Shutterstock

Poor communication from the medical industry and overblown media reports have been partially blamed for an increase in suicide attempts by teenagers and young adults in the US.

In 2003, the US Food and Drug Administration released a warning about the potential link between antidepressant use among young people and suicides. Many antidepressants carry with them a warning of risk of both depression and suicide. The drugs work by increasing levels of chemicals in the brain, such as serotonin. But it's often a balancing act when it comes to finding the right medication and dose -- and since we're dealing with the great unknown of brain chemistry, about which so much is still not understood, it's hard to predict how people will react.


So like most drugs, the side-effects list can sound like a horror show. But in 2003, after a study found that in clinical trials around one percent of teens and young adults on antidepressants began to think of suicide more often, the FDA responded in a cautionary fashion by publishing this warning for physicians -- in fact, several warnings were delivered that year because of studies related to different drugs.

The result of this warning, after it was picked up by the media, was a drop in antidepressant use among teens and an increase in suicide attempts, a team from Harvard Medical School's Department of Population Medicine and the Harvard Pilgrim Health Care Institute has found. "Trends in antidepressant use and poisonings changed abruptly after the warnings," the team writes in a study published in the

British Medical Journal, referring to data analysed from 1.1 million teens, 1.4 million young adults, and 5 million adults.

In the year after the warning, antidepressant use saw a relative decrease among teens of 31 percent, and 24.3 percent amount young adults. Adults were less affected, most likely because the warning was not directed at them. There was a relative increase in suicide attempts involving an overdose of psychotropic drugs of 21.7 percent, and 33.7 percent among young adults in the second year after the warnings. "We observed consistent increases in psychotropic drug poisonings in study sites located in different regions across the country when we combined adolescent and young adult groups." The increase among attempts by adults was negligible, and the actual completed suicide rates remained stable.


The study does, of course, only account for those that were on medication and went off it. Not the many teens and their parents that would have been put off using antidepressants in the first place by the warning. To rule out the possibility that a suicide attempt was in fact an injury or accident, the team also only focussed on psychotropic drug poisonings. Since these account for about 38 percent of suicide attempts, according to the team's data, they believe the figures produced have been grossly underestimated.

All this means there were probably far more suicide attempts not counted for here. "The estimated excess risk of suicide attempt is an underestimate because it is based only on the second year of follow-up and does not include other means of suicide attempts," write the authors. "Since the increase in suicide attempts by poisoning was simultaneous with the significant reductions in antidepressant use, it might be one consequence of under-treatment of mood disorders."

Around 2007, the FDA modified the warning to include young adults and also recommended that doctors consider the dangers of prescribing versus not prescribing antidepressants, and that they monitor suicidal thoughts. And from around 2008 (the BMJ study used data up to 2010), the decrease began to reverse a little -- "however, utilisation remained below 2004 levels" the authors comment.

There can be no one reason attributed to why this happened. But it is highly likely the correlation had something to do with the fear mongering around side effects.


The authors write: "It is possible that the warnings and extensive media attention led to unexpected and unintended population level reductions in treatment for depression and subsequent increases in suicide attempts among young people."

They go on to critique boxed warnings as "crude and inadequate ways" to communicate, "sometimes frightening scientific information to the public". They continue, "information may be oversimplified and distorted when communicated in the media," before acknowledging the role it has to play in disseminating important and positive information. "For example, high profile news reports substantially reduced aspirin use in children and helped eradicate Reye's syndrome."

The weak link is the communication between the medical industry and the media. We see it all the time at Wired.co.uk, how messages can be convoluted in press material, inadvertently flagging up the wrong message or just the most dramatic one. "It is essential to monitor and reduce possible unintended effects of FDA warnings and media reporting," the authors conclude.