Friday, September 07, 2007

CDC: Suicide rate among U.S. girls soars

I find this incredibly depressing. The thing is, antidepressants WORK, and they work on kids as well as on adults.

A few facts about suicide that I lifted from the Dallas Suicide & Crisis Center (where I volunteered for 3 years):
• Here in America, the overall suicide rate is higher than the overall homicide rate. Hard to believe but true: Suicide is the eleventh leading cause of death; homicide the fourteenth.
• Suicide among young people has nearly tripled since the 1950's. Today it is the third leading
cause of death among teens; accidents are #1 and homicide (for teens) #2.
Most suicidal people communicate their intent to kill themselves before they attempt to do
so. (Keep this in mind; it's pertinent to my rant).

Prior to the 1950's, if you got depressed, there wasn’t much that could be done for you. People suffered and “toughed it out”, or they were institutionalized, or they committed suicide. Then, in the early 1950's, Monoamine oxidase inhibitors or MAO inhibitors were discovered and prescribed to fight depression. MAOI's are powerful drugs, but not without problems. Many patients using these drugs experience weight gain, a feeling of being drugged, headaches and, if the person taking them eats certain foods or drinks wine, it's possible to have a stroke. Another class of early antidepressants is tricyclics, named for their atomic structure. These also have lots of side effects, for example, they can cause dry mouth, blurred vision, constipation, confusion, drowsiness, irregular heart beat and...they’re quite lethal if taken in larger quantities than intended. Clearly, it was best to not get depressed in the first place when these were the only drugs available...

Then in 1987, the Eli Lilly Company released a new drug called Prozac, an SSRI (selective seratonin reuptake inhibitor) antidepressant. SSRI’s help the brain to do what it should be doing on its own, and have been compared to insulin for diabetics. The release of Prozac was quickly followed by the release of a variety of other SSRI antidepressants by many other drug companies. Doctors loved SSRI’s and readily prescribed them, not only because they tended to work well, but because they had the added benefit of being incredibly safe compared to MAO inhibitors and tricyclic antidepressants.

By 1990, lots of SSRI’s were being widely prescribed, and not just by psychiatrists, and not just for adults. With almost no danger of overdose, general practitioners were writing a huge volume of prescriptions for SSRI’s, many of those prescriptions “off-label”, meaning, doctors were prescribing drugs for something or someone other than the FDA indication for that drug, including for a lot of depressed adolescents.

Then the research began. Yep, it’s backward, I know, but it’s pretty much always like that. After widespread, off-label use, studies are designed to test the safety and efficacy of drugs in new populations or for treatment of additional conditions. So beginning in the mid-1990's, a lot of studies were designed and run all over America to test the safety and efficacy of SSRI antidepressants used to treat depression in children and adolescents. And eventually, some of that research revealed that kids on antidepressants admitted to thinking about suicide more than kids not taking antidepressants admitted to thinking about suicide.

I remember exactly when these results were released, because at the time, I was working as a clinician in child psychiatry at a site where a great deal of research had been done on using SSRI antidepressants to treat child and adolescent depression. In fact, some of the research done at our site was key to the FDA’s granting of an indication for Prozac to be prescribed for depression in children.

All of us who worked with depressed kids had seen drugs make a difference, and it wasn’t just us. According to the Centers for Disease Control, in the 13-year period from 1990 to 2003, the suicide rate among 10 to 24 year olds fell by 28.5 percent. I didn’t know that statistic at the time the statement was released, but I knew what I knew, and I found the statement about suicidal thoughts misleading and dangerous.

Read it again and think about it. It’s ambiguous. The research didn’t show whether kids taking antidepressants actually think about suicide more than other kids, it only showed that they admit to thinking about suicide more than other kids. And I can say with some authority, as a parent, as a former clinician in child psychiatry who saw hundreds of kids with serious psychiatric disorders, and as a volunteer for 3 years on a suicide crisis line, no one ever wants to hear that anyone he or she cares about is thinking about suicide, and especially not if the person thinking about suicide is your child.

The FDA was apparently as spooked by the finding as any parent would be. In 2003, the FDA issued a warning that the use of antidepressant drugs could increase the chances of suicidal thoughts or actions in children and teenagers, and in October 2004, a “black box” statement to that effect was added to most antidepressants. Not surprisingly, there was a decrease of 22% in the number of antidepressant prescriptions written for children aged 0 to 19 in both the US and the Netherlands following the FDA warning statement.

