Researcher Attempts To Answer Critics Of Suicide, Anti-Depressant Prescription Study

Most of you are aware that in September Robert Gibbons, a researcher at the University of Chicago, authored a study asserting that a 2004 FDA warning issued about suicide risk connected with anti-depressant use led to a drop in anti-depressant prescriptions and an uptick in suicide statistics that year. The study was challenged by many commentators, myself included.

Now, Gibbons attempts to answer critics of the study in this month's American Journal of Psychiatry. The authors of three separate letters challenge him on different points. Gibbons answers them here.

I won't even attempt to summarize the discussion as it's almost too technical to be illuminating. One point Gibbons doesn't address, however: in 2005, the suicide rate in America edged downwards slightly despite a drop in anti-depressant use that year. Which sort of makes his assertions about 2004 a moot point, but a beautiful example of religion in the world of science.

Let me be clear about a connected issue: The evidence on suicides and suicidality and anti-depressant use is mixed. There are messy studies such as Gibbons' from which you cannot draw too many conclusions. There are population-based studies that show no increase in suicides alongside increased anti-depressant use (not that I think population studies offer proof on this question due to the many confounding environmental factors which such studies cannot correct for). There are tightly-controlled clinical studies which show an elevated risk of suicidality (anywhere from 4 percent to 14 percent) connected with anti-depressant use, there is the FDA black box warning which is itself based on real-world data, then there are many tens of thousands of anecdotal reports (if not more) of suicides and suicidality connected with anti-depressant use, not to mention actual suicides during clinical trials of anti-depressants (in some cases, the trials weren't even for depression).

Straight-up: anti-depressant use is risky and, as far as I can tell, the drugs are at best a weak anti-suicide technology. Use with caution.

As exhausting as I find this endless debate, I'll continue to address it as the need arises. Besides, someone wrote something remarkably stupid about suicide in the current issue of a major magazine, and you just know I am not going to let that pass.