Antidepressants, Suicide, and Statistics

The link between antidepressants and suicide has been a popular topic in the news for the past few years. The obvious association is that antidepressants improve depression and therefore decrease suicidal thoughts, suicide attempts, and completed suicides.
But most of the media attention has been on whether antidepressants, especially the commonly prescribed selective serotonin reuptake inhibitors (SSRIs) might increase suicidal thinking in some people.
The news articles were prompted by statistics from research studies with these medications that suggested an increase in suicidal thinking among children. However, there were no actual suicides among the depressed children in these research studies, and the strength of the association between antidepressants and suicidal thinking was far from convincing.
Nevertheless, the FDA took the conservative and controversial step of issuing a warning that many antidepressants could possibly increase the risk of suicidal thinking. As a consequence of the warning, many medical experts worried that suicides among children might actually increase if doctors became reluctant to prescribe antidepressants.
A new, and in my opinion more accurate perspective on SSRI antidepressants and suicide appears in an article published recently in the American Journal of Psychiatry. The authors examined the suicide rate among children ages 5 to 14 years in several countries, including the U.S. They compared these suicide rates with data on the use of SSRI antidepressants.
The results showed that the suicide rate for children was lowest in those countries where the use of SSRIs was highest. The findings remained the same regardless of sex, race, income levels, and access to quality mental health care.
The United States was in this category of high SSRI use and relatively low childhood suicide rate. Overall, the U.S. childhood suicide rate was 0.7 per 100,000 suicides; however, in some countries it was as high as 1.7 per 100,000. The lowest rates of childhood suicide in the U.S. were in large cities like Chicago, New York, Boston, and Los Angeles.
The authors of the article point out that this type of research never can prove a causal relationship, but can only measure the strength of an association. However, the findings certainly are consistent with what those of us who work in the field would expect.