BY JOEL SWANSON

In print | October 11, 2007

Science has taken us all the way to the moon, but the inner workings of our mind still remain a mystery.

A study released last week in the American Journal of Psychiatry suggests that scientists may have located two genes that increase the likelihood that someone will report suicidal thoughts while taking antidepressants. The study only involved one specific antidepressant, Celexa from Forest Laboratories, and as a result it is far too early to generalize its findings.

But that will certainly not stop the media shitstorm that will inevitably follow from such findings. Because of this, we may unfortunately attempt to draw broad conclusions from insufficient data and forget about the individuals that lie behind the numbers.

In September, the Center for Disease Control released somewhat alarming statistics showing that youth suicide rates rose dramatically in 2004, particularly among girls. The suicide rate among girls ages 10 to 14 nearly doubled from 2003, while the rate for older teenagers increased by nearly a third. Teenage male suicide rates saw a more modest increase.

The media response to these findings was predictable. Countless news sources speculated that the rise in suicides can be attributed to new black box warnings that antidepressant use could cause an increase in suicides. In 2004, the FDA mandated that these warnings be included on antidepressants in response to some questionable and largely inconclusive studies that showed that some teenagers were at highest risk for committing suicide for the first few weeks after beginning antidepressant treatment. As a result, antidepressant prescriptions dropped sharply between 2004 and 2005. Apparently, the black box warnings were actually counterproductive, because they discouraged psychiatrists from prescribing these drugs, thus preventing at-risk youth from receiving the treatment they needed and actually causing more suicides than were prevented. At least, so the media narrative goes.

But in truth, the statistics really do not tell us very much about the best way to treat depression. There is little data to support the claim that black box warnings led to increased suicide rates. Black box warnings did not emerge until relatively late in the year in 2004, so it seems unlikely that they could have had a dramatic impact on antidepressant prescriptions and suicide rates for that year. In fact, the rate of antidepressant prescriptions remained almost constant between 2003 and 2004. It is entirely possible that the spike in suicides for 2004 is simply an aberration, and we need to wait until 2005 numbers are released before speculating about any potential link between a decline in antidepressant prescriptions and an increase in suicides. According to Dr. Thomas R. Ten Have, professor of biostatistics at the University of Pennsylvania, There doesn’t seem to be any evidence of a statistically significant association between suicide rates and prescription rates provided in the paper.

This has not stopped some psychiatrists from calling for the black box warnings to be removed. The companies that manufacture antidepressants would naturally like nothing better, as they have taken a large financial hit due to the decline in prescription rates that followed the introduction of the warnings. Indeed, it is probably not coincidental that Pfizer, which manufactures the popular antidepressant Zoloft, donated $30,000 to help cover the cost of a study released in the September issue of AJP which suggested that the rise in suicide rates in 2004 is almost entirely attributable to the warnings. Two of the lead authors of the study, Dr. Robert Gibbons of the University of Illinois at Chicago and Dr. John Mann of Columbia University, have also had extensive dealings with other drug companies that produce antidepressants. Dr. Mann has been a paid consultant of the drug companies Pfizer and GlaxoSmithKline, both of which produce antidepressants, while Dr. Gibbons was used as an expert witness by Wyeth Pharmaceuticals, which produces the antidepressant Effexor.

The fact that the media has been so willing to lend credence to the argument that the rise in suicides can be linked to the black box warnings shows both how sensationalistic it is and how little most people understand about clinical depression. The original studies released in 2003 and 2004 linking antidepressant use to a rise in suicide were equally overblown and misunderstood. If you read the media coverage of these stories and knew nothing else about depression, you would have been led to believe that antidepressant usage itself was the direct cause of these suicides. But those of us who have actually experienced depression know that the reality is far different. The rise in suicides in the first few weeks after beginning antidepressant treatment can be partly attributed to what has been termed the rollback effect. Because energy levels return more quickly than positive moods in the first few weeks of treatment, teenagers experiencing suicidal ideations who previously may not have had the energy to act on them suddenly have this energy, which occasionally leads to disastrous consequences. But the link between antidepressants and suicide is hardly as direct as the media would have had you believe.

And now we’re making the same mistake of drawing too many conclusions with too little data and too little understanding.

The point is, we really can’t make sweeping generalizations about the best way to treat depression. Some people respond better than others to antidepressants. Everyone using these drugs should be monitored closely to ensure that they do not attempt suicide. Healing depression requires compassion, understanding and an individualized treatment program that takes into account different needs and desires. It is extremely difficult to say conclusively what the best way to address depression is because it depends so much on the individual person. If we really want to address increased suicide rates, we need to recognize this.

Joel is a sophomore. You can reach him at jswanso1@swarthmore.edu.

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