Did the antidepressant black box warnings increase risk for suicide?

And the answer is: the jury is still out on this one. Hot off the press BMJ paper concludes that the FDA black box warnings might have increased risk for suicidal behavior... media outlets went immediately along BUT here is the "real" storify:


  1. Lu et colleagues argue that data from a quasi-experimental design study looking at rates of antidepressant prescriptions and psychotropic medication overdoses suggest that suicidal behavior might have paradoxically increased after the FDA issued the black box warning about antidepressants increased risk for suicidality.
  2. Geddes discusses implications of medication-related news on the public perception of the good, the bad, and the ugly effects of medications.
  3. Preda argues that Lu et al.' conclusions are greatly limited but the virtually absent knowledge about how the collected antidepressant data is linked to individual overdoses.
  4. In a time analysis study Barr et al. conclude that the economic crisis might have increased the number of suicides. The important point here is that there are alternative explanations (and not linked to antidepressants) of why the suicide rates might have gone up (independent of the FDA warnings).
  5. A 2007 meta-analysis, also published in BMJ, actually concluded that "antidepressants may cause a small short-term risk of self-harm or suicidal events in children and adolescents with major depressive disorder".
  6. Reuters presents the study findings as a fact. No discussion of limitations!
  7. The OECD data does not seem to support an increase in suicide rates in the OECD countries between 1990-2010. Are we looking at divergent trends between the OECD and the US (where the Lu et al, study was completed) or is it that psychotropic overdoses are NOT a good proxi for suicide?
  8. Uncoupling Antidepressant Use and Psychotropic Drug Poisoning

    Well, some commentators seems to worry about the chosen proxi for suicide...
  9. And they are not alone.
  10. However the media knows a good story when it gets it - 
  11. Worth reading the comments - 
  12. Well should they? Youth depression is not easy to detect, diagnose or treat. Simplification is dangerous. Timini's opinion is that "most states of childhood distress are self limiting and do not require extensive intervention, but when intervention is necessary psychotherapy has, unlike antidepressants, a well established record of effectiveness".