The Issue Update (PDF available above) details the progress of the TGA's Review into the relationship between antidepressant use and suicide among young Australians that was requested by the Australian Minister for Health in 2020.
Background to the Issue Update
In 2004, the US Food and Drug Administration (FDA) warned that antidepressant use approximately doubled the risk of suicidal thinking and behaviour in people aged under 25 years diagnosed with depression, compared with placebo. Because suicidal thinking and behaviour are risk factors for suicide, the warning raises obvious questions about the relationship between antidepressant use and youth suicide.
In 2020, we (Dr Martin Whitely, Dr Melissa Raven and Prof Jon Jureidini) co-authored a research paper - Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends - which examined Australia’s response to FDA warnings. We detailed how flawed research, and a culture of uncritical group-think led by prominent mental health organisations and key opinion leaders, encouraged potential prescribers, particularly general practitioners (GPs), to ignore the FDA warnings.
We also demonstrated that, from 2009 until 2018, rates of both antidepressant use and suicide by young Australians have risen simultaneously and significantly and concluded that:
Causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance. However, there is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves.
In response, Greg Hunt, the Morrison Commonwealth Minister for Health, requested that the Therapeutic Goods Administration (TGA) review our paper. The process is still ongoing.
So far research by the TGA and MedicineInsight have found similar patterns to us; i.e. rising long-term trends for both antidepressant use, and completed suicide and/or attempted suicide among Australians aged under 25 years.
The MedicineInsight research also found the majority of patients aged under 25 who were prescribed antidepressants by a GP were prescribed them on the day they were first diagnosed with depression and/or anxiety reinforcing our concerns about inappropriate (too early) prescribing by GPs.
In addition a recent meta-analysis found that ‘exposure [to antidepressants] significantly increased the risk of suicide and suicide attempt when compared with no antidepressant usage among children and adolescents’ with similar pre-existing risks of suicide.
The PDF document above summarises and critiques the actions to date by the TGA and other relevant parties, and recommends appropriate policy responses. The issue update has been endorsed by numerous prominent Australian and international psychiatrists, psychologists and general practitioners who share our concerns. This issue update has been provided to the new Australian Minister for Health, the TGA, the professional colleges and other important decision makers and stakeholders.
PsychWatch Australia will provide further updates as developments occur.
Dr Martin Whitely, Research fellow, John Curtin Institute of Public Policy, Curtin University.
Dr Melissa Raven, Research fellow, Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide.
Professor Jon Jureidini, Research leader, Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
