Angst and confusion are part of everyone’s teen years. They’re what makes those high school memories so… unforgettable. For some teens the existential misery can reach clinical proportions. But owing to safety risks of antidepressants in teenagers, chemical help is out of reach until they hit 18 years of age. But don’t draw that sigh of relief - or wipe off the black eye-liner - just yet. Some doctors are warning that young adults, too, may find themselves thinking more suicidal thoughts on these psychiatric drugs, just like their teenaged counterparts. The questions remains, however, as to when drug treatment hurts more than it helps.
The FDA has written to drug manufacturers requesting that an additional “black box” warning be added to antidepressant drug labels. They cite recent studies suggesting that 18–24-year-olds taking antidepressants have a greater risk of suicidal thoughts or behavior within their first two months of drug treatment. The statistics come from short-term trials because testing hasn’t yet been completed on longer-term risk.
Per 1,000 patients treated, the FDA study found 5 additional cases (for a total of 13 per 1,000) of suicidal thoughts or behaviors in patients taking antidepressants versus placebos. This is a whack load better than the results for kids 18 and under – 14 additional instances per 1,000 kids. But it’s still worthy of precautions. The good news, says Thomas Laughren, FDA director of the psychiatry products division, data indicated that for most patients the drugs worked at keeping depression at bay. And once patients pass 24, the increase in suicidal tendencies vanishes altogether. Over the age of 65, those on drugs actually showed reduced suicidal behavior and thoughts.
But this is yet another jarring twist in the now years-old drama of youths and psychiatric drugs. In 2004, the FDA advised of increased suicidal thoughts or behavior in under-18s on antidepressants. This was after their own analyses showed a doubling (from 2% to 4%) in the number of subjects with suicidal thoughts, attempts or preparations. Pharmaceutical manufacturers finally added the warnings in 2005 after what appeared to be a widespread industry cover-up on the potentially lethal, and counterintuitive, side effect of their medications.
This newest advice from the FDA comes, ironically, just days after a large review article published in the Journal of the American Medical Association found that antidepressants for kids are not as bad as first measured. The authors concluded that, for many cases, the drugs might indeed prevent more suicides than they cause. After pooling the results from 27 studies, they found that treatment with antidepressants increased suicide indicators by less than one percentage point (from approximately 1% to 2%). The most recent report from the Centers for Disease Control, published in February 2007, found that teen suicide rose 18% between 2003 and 2004.
No matter the numbers, the cover-ups or the specific warnings, the real sticking point is that no one can yet explain why young people show such different behavior on drugs compared to their elders. Suggestions on the table so far include genetic differences in drug metabolism speed, baseline differences in suicidal thoughts, even the teenaged propensity to take medicine irregularly or not at all, leading to withdrawal symptoms that might increase suicidal thoughts. Until doctors figure out what is really going on, more black box labels and warning changes are likely to come.