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National Institutes of Health

Science Update
November 8, 2006

U.S. Youth Suicide Rates Lower in Counties with High SSRI Use

For children ages five to 14, suicide rates from 1996 to 1998 were lower in areas of the country with higher rates of antidepressant prescriptions, according to an NIMH-funded study published in the November 2006 issue of the American Journal of Psychiatry.

Robert D Gibbons, Ph.D., of the Center for Health Statistics at the University of Illinois at Chicago, and colleagues examined suicide data from the Centers for Disease Control and Prevention and prescription data from IMS Health, a commercial company that collects global health care information and represents more than half of all retail pharmacies in the United States. They found that counties with the highest selective serotonin reuptake inhibitor (SSRI) prescriptions generally had the lowest suicide rate—around 0.7 per 100,000 people. The counties with some of the lowest rates of SSRI prescriptions had the highest suicide rate of 1.7 per 100,000 people. Nationwide, 933 children ages five to 14 died by suicide between 1996 and 1998, which corresponds to about 0.8 per 100,000 people annually.

When variables such as sex, race, income levels and access to quality mental health care were taken into account, findings remained the same. The highest suicide rates were found in less densely populated western states, such as Arizona, Utah and Montana. The lowest suicide rates were found in large cities such as Chicago, New York City, Boston, Los Angeles, San Diego, Seattle and Miami.

Although the data are compelling, they do not prove any causal relationship between SSRI use and suicide rates. Recent studies have found that SSRI use may trigger suicidal thoughts and actions in some individuals, prompting the U.S. Food and Drug Administration in 2005 to adopt a "black box warning" on all SSRI prescription labeling. However, Gibbons and his colleagues note that their results are consistent with other studies that report a decline in suicide attempts and completed suicides among adults and adolescents who are prescribed antidepressant medications.

Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationships between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry 163 (11): 1898-1904.