Labels might be responsible for decline in antidepressant use

Doctor worries some who need medication may not be taking it

LEAH POULTON THE UBYSSEY (UNIVERSITY OF BRITISH COLUMBIA)

VANCOUVER (CUP) — The warning labels now printed on a common anti depressant might have led to a sharp decline in prescriptions for the drugs, which is a cause for concern for some doctors.

The labels warn of a connection between the use of selective serotonin reuptake inhibitors (SSRI) and increased suicidal thoughts and behaviours in children and adolescents.

Raymond Lam, professor of psychiatry and medical director of the Mood Disorders Clinic at UBC, said that the labels might be deterring some patients from taking medication that they really need.

The evidence for the warning labels came from a series of clinical trials on children and adolescents, where there was “a small excess of suicidal thoughts” found in those who took the drug compared to those who took a placebo, said Lam.

When all 24 studies were combined, they showed that for every 100 youths who took a placebo, one to three of them might show suicidal behaviors, and out of 100 youths treated with the SSRI medication, two to six of them might show suicidal behaviors.

But Lam suggested that the results were not conclusive enough to warrant the warning labels.

One of the main problems with the studies is that the criteria for volunteers severely limited the subject pool, he said. Volunteers could not have been depressed for more than six months, have any substance abuse problems or other health issues or have suicidal thoughts at the time.

He also pointed out an issue common to clinical trials — the subjects are volunteers.

“Why would someone volunteer their kids for this?” he asked. The subjects “don’t represent the average kid with depression,” he said, adding that there were no deaths by suicide during the studies.

He also pointed out that suicidal thoughts are a common symptom of depression. As the subjects reported just once weekly, it is nearly impossible to prove that the thoughts were caused by the drug.

“We have to be very careful with these types of results,” Lam said. “This isn’t like heart attacks where you can measure it on a piece of equipment.” Other methods of evaluation are needed to substantiate such a finding, he continued.

When four large observational studies were conducted on the same subject, with researchers looking at tens of thousands of youths both treated and not treated with antidepressants, none of them reported any increase in suicidal thoughts or behaviour in those on the antidepressants, Lam pointed out in a recently published article.

Even more indicative are the studies that examined three million patients in the U.K.. There were 15 youths who died from suicide, but not one of them had antidepressants in their blood, Lam continued.

“Even if there is a slight increase in suicidal thoughts, it doesn’t seem to translate to actual suicide deaths,” he said.

“The number of deaths from Tylenol and Aspirin are 10 times, 20 times greater than anything we’re dealing with here,” he said, pointing out that these medications do not carry the same level of warning.

Lam said that, like any medication, it is a matter of the benefits outweighing the risks. He also said this is a discussion that patients must have with their physicians.

“Untreated depression is also dangerous,” he said.

Lam said that this issue has most likely come up with youth and not adults because “youth maybe have fewer coping mechanisms.”

Adults are perhaps more prepared for side effects of antidepressants, such as insomnia or headaches.

“Youth don’t have other ways of dealing with [the side effects], so there’s the possibility that in someone with depression it could come out in suicidal thoughts,” he said.

However, Thomas Newman, an epidemiology professor from the University of California at San Franscisco and member of an expert panel on the issue of warning levels, told the Washington Post, “We have very strong evidence of harm and not very strong evidence of efficacy. It would not be bad if use of these drugs were diminished.”

Health Canada estimated that almost seven per cent of people aged 10 to 24 met the criteria for depression in 2004.