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Letters Antidepressant use and FDA warnings

Link between FDA antidepressant warnings and increased suicide attempts in young people is questionable

BMJ 2014; 349 doi: (Published 09 October 2014) Cite this as: BMJ 2014;349:g5614
  1. Mark Olfson, professor of psychiatry1,
  2. Michael Schoenbaum, senior adviser for mental health services, epidemiology, and economics2
  1. 1Columbia University Medical Center, New York, NY 10032, USA
  2. 2National Institute of Mental Health , Bethesda, MD, USA
  1. mo49{at}

Lu and colleagues hypothesised that US Food and Drug Administration antidepressant safety warnings reduced antidepressant prescribing and thereby increased suicide attempts in young people.1 They investigated associations in three age groups between antidepressant prescribing before and after the warnings and suicide attempts, as measured by psychotropic poisonings in patients presenting to emergency departments or admitted to hospital. We question their conclusions that the FDA warnings were associated with significant reductions in antidepressant use and increases in suicide attempts among adolescents and young adults.

We doubt that poisoning by psychotropic drugs is a “validated proxy for suicide attempts.” Only a minority of suicide attempts in young people involve such drugs. Most self harm injuries in young people do not involve poisoning,2 only roughly half of emergency visits for psychotropic poisonings are intentional,3 and not all intentional self harm in young people reflects suicidal intent.4

The authors reported large “declines” in antidepressant use relative to forward projection of trends before the FDA warning, when antidepressant use had been increasing. In absolute terms, however, they found only a modest decrease in the fraction of adolescents receiving antidepressants, and essentially no change in the fraction of young adults and adults. Yet the hypothesis of increases in suicidality is premised on absolute declines in antidepressant use, not declines relative to a hypothetical projection.

A more plausible explanation is that the FDA warnings slowed previous growth in the rate of antidepressant treatment. In the following years, there was a substantial—but probably unrelated—increase in emergency department visits and hospital admissions related to increasing non-medical use of benzodiazepines, stimulants, and other psychotropic agents by young people.5 6


Cite this as: BMJ 2014;349:g5614


  • Competing interests: None declared.

  • Disclaimer: This letter does not necessarily reflect the opinions of the National Institute of Mental Health, the Department of Health and Human Services, or the US federal government.

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