Did The Gov's Anti-Meds Warnings Work Too Well?

Some psychiatrists are claiming that the government’s “black box” warnings on the risks of antidepressants for teenagers have worked too well, to the point that they’ve scared off worried parents and lawsuit-sensitive doctors, leaving depressed teens undiagnosed and untreated. The rate of suicide among children and young adults jumped 8% in 2004, one year after the warnings went into effect—it was the biggest one-year spike in suicides for that demographic in 15 years, and psychiatrists worry it was caused in part by the 22% drop in prescriptions of antidepressants.

The Netherlands reported an alarming 49% jump in the teen suicide rate from 2003 to 2005. They, too, have a “black box” warning on antidepressants that, ironically, warns consumers that the medication can lead to suicidal thoughts.

So, did a warning for the benefit of the public backfire and worsen the problem, or is something else responsible for the higher rates? Experts are divided. The CDC’s National Center for Injury Prevention and Control says the spike can’t be pinned on just a drop in antidepressant prescriptions, because “suicide is a multidimensional and complex problem.” A psychiatrist concurs, “There are so many social issues that go into suicide rates and how they’re reported.”

But Dr. Mark Riddle at Johns Hopkins Children’s Center says, “There’s been concern that the black box would lead to a reduction in prescribing and therefore an increase in suicides, and my guess is that’s what’s happening.”

Antidepressant warnings scared parents, doctors” [Scientific American]
“Suicide rates of U.S. youths rose 8% in 2004″ [Baltimore Sun]

RELATED
Wikipedia entry on Black Box warnings
(Photo: Getty)

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  1. blue_duck says:

    I’ve been on anti-depressants since I was 12 or 13 and they haven’t brought on thoughts of suicide. Then again, maybe I’m just a super hero…

  2. Voyou_Charmant says:

    :(

  3. If you read another article on the same thing, it says that the rise has been specifically in teenage girls. Gosh, whatever could be inspiring girls to commit suicide? Um…oh right. The massive amount of anti-female legislation that’s been passed in the last 8 years…

    …but yeah…lack of suicide-inducing drugs. That works too.

  4. Anitra says:

    @spiderjerusalem: What do you mean by “anti-female legislation”? I haven’t heard about any laws targeting teenage girls to make their lives (more) miserable.

  5. QuirkyRachel says:

    Or….they could actually get their depressed teens into therapy instead of just taking the easy route of pills. Ooooh, imagine actually working on things instead of just popping a pill?
    Actually, in the cases of depression and anxiety, only taking medication as treatment tends to work better than doing nothing, but is less effective than taking meds and being in therapy (tends to be most effective), or just talk therapy (2nd most effective). In fact interestingly, using only drugs as treatment for depression and anxiety may actually be less effective in the long term than doing nothing.

  6. blue_duck says:

    @QuirkyRachel: You’re thinking logically though, that’s too much to ask for in this case…

  7. @AnitraSmith: Then you haven’t been reading. Look up “parental notification laws”, “abstinence-only education”, laws about husband approval needed for medical care. Look up recent rulings where men who rape intensely underage kids have walked because the judge decided the 10-year-old was used to it/wanted it.

    Also, look at the fact that shops like Club Libby Lu demand girls give up their brains for their bodies (at as young as 3) and then their helicopter parents demand they give up their childhoods for their Ivy League acceptance letter.

    I teach kids around the age where the suicide increase is being seen, and its not hard to see where “tweens” are being pressured from both sides.

  8. @QuirkyRachel: I am confused by your assertion that doping your kids does not fix all of their problems. What is this “therapy” of which you speak?

    Seriously, I’ve watched parents drug their kids rather than even getting a tutor or an aide (which the state would pay for) to help their kid with their learning disability.

  9. BrockBrockman says:

    Well, this is the first semi-rational reason I’ve come across giving some insight to the increase in teen suicide.

