Kids, Antidepressants, and Suicide Risk: A Review of Commercial Bias

Here's a somewhat old paper that I should have posted about some time ago-- thanks to "Primary Care Medical Abstracts," aka Rick Bukata and Jerry Hoffman, for their audio review that brought it to my attention.

Jon Jureidini, Australian psychiatrist and chair of Healthy Skepticism, and Leemon McHenry wrote an editorial reviewing the debate over prescribing serotonin-reuptake-inhibiting (SSRI) antidepressants (Prozac and its cousins) in children and adolescents. Basically they were asking--how did it come to be, when the data now show that these drugs very likely produce virtually no benefit in those age groups and run a small but definite risk of producing suicidal behavior, that the experts in the field touted them enthusiastically? They sort through the various stages of the controversy, citing specific papers that used poor methodology or that were selectively reported. These papers are of two types--first, the papers that claimed drug efficacy in the first place; and second, studies published after the issuance of black box warnings on the use of these drugs in kids, claiming that the suicide rate among adolescents immediately rose as a result of the decreased numbers of prescriptions written for SSRIs. They aim a good deal of their criticism at the "key opinion leaders" in academic psychiatry who are financially beholden to the drug industry and who used their position and reputations to defend the widespread use of these drugs; and to a lesser extent, medical journal editors who should have known that a couple of key studies were so severely flawed as to be not worthy of print. Anyone trying to make sense of this particular controversy will find this article a good compendium of who knew what when.

The authors acknowledge their own conflict of interest in that both were associated with a plaintiff's law firm that brought litigation against the manufacturers. As I have noted several times in the past, it is unfortunate that often, the only physicians in a position to know what actually has happened when data are withheld or selectively reported are those who have had access to internal company documents released only as a result of legal discovery.

Jureidini JN, McHenry LB. Key opinion leaders and paediatric antidepressant overprescribing [editorial]. Psychotherapy and Psychosomatics 78:197-201, 2009.