Reservations about study on antidepressant use by young people and suicidal behaviour after FDA warnings

We agree with several of Lu and colleagues’ conclusions.1 However, we have serious reservations about their conclusion that antidepressant warnings discouraged appropriate pharmacotherapy for depression, resulting in more suicidal behaviours by patients with unmedicated depression. Firstly, we agree that there was no appreciable increase in completed suicide rates in young people coinciding with the warnings, as confirmed by Barber and colleagues.2 Indeed, in 2007, after the warnings, the US adolescent suicide rate reached a 25 year low.3 The quarterly suicide rates in adults presented by Lu and colleagues are generally below age specific US suicide rates, which suggests under-reporting. However, we would not expect systematic under-reporting of suicides to affect the trend analyses if the level of under-reporting remained constant. We also agree that a trend change in antidepressant usage occurred after the warnings. However, it is unclear whether this change is entirely due to the warnings because promotional spending on antidepressants by drug companies dropped by about a third during the same period (by roughly $200m (£124m; €158m) per quarter between 2004 and 2006.4 We agree, too, that psychotropic …