From Our 2007 Archives

Suicide Attempts Fall After Depression Treatment Begins

By Ed Edelson
HealthDay Reporter

MONDAY, July 2 (HealthDay News) -- Suicide attempts dropped among people with depression soon after they started treatment, either with antidepressant drugs or psychotherapy, a study of more than 109,000 patients shows.

The study results come after a controversial 2004 recommendation on antidepressant labeling from the U.S. Food and Drug Administration (FDA). That move slapped a strong "black box" warning on the labeling of drugs called selective serotonin reuptake inhibitors (SSRIs), which include Celexa, Paxil, Prozac and Zoloft.

The warning outlined the potential for an increase in suicidal thoughts among teenagers and young adults prescribed the medications. The warning also urged closer clinical monitoring of these patients.

However, "the FDA warning was based on placebo-controlled trials," noted lead researcher Dr. Greg Simon, a psychiatrist and researcher at Group Health, a Seattle-based nonprofit health care system. "They did not look at suicide attempts, because they were too rare. In the whole group of studies the FDA looked at, there were only two suicide attempts," Simon said.

The current trial, published in the July issue of the American Journal of Psychiatry, does focus on suicide attempts. It finds that pharmaceutical and psychotherapy treatments aimed at fighting depression reduce those attempts.

Simon's study looked at suicide attempts among more than 70,000 people who got an antidepressant prescription from their primary care physicians, almost 7,300 people who got prescriptions from a psychiatrist and more than 54,000 who started psychotherapy for the treatment of depression.

"The pattern of [suicide] attempts over time was the same in all three groups: highest in the month before starting treatment, next highest in the month after starting treatment, and declining thereafter," the report said. "Results were unchanged after eliminating patients receiving overlapping treatment with medication and psychotherapy. Overall incidence of suicide attempts was higher in adolescents and young adults, but the time pattern was the same across all three treatments," the study authors found.

The overall incidence of suicide attempts in the first six months was highest in those taking antidepressant drugs prescribed by a psychiatrist (1,124 attempts per 100,000), lower among those starting psychotherapy (778 per 100,000) and lowest of all among those who were taking antidepressants prescribed by a general practitioner (301 per 100,000).

The bottom line: "Our study indicates there is nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves or protect them from suicidal thoughts," Simon said.

"Instead, we think that on average, starting any kind of treatment medication, psychotherapy or both, helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it," he said.

The new report "is one of a couple showing that prescribing antidepressant medication for people who are depressed has the potential for reducing the number of suicide attempts," said Dr. J. John Mann, chief of the department of neuroscience at the New York Psychiatric Institute, New York City.

Mann co-authored one such report, which relied on U.S. Veterans Administration data. "We found exactly the same thing" as the Simon report, Mann said. "Antidepressant treatment resulted in lower rates of suicide attempts after people went on to treatment."

Such studies "suggest that these medications may be more beneficial than has been thought in the past," Mann said. "If there is a risk in these medications, it clearly is outweighed by the benefits. No treatment is the worst option of all."

Simon also pointed out that the FDA warning reduced use of SSRI drugs for treatment of depression, but it has not appeared to increase doctors' monitoring of young people who are taking the drugs. The standing recommendation for three follow-up visits to the therapist prescribing antidepressant drugs was observed in only 21 percent of cases, the researcher said.

"That is where we are poor in practice," Simon said. "My concern is that the practical impact of the warning was [only in] reduced rates of treatment."

SOURCES: Greg Simon, M.D., psychiatrist, Group Health, Seattle; J. John Mann, M.D., chief, department of neuroscience, New York Psychiatric Institute; July 2007, American Journal of Psychiatry

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