Antidepressant warnings scared parents, doctors

By Julie Steenhuysen

CHICAGO (Reuters) - Highly publicized government warnings that antidepressants could cause suicidal thoughts in adolescents may have scared off parents and doctors alike, meaning fewer depressed children are being diagnosed, U.S. psychiatrists say.

The warnings, starting in 2003, were followed by the biggest one-year spike in suicide rates in 15 years among U.S. children and young adults, according to figures released last week by the U.S. Centers for Disease Control and Prevention.

Psychiatrists say the 8 percent increase in youth suicides in 2004 is the inevitable byproduct of those warnings, and caution that the trend may continue.

"Parents became very concerned," said Dr. Louis Kraus of the American Academy of Child and Adolescent Psychiatry and a psychiatrist at Rush University Medical Center in Chicago.

While the U.S. Food and Drug Administration's "black box" warnings on antidepressants were not recommended until late 2004, they were preceded by a series of public health warnings in both the United States and Europe.

"Most of my patients remained on medication but it took a lot of discussion," Kraus said in a telephone interview. "The majority of kids that were on antidepressants did not have the luxury of having a child psychiatrist."

Most pediatric antidepressant prescriptions are written by primary-care physicians and the warnings affected them as well, he said.

"Pediatricians became very wary of this and many opted not to prescribe antidepressants anymore," Kraus said.

Depression is the leading cause of suicide, which is the third-biggest killer of children and young adults between the ages of 10 and 24.

Dr. Andrew Leon of Cornell University in New York, who served on the FDA panel that approved the black box advisory, said it is too early to link the warnings and the spike in suicides. But the build-up to the warnings may be playing a role.

FEAR OF LAWSUITS

"Parents read in the paper that there is a risk and they might not want to give their kids antidepressants," Leon said. "Physicians might be concerned about litigation."

Leon said trial lawyers were at the 2004 hearings leading up to the black box warnings on antidepressants for pediatric patients, and again last December during FDA hearings on whether to extend the warnings to young adults.

"Trial lawyers were almost advertising themselves," he said.

Robert Gibbons of the University of Illinois at Chicago, who also served on the FDA scientific advisory panel, said he voted against the pediatric warnings.