WASHINGTON -- Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants do not increase the risk of suicidal thinking or suicide attempts in youth, according to a new

report released in late January by the American College of Neuropsychopharmacology

(ACNP).  The report also noted that several SSRIs have been shown to be

effective for treating depression in this population.  ACNP appointed a

special task force of the nation's leading scientists in the field to review

the available research on the use of antidepressants and youth under 18 years

of age.

   

"The evidence linking SSRIs to suicide is weak," said J. John Mann, MD,

co-chair of the ACNP Task Force and professor of psychiatry at Columbia

University College of Physicians and Surgeons, and chief, Department of

Neuroscience, New York State Psychiatric Institute.  "There are strong lines

of evidence in youth -- from clinical trials, epidemiology and autopsy studies

-- that led the ACNP Task Force to conclude that SSRIs do not cause suicide in

youth with depression."

   

ACNP established the task force after regulatory agencies in the United

States and United Kingdom voiced concerns in about the possibility that

treatment of depression in children and adolescents with SSRIs may increase

the risk for suicide.  The FDA convened an advisory committee hearing to

review the issue on Feb. 2, .

   

"The most likely explanation for the episodes of attempted suicide while

taking SSRIs is the underlying depression, not the SSRIs," said Graham Emslie,

MD, co-chair of the ACNP Task Force and chief, Division of Child and

Adolescent Psychiatry and Professor of Psychiatry, The University of Texas

Southwestern Medical Center at Dallas.  "The potential benefits of SSRIs

outweigh the risks."

   

The ACNP Task Force reviewed clinical trials of more than 2,000 youth and

found that there were no statistically significant increases in suicide

attempts, self-harm, and suicidal thinking related to SSRI use.  Importantly,

they found that there were no suicide deaths in any of the trials.

   

The ACNP Task Force concluded that if anything, the increased use of SSRIs

appears to have lowered the risk of suicide worldwide based on a review of

epidemiology studies from several countries.  The group noted that the rate of

youth suicide in 15 countries has declined by an average of 33 percent over

the past 15 years.  This period of time coincides with increases in

prescribing rates for SSRIs.

   

The ACNP Task Force also cited an autopsy study, which suggests that

suicide is more likely when depressed individuals do not take their

medication, rather than when they take it.  A study of adolescent suicides

found that of the 24 percent who had been prescribed antidepressants, none

tested positive for SSRIs at the time of their death.

   

The Task Force found several SSRI trials that showed efficacy in treating

depression in youth, while other trials failed to demonstrate efficacy.  They

noted that differences in drug effectiveness across clinical trials may be

from differences in methodology and recommended additional study.

   

The report concluded that another category of antidepressants known as

tricyclics were ineffective in patients under 18 years of age.  Other forms of

treatment were found to be not widely available to youth, or insufficient data

were available to support their effectiveness.

   

Childhood depression is a serious public health problem that carries the

risk of suicide.  ACNP urged clinicians to ask depressed patients about

suicide, suicidal thinking, and plans for suicide.

   

The report also includes research and regulatory recommendations.  ACNP

urged that all data held by FDA or pharmaceutical companies should be made

rapidly available to allow ACNP and other research organizations to conduct an

independent evaluation of the risks and benefits of SSRIs in youth and adults

with depression and other mood disorders.

   

Evidence reviewed includes all published clinical trial data in youth.

The Task Force also obtained and reviewed unpublished data from several drug

companies and data reported to the United Kingdom's drug regulatory agency.

   

"The Task Force emphasizes that its findings and recommendations are

preliminary," said Mann.  "While ACNP reviewed all published data and some

unpublished data, it does not have access to a substantial amount of data

available to the FDA or to pharmaceutical companies."

   

The full version of the ACNP Task Force report will be released in the

spring or early summer of .  For a copy of the executive summary of

preliminary findings, visit http://www.acnp.org or call Betsy Murrett at (202) 745-

.

   

The ACNP, founded in , is a professional organization of more than 700

leading scientists, including four Nobel Laureates.  The mission of ACNP is to

further research and education in neuropsychopharmacology and related fields

in the following ways: promoting the interaction of a broad range of

scientific disciplines of brain and behavior in order to advance the

understanding of prevention and treatment of disease of the nervous system

including psychiatric, neurological, behavioral and addictive disorders;

encouraging scientists to enter research careers in fields related to these

disorders and their treatment; and ensuring the dissemination of relevant

scientific advances. ACNP is a non-profit, professional society with revenues from a variety of

sources including membership dues, publication sales, registration fees, and

unrestricted educational grants from the pharmaceutical industry.  The ACNP

Task Force on SSRIs and Suicide was supported solely by the ACNP. There was no

financial support from the pharmaceutical industry for this Task Force.

 

Source: American College of Neuropsychopharmacology