Remember when everyone was suddenly terrified of antidepressants because supposedly they made teenagers kill themselves? Think 2003-2004, when we were all on our Nokia phones and freaking out about the suicide risk of SSRIs like Prozac and Zoloft.
Pointing Fingers at Prozac
What had happened to cause all that panic? An FDA study had been released showing that 4% of participants age 18-24 experienced suicidal thoughts or attempted suicide after they started taking antidepressants, compared to 2% of equally depressed patients taking the placebo. The findings exploded across the media, and scary sounding “black box warnings” were slapped onto millions of pill bottles. Antidepressants were demonized—and the people who took them seemed that much freakier than they would have without the surrounding fear factor.
Now a Harvard study published in the British Medical Journal has shown that the Prozac panic may have backfired. In the wake of the overblown headlines, fewer people received prescriptions for antidepressants—and more people tried to kill themselves. Whoops.
Turns out They Help More than Hurt
The Harvard researchers tracked 2.5 million teenagers and young adults —the same age group targeted by the original FDA study—from 2000-2010. After the suicide warnings broke, SSRI prescriptions dropped over 30% nationwide. Meanwhile, suicide attempts went up 22% for teens and 34% for young adults. Essentially, some people who needed antidepressants simply weren’t getting them.
I could have been in that study. Years ago, when I was in the 18-24 range and kind of wanted to kill myself, my school psychiatrist prescribed me generic Prozac (plus some yummy benzos, which I liked). After a few weeks on the antidepressant, which didn’t give me any side effects, I kind of wanted to kill myself a lot less often. But I still kind of wanted to sometimes, and with suicide, sometimes that’s all it takes. After a weirdly noncommittal “test run” with those lovely benzos and some liquor, I ended up getting a higher dose of Prozac, a more expensive therapist and some time off school. And it worked. I was actually able to function. I felt so good on my ramped up dose that I could actually enjoy myself, go party, unilaterally decide I didn’t need Prozac anymore, do a lot of coke instead and develop a whole new series of problems. But that’s a story for another day. The point is that what I’d needed to overcome my suicidal ideation wasn’t less Prozac. It was more.
The Risk of Media Hype
It’s not that medication is the answer to every sad kid’s woes. There are several other treatment methods for clinical depression, from lots of individualized couch-time to strategically placed magnets. But the numbers speak for themselves: for some people, the drugs do help. Even though additional studies had shown that restricting SSRIs had failed to reduce teen suicide rates in the UK, many brushed those results off as “no harm no foul.” But the fact that suicidality in the US actually increased during the same interval meant that maybe there was a foul after all.
By failing to prescribe SSRIs to patients who might have benefitted from them, psychiatrists were “throwing out the baby with the bathwater,” to borrow my grandma’s metaphor. While blaming overreactive media or overcautious doctors is not very productive, it remains a cautionary tale about the power of press and panic in the Internet age.
Courtesy of Tom Varco (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
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