  10. Anitra says:

    @spiderjerusalem: I’m not arguing that teens aren’t under a lot of stress, or that depression isn’t rising. But if their families are so screwed up that they are being seriously effected by parental-notification laws, abstinence-only education, and shitty rape-case rulings, then they’re probably not getting therapy and anti-depressants either.

    Unfortunately, you can’t legislate away bad parenting, which the US seems to be trying to do (poorly). And without good parents, you end up with a lot of messed up kids. I was a teenager not too long ago, and I’ve seen plenty of it.

  11. Thain says:

    @spiderjerusalem: Transmetropolitan for the win!

    Perhaps the government should start mentioning proven effective alternatives to medication, rather than just saying the medication is dangerous. The Touch Institute has multiple studies showing the effectiveness of massage therapy in effecting behavioral change and lowering Cortisol levels in depressed adolescents, but when’s the last time parents were told that massage therapy might be beneficial to their children?

  12. Thain says:

    @anitrasmith: It’s true that you can’t legislate away bad parenting, but, if Aldou’s Huxley’s Brave New World is any indication, you don’t WANT to legislate it away. Less government involvement is always better than more.

  13. @Thain: I believe it was on that episode of Law and Order where the stepmother was indicted for photos of her using massage therapy on her child (which was later proven to be legitimate, but didn’t stop the state from trying to press charges).

  14. andrewsmash says:

    @spiderjerusalem: The biggest opponent of alternative therapies is the pharmaceutical companies, and that’s just because they might work better for some people.

    It’s sad how much impact these corporate whores masquerading as medical professionals have at the legislative level. If we were allowed to see third-party studies independent of corporate influence, I can guarantee we would see that 90% of psychiatric medication given to children under 18 are an effort to control behaviors that exist independent of an actual psychologically-related condition. Look at the recent studies indicating the effects of artificial additives on hyper-activity. If we wanted to correct that, we would ban those additives in food marketed and available to children, but instead we recommend sedatives. It just shows that if you want to raise healthy and happy children, you can’t trust the minimum standards of our society.

  15. Some psychiatrists are claiming that the government’s “black box” warnings on the risks of antidepressants for teenagers have worked too well, to the point that they’ve scared off worried parents and lawsuit-sensitive doctors, leaving depressed teens undiagnosed and untreated.

    But can’t you diagnose and treat teens without perscriptions?

    Interesting that it’s happening more in teen girls. I wouldn’t be surprised if birth control pills had something to do with it: I tried switching to a less expensive pill (it was also low dose) and it made me nuts. But then I’m not on it to prevent pregnancy.

  16. ceejeemcbeegee is not here says:

    I’d be wary of the meds too if it caused things like ‘increased gambling’. I’d rather be depressed than depressed AND broke.

  17. allthatsevil says:

    When I was diagnosed with severe anxiety a few years ago, my doctor had me try a laundry list of different anti-depressants. They all had side-effects that I wasn’t willing to put up with, but the last one I was on made me severely depressed. I think it was Cymbalta. When he started to recommend the next popular drug I told him I wasn’t going to take any more and I quit, cold turkey. I have Xanax for extreme situations, but my current prescription of 30 pills was last filled over a year ago, and I still have at least half of them.

    Since then, I’ve found much better relief in other ways, such as counseling. When it comes to teens, it really does come down to the parents. Most parents don’t know how to communicate with their teens because it isn’t easy, so some throw drugs at them instead. I think what most kids want is simply someone to talk to, someone who will listen without judging. I think it is getting harder and harder to be a teenager these days; there are so many more adult responsibilities they have to take on, but they’re still treated like children.

    So, in my opinion, this claim that drug warning labels are to blame for higher suicide rates is a combination of drug companies looking out for themselves, incompetent psychiatrists, and parents looking for an easy fix.

  18. allthatsevil says:

    @ceejeemcbeegee: That was actually a drug for restless leg syndrome, but yeah, I agree. Most of the time the side effects are not worth the risk of taking the drug – to me, at least.

  19. hoo_foot says:

    There was a Washington Post article last week about the US study, and it mentioned that Pfizer kicked in some of the funding for it.

