Report: Canadian Youth Suicides Increased After Warnings On Anti-Depressants

Here's a study fresh out of the Canadian Medical Association Journal asserting that the rate of youth suicide in the Canadian province of Manitoba increased dramatically following government warnings in 2004 of risks of suicide and suicidality in youths associated with the use of anti-depressants. Prescriptions of anti-depressants to kids dropped and suicides went up, according to Canadian researchers.

That's exactly the opposite of what a recent British study found--a drop in suicides among British youth at the same time that anti-depressant warnings were hitting the UK and prescriptions for anti-depressants went down. It's also at variance with experience in the US where a study attempting to link decreased anti-depressant use to increased suicides has largely been discredited.

Still, the Canadian data is concerning not simply because of an increase in the rate of suicide among youths from .04 suicides per 1,000 people before the warning to .15 suicides per 1,000 people after the warning, but also because kids with depression didn't see doctors as often as before (the rate dropped by 10 percent), essentially cutting them off from any therapeutic intervention such as psychotherapy much less medications.

Why the Canadian data is at variance from the UK and the US is beyond me. Although I can't access the full paper and am not aware of the absolute number of suicides in Manitoba among this age group, it's likely a small number (an estimated 1.2 million people live in the province, most of them in and around Winnipeg), so a sudden uptick in suicides can skew the data quite a bit. What's more, Manitoba may well be an outlier province in terms of social behavior from the rest of Canada, so it'll be interesting to see if these same sort of changes are reflected in the youth suicide rates in other provinces. Keep in mind that Manitoba's population comprises about 3.6 percent of the total population of Canada, so I don't want to read too much into this study.

But a suicide is still a suicide and I am beginning to wonder if we will ever sort out the great anti-depressant/suicide question. Population based studies tell us different things each time out or so it seems.

Here's how the lead Canadian researcher, Laurence Katz, makes sense of things:

""We can't say the warning, or the change in anti-depressant use or the physician office visits caused changes in suicide rates," says Katz...."

"Katz says he didn't have a problem with the warnings themselves. But he says some people leaped to the assumption 'that these medications lead people to kill themselves.'

"'We don't know that yet. What we do know from those randomized controlled trials, that there may well be a small subgroup of children and teenagers with depression who when they receive a medication do experience an increase in suicidal thoughts, or even suicidal behaviour.'"

This whole matter is one of the diciest in all of medicine. It certainly deserves a more complete answer than the mixed evidence we have these days.

Thoughts?