So what happened next? Well, maybe fewer kids were admitting to having suicidal thoughts, but more kids were acting on those thoughts than had happened in a long time. The youth suicide rate in the U.S. rose 14% between 2003 and 2004; in the Netherlands it rose 49%. As if that weren’t depressing enough, the suicide rate for U.S. girls ages 10-14 increased by 76% in that same time period(!!!), with 94 suicides in that age group in 2004, compared to 56 in 2003.

Here’s the thing...and I admit this is sort of’s better, always, if a person who is thinking about suicide can bring him or herself to talk with someone about those thoughts. Because if they can tell you they’re having those thoughts, you have the opportunity to intervene, to get them some help. In child psychiatry and on the crisis line, we always asked about suicide. With kids, barring evidence to the contrary, I’d usually start off a little oblique: "Do you ever feel so bad that you think about hurting yourself? Would you dare to tell me if you did have thoughts like that?" However, if a kid had made an attempt of any sort, or even a threat to attempt, I never danced around with those kids. I'd confront: “You told your Mom that you’d like to kill yourself. How would you do it?” Kids without a plan were handled differently from kids with a plan, but all of them were taken seriously, and assessed at length as to how best to keep them safe from harming themselves.

So yeah, there’s a lot of talking about suicide when dealing with depression, whether you’re talking with kids or with adults. People have this idea: you’ll plant the idea in their head. Not so. People who are depressed, whether young or old, come round to the idea of ending the pain on their own. There is no “What a great idea” moment when someone finally has the cajones to ask them if they’re thinking about suicide.

So if you're worried about someone...anyone...harming themselves...ASK. It can't hurt and it might help. There's more information about suicide HERE


Cynthia said...

::Kissing you with tears in my eyes:: Thank you. As the mother of a teenager who tried to kill herself and has fought her way back to life, health and sometimes even happiness, I know that it's far, far better for someone to talk about suicide, no matter how hard the conversation, than to see it.

emmapeelDallas said...


I'm so glad that your daughter made it safely through that dark place...if only everyone could make it safely much promise is lost to suicide...

TJ said...

Yes, yes and YES!!!
I have heard some incrediable stories about young girls and Lexapro.
I never use to like that idea of a man made pill to shut out emotions until I came to understand more the need.
Great entry Judi...
Love TJ

Chris said...

Very impressive post and one can't stress how important of a topic it is. Thanks for sharing with everyone, it needs to be heard.

Have a great weekend!
My Blog

dreaminglily said...

My uncle went on antidepressants when my oldest cousin (now 27) was about 10-12. He tried to drive the car, with my three cousins and my aunt, off a bridge into a river. Those made him insane. For some they work but for the people they don't... it just makes it worse.

I tried to kill myself when I was nine, never told anyone until I got older. I have had depression off and on my whole life, it was horrible between eight and sixteen though. So many times I tried and failed.

The thing is I've talked to a lot of kids that are thinking about suicide or have tried it. Sometimes I wonder why people find it surprising that so many kids think of it, no less attempt it. I've had to talk three of my friends out of it.

Honestly think that my experience was the best thing that could have happened, because younger people especially listen to me. Sometimes all people need is someone to listen and relate. Just wish more people were willing to open up like that.

I liked your entry, had to share my side too.

emmapeelDallas said...

Thanks for commenting, Lily. I'm sorry to hear you were so depressed you attempted suicide, and I'm happy that you're still here with us.

I'm sorry to hear about your uncle, too, however, I have to disagree with your statement "for some people they work but for the people they don't, it just makes it worse." That's not so. Most people who are depressed (adults and children) do best with a combination of medication and talk therapy. I don't know if your uncle was getting talk therapy, but clearly, whatever meds he was taking were wrong for him. However, that doesn't mean that no medication would have helped him, and his experience is not the experience of most people who take antidepressants, and especially not the antidepressants that are available today. I would never suggest that meds work for everyone, however, for most people, if the meds don't work, they simply don't work, but they don't exacerbate the depression and distorted thinking that is already there. That said, it's well known in psychiatry (though perhaps not so much in general medicine) that SSRI antidepressants can "flip" an undiagnosed bipolar person into mania, and that is a very serious matter. I believe that anyone who is in full blown mania needs to be hospitalized until they're stable, both for their own safety and for the safety of others.

redsneakz said...

What about the idea that that they could take someone in a deep depression and give them enough energy to suicide? Admittedly, such people need hospitalization until they've passed through the current suicidal stage...

(I've been on anti's for about a dozen years, on and off, and have finally realized that it's a life-long battle that I'm fighting.)