    Yeah, that’s not biased at all….

  20. Amy Alkon says:

    Ooooh, imagine actually working on things instead of just popping a pill?

    Some depression is biochemical. Some can be dealt with via cognitive behavioral therapy, founded by Aaron Beck and the late Albert Ellis.

    There’s too much thinking like that above. Sure, you shouldn’t run around harboring a bunch of unresolved psychological problems. But, if taking a pill can make your life better, and the side effects for you are small or negligible, why not?

    I take Ritalin for ADHD. It’s changed my life. I only wish I’d been diagnosed when I was still in school (instead of in the late 90s). Without Ritalin, well, my head is comparable to a treehole full of squirrels — each of them running off in different directions.

    Better living through chemistry? I’m all for it. As for those who are opposed wholesale, well, try thinking instead of repeating the nonthink of those who are against “Big Pharma” and the like.

    (Blowing a big wet kiss to “Big Pharma.”)

  21. zolielo says:

    Just say no…

  22. Xkeeper says:

    @allthatsevil:

    When it comes to teens, it really does come down to the parents. Most parents don’t know how to communicate with their teens because it isn’t easy, so some throw drugs at them instead. I think what most kids want is simply someone to talk to, someone who will listen without judging. I think it is getting harder and harder to be a teenager these days; there are so many more adult responsibilities they have to take on, but they’re still treated like children.

    I’m currently 19, and I can fully agree. I have a lot of problems talking to my parents and a lot of other things — for example, several months ago I was talking with a good “friend of my mom” whom I had trusted well, mentioned my growing consideration of moving out of state, mentioned it was private, not actually being considered…

    …and within a few days it was telephoned (as in the game) to my mother, translated into something like “he’s moving in with a rapist/murderer”. Needless to say, I do *not* like talking to my family anymore.

    And, again, I can also vouch for your last line. Quite often I’m told that I am an ‘adult’, and how I have responsibilities x, y, and z, yet not long after (or even in the same conversation!) I’m told that I’m just a child.

    @Amy Alkon:

    I don’t think it should be “pill popping”, as much as “what works for you”. For example, some people might have better reactions to pills, therapy, massaging, whatever. Just outright saying “Y is bad for you, X is better!” accomplishes nothing.

  23. Hambriq says:

    @QuirkyRachel: “In fact interestingly, using only drugs as treatment for depression and anxiety may actually be less effective in the long term than doing nothing.”

    Are you joking? I mean, on one hand, I don’t like the idea of drugging our kids just because they have a shitty day, but come on now. Now you’re just being ignorant. If you can show me one legitimate medical study which verifies this exceptionally dubious claim that you just made, I’ll buy you a big ol’ bottle of Vicodin.

    The fact is, a good percentage of depression is a result of biological factors. This does not mean they can only be dealt with using medications. But to suggest that anti-depressants are never the answer is just as ignorant as suggesting that they are always the answer. Almost every therapist worth his or her salt will weigh the risks of a specific patient, and determine if they can be treated using strictly therapy. If they don’t respond adequately to therapy, or the initial risks are too great, concurrent anti-depressant treatment should be used.

    Now, what I really don’t agree with is family practice doctors and other non-specialists prescribing the drug of the day when their patients come in to complain about feeling down. I see way too many one-two punches of Lexapro/Klonopin getting prescribed by the same doctors who prescribe kids antibiotics, cough syrup, and asthma medicine. Granted, some of these prescriptions may be a result of referrals from the patient’s therapist… But I’m certainly not naive enough to think that this is the case every time.

  24. Hambriq says:

    @Amy Alkon: “Better living through chemistry? I’m all for it. As for those who are opposed wholesale, well, try thinking instead of repeating the nonthink of those who are against “Big Pharma” and the like.

