Abstract
In 2004, the US Food and Drug Administration (FDA) controversially issued a black box warning that antidepressants were associated with an increased risk of suicidal thoughts and behaviours in people aged under 18 years. In 2007, the warning was expanded to include young adults aged under 25 years. In 2005, the Australian Therapeutic Goods Administration responded to the FDA warning by requiring Product and Consumer Information leaflets to be updated to reflect the risk. However, there was considerable debate, and at times emotive backlash, in academic journals and the international media. Prominent US and Australian mental health organisations and psychiatrists challenged the FDA warning. They argued that, on balance, antidepressant use was likely to reduce the risk of suicide. Several ecological studies were cited misleadingly as evidence that decreasing antidepressant use increases suicide risk. From 2008 to 2018, Australian per-capita child, adolescent and young adult antidepressant dispensing (0–27 years of age) and suicide (0–24 years) rates have increased approximately 66% and 49%, respectively. In addition, there was a 98% increase in intentional poisonings among 5 to 19 year-olds in New South Wales and Victoria between 2006 and 2016, with substantial overlap between the most commonly dispensed psychotropics and the drugs most commonly used in self-poisoning. These results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people. 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 and self-harming, often by intentionally overdosing on the very substances that are supposed to help them.
Highlights
In 2004, the US Food and Drug Administration (FDA) issued a black box warning that using antidepressants was associated with an increased risk of suicidal thinking and behaviour in people under 18 years of age with depression and other psychiatric disorders
The proportion of 0–17 yearolds dispensed an antidepressant rose from 1.3% to 1.8%, and the proportion of 18–27 year-olds increased from 7.7% to 9.4% (58)
Along with other factors, McGorry attributed increasing self-harm and suicidal behaviour to under-funding of headspace, without acknowledging the possibility that the off-label prescribing of antidepressants to under-18 year-olds promoted in the Evidence Summary prepared by headspace and Orygen might be part of the problem
Summary
This review uses long-term, real-world data to analyse how competing perspectives on antidepressant use and youth suicide and self-harm fit with Australian evidence. Australian suicide statistics are more rigorous than those of many other countries. This review analyses the role of influential players in the Australian mental health arena, a neglected focus of research. Antidepressant dispensing data cover the age-range 0–27 years; suicide data cover ages 0–24 years. Antidepressant data are for financial years (July to June), but suicide data are for calendar years. Antidepressant dispensing data collection changed in 2011/ 12, including low-cost prescriptions that had previously been excluded. Many factors will have impacted suicide rates over the period analysed and it is impossible to isolate the effects of specific factors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
