Re: Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study
There are several problematic aspects to this report. For starters, the authors equivocated about whether described differences are statistically significant. They used the term ‘significant’ a lot but they used the term ‘statistically significant’ only once. That was in relation to psychotropic drug poisoning among adolescent males. The data for adolescent males look like outliers (Table 2). The lack of an effect for adolescent females does not comport with the well-known preponderance of adolescent females among adolescent suicide attempters. Moreover, even the single claim of statistical significance was assigned no p value and was uncorrected for multiple comparisons.
Second, they focused just on the second year after the black box warning period but they did not examine trends following the warning in the same way as they projected trends from before the warnings. So, when we take a hard look at Figure 1, the rate of suicide attempts among adolescents didn’t change for 11 quarters after the end of the black box period. The suicide attempt rate didn’t start to rise until the rate of antidepressant drug prescribing started to rebound. Go figure.
Third, among the young adults (Figure 2) there was no change in antidepressant drug prescribing – just a flat trajectory. Plus, there was no change in sample size, so the rise in psychotropic drug poisonings was unrelated to change in antidepressant drug use – absolute or per capita. Something else was going on. Meth, anybody? Oxycodone, anybody? These authors don’t have a clue. This points up how inadequate is their proxy measure of suicide attempts.
Fourth, there was no change in the hard outcome of completed suicide. The authors tried to finesse this finding with the statement that completed suicide is a rare event. Well, it’s not that rare, especially when you trumpet that you have a sample size in the millions.
I won’t even bother to critique the special pleading and the tendentious tone of this report. The decision to publish it was not the BMJ’s finest hour.
Bernard J Carroll