MEDICATIONS: AS ANTIDEPRESSANT MEDICATION TREATMENT INCREASES, ADOLESCENT SUICIDE RATES DECREASE

October 15, 2003 — Increases in antidepressant medication use are associated with decreases in rates of suicide among older adolescents and adolescent males, according to an article in the October issue of The Archives of General Psychiatry, a journal of the American Medical Association.

Despite declining suicide rates in the United States, suicide is still the third-leading cause of death among adolescents aged 15 to 19 years old, and the fourth-leading cause for adolescents aged 10 to 14 years old, according to the article. Recent increases in antidepressant medication use among adolescents may be partially responsible for the decline.

Mark Olfson, M.D., M.P.H., of Columbia University, New York, and colleagues explored possible relationships between changes in rates of suicides among adolescents and changes in antidepressant prescriptions to adolescents between 1990 and 2000.

The researchers calculated the number of antidepressant prescriptions filled by youths aged 10 to 19 years old in 588 ZIP code regions in the United States using data from the nation's largest pharmacy benefit management organization. The number of suicides that occurred in the same ZIP codes was determined using data from the national suicide mortality files. The researchers also used regional and sociodemographic data from the 1990 and 2000 U.S. Census and Area Resource Files, including the number of psychiatrists, child psychiatrists and pediatricians per capita for each region studied.

The researchers found that in 1990 and in 2000, there was a positive association between regional antidepressant use and suicide, indicating that regions that had high rates of antidepressant use among adolescents also had higher suicide rates. However, the authors also found a "significant adjusted negative relationship between regional change in antidepressant medication treatment and suicide during the study period."

The researchers also found "A one percent increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicides per 100,000 adolescents per year." These significant inverse trends in antidepressant medication treatment and suicide rates were present for older adolescents (age 15-19) and males but not for younger adolescents or females. "Compared with younger adolescents who commit suicide, older adolescents who commit suicide are more likely to have a diagnosable disorder, including depression, and so these patients may be more likely to benefit from antidepressants," the researchers write.

They conclude: "An inverse relationship between regional change in use of antidepressants and suicide raises the possibility of a role for using antidepressant treatment in youth suicide prevention efforts, especially for males, older adolescents, and adolescents who reside in lower-income regions."

Editor's Note: Dr. Olfson serves on an advisory board and is a principal investigator for a research grant from Bristol-Myers Squibb; is a consultant on a research project sponsored by Wyeth Pharmaceuticals; and is a co-investigator on projects sponsored by Eli Lilly & Company and GlaxoSmithKline. Dr. Marcus is a consultant on a research project sponsored by Wyeth Pharmaceuticals.