Mounting evidence that taking antidepressants increases the risk of suicide among young Australians has triggered the Albanese Government Health Minister, Mark Butler, to order the development of 'new evidence-based guidelines for their safe use'. The commitment by Minister Butler that new guidelines would be developed by the end of 2022 was reported in the Sunday News Ltd tabloids on 26 June 2022 (see far below) and is welcomed by PsychWatch Australia.
Background Information - No antidepressant is approved by the Therapeutic Goods Administration (TGA) for the treatment of depression or anxiety in Australians aged under 18 years. However, from July 2019 to June 2020, 115,482 children and adolescents (0-17) were dispensed antidepressants, subsidised via the Pharmaceutical Benefits Scheme (PBS).[1]
A small proportion of this prescribing was on-label (i.e. approved by the TGA) for Obsessive Compulsive Disorder (OCD). However, most was off-label prescribing for the treatment of depression and/or other (non-OCD) anxiety disorders and most was done by general practitioners (GPs). Since 2005 antidepressants have carried the TGA's highest possible boxed warning for increased risk of suicidal thoughts and behaviours in people aged under 25 years.
The catalyst for Minister Butler's intervention was research published in 2020 - Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends - that was conducted by the PsychWatch Australia editorial team (Dr Martin Whitely and Dr Melissa Raven) and Adelaide child and adolescent psychiatrist, Professor Jon Jureidini.
Our research detailed that, since 2008, an alarming rise in per-capita suicide rates among young Australians had coincided with increasing antidepressant use. We 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.
Concerns about the possibility that antidepressants may pose a suicide risk for young people became prominent in 2004, when the US Food and Drug Administration (FDA) warned that antidepressants (compared with placebo) approximately doubled the risk of suicidal thinking and behaviour in people aged under 25 years diagnosed with depression. Because suicidal thinking and behaviour are risk factors for suicide, the FDA warning raised obvious questions about the relationship between antidepressant use and youth suicide.
Our research also detailed how flawed research, and a culture of uncritical group-think led by prominent mental health organisations and high-profile psychiatrists, encouraged potential prescribers, particularly GPs, to ignore the FDA and TGA warnings.
It prompted a review of the relationship between antidepressant use and youth suicide by the TGA, and a MedicineInsight Report, examining the prescribing patterns of 444 general practices across Australia. Both found similar patterns to those identified by us, i.e. rising long-term trends for both antidepressant use, and completed and/or attempted suicide among young Australians.
Specifically:
The TGA found that among Australians aged 0-24 years, the antidepressant dispensing rate ‘increased steadily from 3.3 per 100 in 2013 to 4.5 per 100 in 2019’ and the suicide rate was 29.7% higher in 2016-19 than in 2009-12.
The MedicineInsight Report found that from 2011 to 2020, a large (1.8 times) increase in antidepressant prescribing rates for patients aged under 25 years, coincided with massive increases in the rates of suicide attempts (3 times), suicidal ideation (4.5 times), self-harm (3.3 times) and all forms of suicidality (3.7 times)
In addition, a meta-analysis published in May 2022 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.
Note: for a more detailed summary of the TGA response, the MedicineInsight Report and the recent meta-analysis download the PDF below.
What else needs to happen? Although it remains true that a causal link between antidepressant use and completed suicide has not been definitively proven, all the credible independent evidence is pointing in the same direction.
As a result, we have called on Minister Butler and the Albanese Government to stop PBS-subsidisation of off-label prescribing of psychiatric drugs by GPs to children and teenagers (aged 0-17).
This would not completely stop reckless prescribing of psychiatric drugs to children. Unfortunately the quality of service offered by psychiatrist is notoriously variable, and closer monitoring of frequent prescribers is warranted. However, at least psychiatrists are trained mental health specialists. In contrast, GPs lack psychiatric expertise. They must not be allowed to continue prescribing off-label antidepressants to Australian to children and adolescents.
Put plainly, taxpayers should not continue paying for psychiatric drugs prescribed off-label by time-poor, non-expert GPs - drugs that are probably causing some Australian children and teenagers to kill themselves. To allow this to continue would be a gross violation of the expectation that doctors should first-do-no-harm.
Minister Butler has made a promising start by ordering the development of new evidence based guidelines, and we hope it is a sign of good things to come. PsychWatch Australia will continue to monitor and report on developments.
Editor PsychWatch Australia
Endnotes
[1] Australian Institute of Health and Welfare website, Mental Health Services in Australia. Mental health-related prescriptions 2019-20 tables, Table PBS.6: Number of patients dispensed one or more mental health-related medications, by type of medication prescribed and age group, 2013–14 to 2019–20 Available at https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-related-prescriptions (accessed 13 June 2022)
The article below is from the Sunday Telegraph (NSW) June 26 2022 edition. Similar articles appeared in the Herald (Vic), Courier Mail (Qld), Advertiser (SA), Mercury (Tas), and the Territory Times (NT).
