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Depression: Bluer than blue

POSTED 7 SEPTEMBER 2006

Depression: The suicide link
 Balding man in glasses leans back in chair, looking pensively at cameraEach year, approximately 1 person in 10,000 commits suicide in the United States, and psychologists say most of the deaths result from depression. If you can hardly get out of bed and have no hope that things will get better, why bother staying alive?

Painter Mark Rothko (1903-1970), a depressive, took his own life after creating color-field masterpieces (see "The Object..." in the bibliography). Photo: National Gallery

Common sense, and considerable evidence, says that treating depression would reduce the death toll, but the Food and Drug Administration cast a bleak light on antidepressants in 2004, when a large analysis linked child and adolescent use of anti-depressants with a slight rise in suicidal behavior (but no increase in suicide itself). Suicidal behavior includes thinking or talking about suicide, but not trying to take your own life.

Then, in 2005, another study associated antidepressants with an increase in suicidal behavior (but not suicide) during the first 10 days of treatment.

Photo of and quote by Emily CarrThat association is logical and not necessarily dangerous, wrote Simon Wessely, of the Institute of Psychiatry, London: "...antidepressant prescription is indeed associated with suicidal behavior, and strongly so. This simply means that antidepressants are being prescribed for the right indication, and that they do not immediately eliminate suicide risk. That we knew."

In any event, the Food and Drug Administration now requires a "black-box" warning label on what are known as selective serotonin reuptake inhibitors or SSRI meds. But the evidence is mixed, since other studies have found a lower risk of suicide, even during the first month of taking antidepressants.

Dr. Feelgood?
In a 2006 article, Julio Licinio, who now chairs the department of psychiatry and behavioral sciences at the University of Miami, linked SSRIs with falling, not rising, suicide rates. Licinio and co-authors found that suicide rates started to drop in 1988, the year fluoxetine hit the market (Fluoxetine, AKA Prozac, is the most widely prescribed antidepressant in the world). From the early 1960s to 1988, the U.S. suicide rate hovered between 12.2 and 13.7 per 100,000. Then, after Prozac was introduced, it "gradually declined" to a nadir of 10.4 per 100,000 in 2000. The statistical analysis linked the declining suicide rate with growing use of fluoxetine. It also suggested that 33,600 more Americans would have taken their lives since 1988 without the SSRIs.

In a press release, Licinio said the "findings certainly suggest that the introduction of SSRIs has contributed to a reduction of suicide rates in the United States. Much of the psychiatric community fears that the absence of treatment may prove more harmful to depressed individuals than the effects of the drugs themselves. Woman in short sleeves stands behind a podium, smiling coyly to the sideMost people who commit suicide suffer from untreated depression."

Actress Ashley Judd recently revealed that she is being treated for depression. Photo: State Department

While Prozac maker Eli Lilly was not aware of the study until it was accepted for publication, Licinio now consults for Lilly.

So despite all the hubbub linking antidepressants with suicidal behavior, many scientists warn against over-reaction. For example, the American Psychiatric Association and American Academy of Child and Adolescent Psychiatry observe, "There is no evidence that antidepressants increase the risk of suicide. There is, however, much evidence that depression significantly increases a child's or adolescent's risk for suicide."

What are the treatment options?

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Megan Anderson, project assistant; Terry Devitt, editor; S.V. Medaris, designer/illustrator; David Tenenbaum, feature writer; Amy Toburen, content development executive

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