    I think we need more thinking like this. Granted, I don’t think drugs are always the answer, and sure, I’m a little bit biased. But when you’ve got cancer, when you’ve got AIDS, when you’ve got Parkinson’s, MS, any kind of chronic, uncurable condition, suddenly, you start becoming a lot more friendly to “the man”. I won’t get into the whole health care debate, but you can’t really argue against the fact that when it comes to research and development of new medicines, the U.S. is head and shoulders above the rest of the world.

    Why? Because Pharma is a massive, billion dollar industry. Because we pay so much for it. We can debate the causes and consequences of the rising health care costs all we want, but the bottom line is that all the money we’re spending isn’t just lining CEO’s pockets, its going towards developing new drugs. Most people don’t see this, they just see the bullshit ads for Restless Leg Syndrome, or they see the countless thousands of the over-medicated. But when you get diagnosed with an obscure disease like PNH, you’ll be thanking your lucky stars we pump so much money into the Pharma industry.

    Now, granted, all the drugs in the world won’t do us any good if we can’t afford to use them. And all the free health care in the world won’t do us any good if the health care we get is of poor quality. So obviously, a balance must be struck between the two. But you people should think about that next time you lambaste Big Pharma.

  25. 5cents says:

    Besides, teenagers are supposed to be depressed not happy. Part of growing up and all that innit?

  26. Mariallena says:

    Oh, please!

    This article is just a piece of fluff planted by the pharmaceutical companies because of slowing sales of antidepressants.

    The warning was recommended at the end of 2004 and it caused increased suicides in 2004? How is that? Are the teenagers that committed suicide clairvoyants?

    Big pharma is seeing a dent in their gigantic profits and are trying to create the illusion that our poor depressed kids are going untreated because of those big bad black government warnings.

    I would like to know how much money the doctor quotes in the article receives from big pharma.

  27. HaxRomana says:

    Lots of people are missing the point. I don’t think any doctor/psychologist/psychiatrist ever recommended that anyone take antidepressants without also getting therapy. The point of the drugs is that they chill you out (i.e. they mitigate the biological factors that often cause or exacerbate mental health issues) so that the therapy can be of some use to you.

  28. @HaxRomana: OK, if a psychiatrist suggests a kid takes Ritalin, more because he’s getting kickbacks from the company than because the kid actually has ADHD, do you think that at ANYTIME during the therapy, he’s going to admit he’s put the kid on the wrong medication? And do you think parents are going to drag their kid to multiple therapists and put their kids on multiple drugs to see which one’s better?

    I have a friend who was not ADHD, nor autistic, but psychotic, but he was put on Ritalin for 15 years because he had a psychiatrist who would not admit he was wrong, even when the Ritalin only really exacerbated my friend’s psychotic episodes.

    I do think pharmaceutical companies have their place. My friend is delightful now that he is on anti-psychotics, but his ENTIRE CHILDHOOD was messed up because his doctor was a prick and his parents were too scared/comfortable/whatever to change anything.

  29. Her Grace says:

    @Amy Alkon: My depression was likely a combination of biochemical and situational. I’ve always been anxious and nervous, and when that turned into a flow-blown anxiety disorder in my teens, it triggered depression. Who wouldn’t be a bit depressed if they knew they were acting in an insane manner? For me, drugs worked too. If I had to do it again, I knowing the possible side effects, I can’t say for sure if I’d take Zoloft or not. But talk therapy wasn’t going to help, as my anxiety was entirely irrational and not something I could verbalize.

    No answer to any psychological problem will be the same for everyone. Disorders can be misdiagnosed–I think I was put on the Zoloft for depression rather than anxiety, now that I try to recall–and many have both biochemical and other causes. NO therapy will work for everyone. I think it’s just as much of a cop-out to blame Big Pharma and use only ‘alternative’ (not really a great term; I prefer something that gets to the heart of the lack of testing and proving efficacy, and once something has proven it’s efficacy it becomes ‘normal’ or ‘mainstream’ or whatever you like) therapies as it is to only drug kids and not evaluate them as individuals who may require rediagnosis later.

    As for Pfizer helping to pay…who else would fund such a study?