Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults

Laurence Y. Katz; Anita L. Kozyrskyj; Heather J. Prior; Murray W. Enns; Brian J. Cox; Jitender Sareen

doi:10.1503/cmaj.071265

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Antidepressants and suicide
Jon N Jureidini

Posted on: 23 April 2008
Searching for a reason
Douglas Curry

Posted on: 11 April 2008
think depression,think adolescents
diane sacks

Posted on: 11 April 2008

Posted on: (23 April 2008)

Antidepressants and suicide
Jon N Jureidini
Katz and colleagues’ study is methodologically superior to comparable work [1]. For example, in calculating the relative risk of suicide in Manitoba before and after the June 2004 Health Canada warning about the safety of antidepressants, the authors exercise appropriate statistical caution, recognising that the numbers are small and subject to random fluctuation. Nevertheless there is evidence of bias in their paper....
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Katz and colleagues’ study is methodologically superior to comparable work [1]. For example, in calculating the relative risk of suicide in Manitoba before and after the June 2004 Health Canada warning about the safety of antidepressants, the authors exercise appropriate statistical caution, recognising that the numbers are small and subject to random fluctuation. Nevertheless there is evidence of bias in their paper.
First, it is claimed: ‘The rate of completed suicide among children and adolescents increased significantly after the Health Canada warning was issued (RR 1.25, 95% CI 1.08–1.44; annual rate per 1000 = 0.04 before and 0.15 after the warning).’ This claim is based on comparing suicide rates up to the end of 2003 with those from the beginning of 2004. Yet the sentinel event occurred nearly halfway through the 2004 calendar year.
Secondly, Katz et al ignore the implications of 74-85% of Manitoban adolescents who commit suicide being aboriginal. Are suicidal behaviour, utilisation of Mental Health services or antidepressant prescribing comparable in aboriginal and non-aboriginal populations? Is there evidence that it is valid to compare a largely aboriginal population of suicides and a largely non-aboriginal population of health service users?
Thirdly, data that are not part of the study methodology are introduced in the Results and Conclusion sections as evidence against a link between antidepressants and suicide (antidepressant use amongst adolescents who completed suicide; an unpublished and unattributed review of autopsy results). Claims should be supported by data collected with clearly specified methodology, available for independent scrutiny.
The distortions in reporting of this paper are subtle, but favour antidepressants. Given that the evidence in this area is so unclear, rigour in reporting is essential.
[1] Jureidini J. The Black Box Warning: Decreased Prescriptions and Increased Youth Suicide? American Journal of Psychiatry 2007;164:1907.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (11 April 2008)

Searching for a reason
Douglas Curry
Big Thank You to Laurence Y. Katz, MD, Anita L. Kozyrskyj, PhD, Heather J. Prior, MSc, Murray W. Enns, MD, Brian J. Cox, PhD and Jitender Sareen, MD for the research and report.
From personal experience what I refer to as the "Suicidal State", comprises a number of psychic characteristics the most important of which is Suicide Fatalism.
Suicide Fatalism includes thinking that concludes all help avenues...
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Big Thank You to Laurence Y. Katz, MD, Anita L. Kozyrskyj, PhD, Heather J. Prior, MSc, Murray W. Enns, MD, Brian J. Cox, PhD and Jitender Sareen, MD for the research and report.
From personal experience what I refer to as the "Suicidal State", comprises a number of psychic characteristics the most important of which is Suicide Fatalism.
Suicide Fatalism includes thinking that concludes all help avenues are not useful, a withdrawal from therapy, withdrawal from social interaction and a confirmed strong belief and conclusion that death is the only option.
Paying attention to a Health Canada warning would be so far removed from Suicide Fatalism as to be a non contributing factor.
Please continue this research.
Thank you
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (11 April 2008)

think depression,think adolescents
diane sacks
Dr Stewart’s comments and the article by Gilbody and colleagues in the April 8, 2008 issue of the CMAJ emphasized the enormous burden of illness and high prevalence of depression in Canadian society.
I would like to remind physicians that the majority of adult patients with Major Depressive Disoredr experienced the onset of the disorder in adolescence. In addition, suicide the second leading cause of death in...
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Dr Stewart’s comments and the article by Gilbody and colleagues in the April 8, 2008 issue of the CMAJ emphasized the enormous burden of illness and high prevalence of depression in Canadian society.
I would like to remind physicians that the majority of adult patients with Major Depressive Disoredr experienced the onset of the disorder in adolescence. In addition, suicide the second leading cause of death in Canadian adolescents, has depression as a major precursor. It is essential if we are to have an impact on this disorder that we attempt to diagnose it as early as possible.
To aid with this,GLAD-PC, Guidelines for Adolescent Depression in Primary Care (available free on the internet) is a toolkit devised under the leadership of Dr. Peter Jensen of Columbia University and Dr Amy Cheung of Sunnybrook Hospital with input from Canadian and American family physicians and pediatricians. When modified by individual physicians it has the potential to increase the ability for primary care community physicians to assess, diagnose and begin treatment of adolescents with depression.
Conflict of Interest:
None declared
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Competing Interests: None declared.