decreases in the use
of SSRIs in the adolescent population were noted,” said David Shern,
president of Mental Health America in a statement issued Monday. “Other
research has indicated a general relationship between the use of SSRIs
and decreasing suicide rates in the general population.

“We must therefore wonder if the FDA’s actions and the subsequent
decrease in access to these antidepressants have caused an increase in
youth suicide.”

Warning Labels May Scare Doctors, Parents Some doctors say the
additional black box warnings may have led medical professionals to be
less confident in prescribing antidepressants.
“In the state of Michigan, we have found that our colleagues in
pediatrics have become increasingly uncomfortable with the prescription
of SSRIs following the institution of the black box warning,” said Dr.
Sheila Marcus of the section of child and adolescent psychiatry at the
University of Michigan Hospitals.

“The past history of such FDA warnings has revealed that they create
barriers to care and unnecessarily frighten families away from seeking
treatment,” Nemeroff said.

Whether SSRIs actually increase the likelihood that a child or teen will
commit suicide is still unclear. Studies at the time did show that young
patients taking the drugs did have increased thoughts of suicide. But
whether increased thoughts lead to increased action when it comes to
suicide is still a matter of debate. “There could be a small
relationship, but we don’t have the evidence to support that there is a
causal link at this point in time,” said Bernadette Melnyk, dean and
professor of nursing at the Arizona State University College of Nursing
and Healthcare.

“What we know about the link between antidepressants and suicide is they
can cause an increase in suicidal thinking, but no study has shown an
increase in suicides as a result of antidepressants,” said Lori Evans,
project coordinator of Treatment of Adolescent Suicide Attempters.

“We do not have the data to know if there has been a significant
decrease in the amount of prescriptions given to teens since the
warning. Therefore we certainly cannot say there is a causal link.”

But Fassler said the new figures suggest that the black box warnings may
be doing more harm than good.

“The FDA decision to place a black box warning on these medications
remains controversial,” Fassler said. “To this day, there are no data
demonstrating that SSRI antidepressants increase the actual risk of
suicide.

“Conversely, the current data suggest that the decreased use of these
medications is, in fact, associated with an increase in actual deaths
attributable to suicide.”

More Evidence Needed

Despite the suggestions of a connection between the drop in SSRI
prescriptions and the spike in child and teen suicides, more research
will be needed before a conclusive link can be drawn.

And some say the government has not yet sought an adequate answer to the
question of whether this link truly exists.

“I don’t think that we know for sure, and that is the fundamental
problem here,” said Dr. Bennett Leventhal, director of the Center for
Child Mental Health and Developmental Neuroscience at the University of
Illinois. “The NIH, CDC and other agencies have failed their
responsibility of funding proper studies with enough power to answer the
important questions about medical treatment of suicide in children, as
well as the side effects of these medications.”

Another possibility is that a shortage in child therapists could lead to
a decreased ability of children and teens to seek psychological help
when it is needed. “We lack approximately 30,000 child psychiatrists in
the U.S., so the gaps in mental health services for those children and
youth who need them are huge,” said Bernadette Melnyk, dean and
professor of nursing at the Arizona State University College of Nursing
and Healthcare.
“With one out of four children and teens affected by a mental health
problem, less than 25 to 30 percent receive any treatment.”

Leventhal said the lack of trained professionals means young patients
must sometimes wait a long time for treatment.
“Depression is horrible, but waiting without treatment is worse,” he
said.
“Imagine if we tolerated that for cancer or heart disease.”

But the fact that the jump in youth suicide corresponded with the
changes in SSRI labeling has many suggesting that the government
re-examine its policy toward antidepressant warnings. “I hope the FDA
studies this report carefully,” Fassler said. “I think they have an
obligation to monitor the impact of their regulatory decisions and to
make such modifications as may be appropriate based on subsequent
research findings.”

(Copyright 2007 by ABC News. All Rights Reserved.)

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