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Warnings of suicides led to suicide attempts

Government warnings a decade ago about the risks associated with children and adolescents taking antidepressants appear to have backfired, causing an increase in suicide attempts and discouraging many depressed young people from seeking treatment, according to a study published in the academic journal BMJ.

Researchers said their findings underscore how even well-intentioned public health warnings can produce unintended consequences, particularly when they involve widespread media attention and sensitive topics such as depression and suicide.

In 2003 and 2004, the Food and Drug Administration issued a series of warnings based on data that pointed to an increase in suicidal thinking among some children and adolescents who were prescribed a class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. They included such drugs as Paxil and Zoloft.

In late 2004, the agency directed manufacturers to include a “black box” warning on their labels, notifying consumers and doctors about the increased risk of suicidal thoughts and behaviors in youth being treated with these medications.

The FDA warnings received a flood of media coverage that researchers said focused more on the tiny percentage of patients who had experienced suicidal thinking due to the drugs than on the far greater number who benefited from the drugs.

“There was a huge amount of publicity,” said Stephen Soumerai, professor of population medicine at Harvard Medical School and a co-author of Wednesday’s study.

“The media concentrated more on the relatively small risk than on the significant upside.”

The researchers pointed to headlines in publications such as the New York Times (“FDA links drugs to being suicidal”) and the Washington Post (“FDA confirms antidepressants raise children’s suicide risk”), that, they wrote, “became frightening alarms to clinicians, parents and young people.”

As a result, antidepressant prescriptions fell sharply for adolescents aged 10 to 17 and for young adults aged 18 to 29.

At the same time, researchers found that the number of suicide attempts rose by more than 20 percent in adolescents and by more than a third in young adults.

“There was a sort of overreaction by the media, but also an excessive caution on the part of patients,” said Christine Lu, a Harvard Medical School researcher and co-author of the study released Wednesday.

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