Last Sunday (14 June 2020) the Sydney Morning Herald reported Australian Government Health Minister Greg Hunt had instructed his department to conduct a review of research led by PWA's editorial team - Dr Martin Whitely, Dr Melissa Raven - on the relationship between antidepressant use and youth suicide.
Minister Hunt's welcome decision followed significant media coverage of our research and a brilliant speech by Julian Hill MP (the Labor Member for Bruce) in the Australian Parliament calling for an inquiry.
It is heartening to see cooperation between politicians from both the governing Liberal Party and the Labor Opposition. It offers real hope of safer prescribing practices and improved outcomes for young Australians.
Our research, published in Frontiers in Psychiatry, examined the Australian response to the 2004 and 2007 US Food and Drug Administration (highest level) black box warnings that antidepressants use (compared to placebo) roughly doubles the risk of suicidal thoughts and behaviour in people aged under 25 years who have been diagnosed with depression and other psychiatric disorders.
We detailed how in response to the FDA warnings prominent Australian suicide prevention experts and mental health organisations - including Professors Ian Hickie and Patrick McGorry and Suicide Prevention Australia - challenged the FDA warnings and argued that antidepressant use decreases the risk of suicide in young people.
However, the real world outlined in our paper doesn't support Professor Hickie's, McGorry's and Suicide Prevention Australia's assertions. Since 2009 the rates of both antidepressant use, and suicide among young Australians, have risen sharply.
Specifically the number of suicides by Australians aged 0 to 24 rose from 279 in 2009, to 458 in 2018 (a 49% increase in the per-capita rate). From 2008-09 to 2017-18, the proportion of Australians aged 0 to 27 using antidepressants grew from about 2.9% to 4.8% (an estimated 66% increase in the per-capita rate).
We also detailed evidence of a substantial increase in rates of self-harm by young Australians, with prescription antidepressants among the drugs most commonly used in self-poisoning.
Despite the FDA suicidality warnings, and the fact that no antidepressant is approved for he treatment of depression in people aged under 18 years, 101,174 children and adolescents (1.8% of Australians aged 0-17) and 328,879 young adults (9.4% of Australians aged 18 to 27) were dispensed an antidepressant in 2017/18.
In addition our research identifies significant errors and misrepresentations in previous journal articles and position statements authored by Professors Hickie and McGorry, and Suicide Prevention Australia. Rather than respond to these detailed criticisms during a radio interview on ABC Radio National* Professor McGorry described our peer reviewed journal article as "propaganda". (*Relevant comments begin at the 27 minute 10 second mark of the podcast.)
McGorry was also critical of the Australian Financial Review for publishing a page 3 article headlined suicide prevention experts may have it horribly wrong written by two time Walkley Award winning journalist Jill Margo that covered our research.
Fortunately, unlike Professor McGorry, Minister Hunt and Julian Hill MP have demonstrated open-minds and an interest in the evidence that should see a thorough examination of the relationship between antidepressant use and suicide by children, adolescents and young adults.
At last we at PsychWatch Australia are optimistic that robust evidence may guide antidepressant prescribing practices. But we will be keeping a close eye on developments and provide regular updates.
Our paper, titled Antidepressant Prescribing and Suicide/Self-Harm by Young Australians - Regulatory Warnings, Contradictory Advice, and Long-Term Trends is available here.
WARNING: DO NOT ATTEMPT TO WITHDRAW FROM OR REDUCE THE DOSE OF AN ANTIDEPRESSANT OR ANY PSYCHOTROPIC MEDICATION WITHOUT THE INTENSIVE SUPPORT OF A COMPETENT MEDICAL PRACTITIONER. EVIDENCE SUGGESTS THE RISK OF SUICIDE, SELF-HARM OR OTHER SEVERE ADVERSE EVENTS IS SIGNIFICANTLY HIGHER WHEN COMMENCING, CEASING OR CHANGING DOSES.