Study: Fewer Depression Diagnoses "Unintended Consequence" Of Suicide Warnings On Anti-Depressants

I just about fell over laughing yesterday when a couple of readers passed along a new study from the Archives of General Psychiatry, which purported to examine US national rates of depression diagnoses and anti-depressant use from a selected database. This is all part of an attack by orthodox, conservative forces in psychiatry and public health who remain utterly freaked out that the FDA issued black box warnings on anti-depressants for suicide and suicidality in 2004 and 2006, shattering the public image of the drugs as totally safe for one and all. Ever since, the orthodoxy has been striking back on a regular basis, desperate to prove that anti-depressants are safe, efficacious and that depression treatment always works.

The results of the AGP study were that between 1999 and 2004 the rate of depression diagnosis among children (ages 5 to 18), young adults (19 to 24) and adults (25 to 89) increased appreciably as did anti-depressant use, but after 2004 rates of diagnosis dropped back towards 1999 levels when researchers had projected that they would increase annually at the same rate as between 1999 and 2004, quite the wild assumption on researcher part. Even worse, according to the researchers, is that depression diagnoses among people seeing PCPs fell 44 percent among children, 37 percent among young adults and 29 percent among adults.

Personally, I count such findings as a victory, although I've got to note that the researchers' database doesn't exactly dovetail with what's gone on in the broader culture--an increase in anti-depressant prescriptions since 2004 (up 2.4 percent in 2008 as I noted in April), presumably tied to an increase in diagnosing of depression. But I'll take their figures at face value.

Perhaps I'm too much the contrarian, but I'd think one of the takeaways from this study ought to be that either Americans are less depressed than they were before (which would be a wondrous finding) or they are refusing to participate in a system of care where the evidence base is corrupt and the treatments are often ineffective with deleterious results for many patients. Both of those would strike me as possible and positive explanations for the dynamic. But not for researchers, who noted:

"The findings suggest that initial unintended consequences of the FDA warnings have continued through 2007, the authors conclude. 'Diagnosing decreases persist,' they write. 'Substitute care did not compensate in pediatric and young adult groups, and spillover to adults continued, suggesting that unintended effects are nontransitory, substantial and diffuse in a large national population. Policy actions are required to counter the unintended consequences of reduced depression treatment.'"

What unintended consequences would those be? The suicide rate isn't much changed in this country and anti-depressant use was up in the US in 2008, so you have to wonder what planet these researchers are on and why none of the article's peer reviewers pointed this out to them.

And when public health researchers demand "policy actions," it's time to head for the hills. Who knows what policy actions those would be? Forced depression diagnoses? Forced treatment with anti-depressants? Rates of depression diagnoses to meet researchers' prior forecasts or else? The orthodox wing of psychiatry has lost its mind.

The thing that troubles me the most about these sorts of studies is that they rest on the assumption that ivory tower researchers know what level of depression and diagnosis of the same is "right" for America, that anything less than that level or a suitable annual increase is unacceptable and demands policy intervention, that anti-depressants are always curative and healthful, and that depression can never be allowed to go untreated with medications. And for them to act unaware of the recent WHO study on anti-depressants and suicidality (which found plenty especially among kids and teens), a 2007 study out of the STAR*D research which found over 8 percent suicidality induction in adults in the study (hell, it was published in AGP, so how could they ignore it?) and last year's British study finding that suicide rates went down after the UK banned most anti-depressant use amongst people aged under 18 is simply blind religiosity. It's the Nanny State run amok.

It's time for it to run away.

It's also worth noting that the researchers reported having received funding in the past from Eli Lilly, Forest Pharmaceuticals, Lundbeck and the American Foundation for Suicide Prevention.

Just as I finished writing this post, the AP's coverage of the study appeared. Look at what one of the study authors claims:

"The new research can't explain why diagnosis rates have declined, said lead author Anne Libby of the University of Colorado Denver. Diagnosis rates for anxiety and bipolar disorder, also sometimes treated with antidepressants, also fell.

"'It could be that people who have depression aren't coming forth and getting diagnosed,' Libby said. 'It could be that providers are increasingly reluctant to diagnose cases of new mental health problems.'

"Libby said the FDA 'should reopen its discussion about the boxed warning on antidepressants.'"

While I need to see the full study before deciding how much to celebrate drops in bipolar and anxiety diagnoses, I can assure Libby that any attempt to rescind the FDA's black box warning will be met will extreme resistance from the patient community.

Also from the AP:

"Pinning the slumping diagnosis rates on the FDA warning is a leap, said Dr. Peter Lurie of Public Citizen's Health Research Group, which has warned of antidepressant risks in kids. There could be other explanations.

"'It's possible that the drive toward more diagnosis and treatment had been nearing a point of exhaustion,' Lurie said. 'The data are interesting but the conclusion seems forced.'

"Lurie also questioned the authors' suggestion that the FDA overreacted.

"'Is the implication that patients would be better off kept in the dark (about risks)?' he asked."

It's been clear to me for a long time that the orthodox camp does want patients kept in the dark about risks. If anyone thinks anti-depressants are super safe, please review this post of mine from yesterday.