Antidepressants tied to lower suicide rates in kids

NEW YORK, Nov 4 (Reuters) In US counties with the highest rates of prescriptions for selective serotonin reuptake inhibitors (SSRI), a type of antidepressant, the rate of suicide among children ages five to 14 is lower than that observed in counties with lower rates, according to a new report.

''Three large population studies in adults and adolescents found an inverse relationship between SSRI use and increased risk of suicide,'' lead author Dr Robert D Gibbons told Reuters Health.

''But there have been no such studies of younger children.'' In 2004, the US Food and Drug Administration (FDA) advisory panel began requiring a black box warning on SSRI prescriptions, based on reports that fluoxetine (Prozac) increased suicidal thoughts in children and adolescents.

''Now we are evaluating whether suicide rates have increased since the black box warning was required,'' Gibbons told Reuters Health, ''and to see if decreased use of SSRIs is associated with actual suicide.'' ''If we see that decreased prescribing of SSRIs brought about by the black box warning is leading to an increased completed suicide rate in kids, we want to get that message out as quickly as possible.'' Gibbons, a biostatistician at the University of Illinois at Chicago, and associates analyzed data from the Centers for Disease Control and Prevention regarding suicides among children five to 14 years of age. The data covered the period 1996 through 1998, and was grouped by county. They then linked this data with SSRI prescriptions from a random sample of 20,000 pharmacies.

Among nearly 39 million children ages five to 14, there were 933 suicides between 1996 and 1998 (0.8 per 100,000 children per year).

Since the implementation of the black box warning, the rate of antidepressant prescriptions in children fell by about 30 per cent, the authors note. Subsequently, the overall observed suicide rate was as high as 1.7 per 100,000 for counties with the lowest decile of SSRI prescriptions. At the highest decile, the rate was 0.7 per 100,000.

The association between SSRI prescriptions and completed suicides remained significant after adjusting for income and access to mental health care.

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