Despite the decline, however, suicide remains more common among young males than young females. For every one adolescent female (aged 15-19 years) who commits suicide in the UK, there are three adolescent males, the study revealed.

The research, which was carried out as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, showed that there were 1,722 adolescent and juvenile deaths by suicide in the UK between 1997 and 2003, which represents 4% of all suicides in that time period. The majority of young people were aged 15-19 (93% of the sample), and overall, the most common methods of suicide were hanging, followed by self-poisoning.

“Between 1997 and 2003, we found that suicide rates fell significantly, although we can only speculate on what factors may have contributed to the decline,” said Dr Kirsten Windfuhr, from the Centre for Suicide Prevention at the University of Manchester. “Although changes to antidepressant prescribing may have been one factor contributing to changing suicide rates, it is likely that a combination of factors, both clinical and socio-economic, will have contributed to the decrease in suicide rates. Suicide is a rare event, and is, thankfully, rarer still among children and adolescents. However, it is still one of the leading causes of death among young people and continued monitoring of recent suicide trends is important.”

Over the seven year period, only 14% of young people who committed suicide were in contact with mental health services in the year prior to their death, compared to 26% in adults. Again, there was a marked difference between males and females, with 20% of young females in contact with mental health services compared to only 12% of young males.

“The low rate of service contact in young males is particularly interesting. Young men currently have the highest rates of suicide in the UK, and yet they are least likely to seek help,” said Windfuhr. “Further research is needed to identify the specific risk factors associated with young suicide, and a multi-agency approach including health, social and education services may be the most effective strategy for preventing suicide in young people. In particular, research should be focused on the barriers which prevent young males from seeking help.”

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Medline and the Cochrane Database were searched to identify RCTs of antidepressants for major depression approved by the Food and Drug Administration. Included studies enrolled outpatient participants aged 18-65, lasted 6-12 weeks, compared an antidepressant to placebo or another antidepressant and were published in English after 1985. Excluded trials enrolled inpatients, pregnant women and subjects with psychosis or mania.

Mixed-effects logistic regression models including study type (placebo-controlled or comparator) and study duration (6, 8 or 12 weeks) as fixed effects determined whether these factors affected response and remission rates. In the 90 trials analyzed, the odds of depression response (OR = 1.79, 95% CI = 1.45-2.17, p < 0.001) and remission (OR 1.53, 95% CI = 1.11-2.11, p < 0.001) were significantly higher in comparator relative to placebo-controlled trials. Trials lasting 8 (OR = 1.37, CI = 1.14-1.64, p = 0.001) and 12 (OR = 1.52, CI = 1.12-2.07, p = 0.008) weeks had significantly greater response rates than 6-week trials without differing themselves.

Response and remission rates to antidepressants are significantly affected by study type and duration. Clinicians and researchers must consider the study design when interpreting and designing RCTs of antidepressant medications, researchers urge.

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Whether the danger comes from depression, the drugs used to treat it, or something else, doctors are paying more attention to this association. During the 1990s, depression began to emerge as a possible cause of bone loss, rather than a result. Scientists studied women who didn’t have osteoporosis symptoms or even know they had the condition.

They found lower bone mineral density in those who were depressed. Moreover, the link was found in both younger women and women past menopause. Other studies have found a similar relationship, so investigators have been looking at hormones and brain chemicals potentially involved in both depression and bone loss.

Researchers working with an animal model found that depression triggers the release of noradrenaline, which interferes with bone-building cells. Moreover, they found that imipramine—a member of an older class of drugs called tricyclic antidepressants—reversed both depression and depression-induced bone loss.

It may be a long time before the depression-osteoporosis connection is fully clarified. In the meantime, Harvard Women’s Health Watch suggests that you continue taking an antidepressant if you already use one; depression is a serious illness that can have profound consequences. You may also want to talk to your doctor about getting a bone density test, and make sure you get adequate calcium.

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When a possible connection was suggested between teens who take antidepressant medications and a higher suicide rate, Hendricks Brown, professor and director of the Prevention Science and Methodology Group, USF College of Public Health, decided to investigate along with his colleague Robert Gibbons from the University of Illinois at Chicago.

Their study appears in the September 2007 issue of the American Journal of Psychiatry, titled “Early Evidence on the Effects of Regulated Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents.” The researchers report findings contrary to earlier studies suggesting a link between antidepressants and suicidal thinking and behavior in youth.

“The overall effect of these newer antidepressants is very likely that they reduce suicide risk considerably,” Brown said. “Overall, the new antidepressants provide a large protective benefit. If there is any group of people who are adversely affected by taking these antidepressants, it has to be a very small group.”

The findings are compelling, especially in view of the FDA’s requirement in May for major black-box warnings to be placed on antidepressants for youth and young adults that advise of a potential suicide risk. The warnings, in turn, have led to a marked reduction in antidepressant use in adolescents and adults.

Suicide is the third leading cause of death in adolescents in this country, following only unintentional injuries and homicide. In real numbers, about 30,000 young people take their own lives in America each year.

These overwhelming figures, in addition to his own experiences with families who had lost loved ones to suicide, motivated Brown to devote enormous efforts to the study of teenage suicide prevention.

“People need to know if the antidepressant medication they are taking is increasing or decreasing their risk for suicide,” Brown said. “It would be bad if antidepressants were causing an increase in suicides, in which case the appropriate policy would be to restrict their use in adolescents. It would be even worse if FDA policies led to less treatment of depression and more suicides.”

Brown and his group examined different statistical approaches that might assess whether a widely used class of antidepressants known as selective serotonin reuptake inhibitors (i.e., Prozac, Zoloft, Paxil, Celexa) were causing more or less suicides in the teenage population.

The analysis was problematic because suicide occurs in one person out of 10,000 youth, but there were only a few thousand youth enrolled in all the clinical trials of antidepressants. And in none of these trials was there a suicide, either among those given an antidepressant, or those given an inactive placebo. There was no ability to compare rates because the number of subjects in the clinical trials was too small.

Given those limitations, Brown used several data sources where depressed individuals were treated differently with different classes of antidepressants or no medication, and he examined the rates of suicide along with the rates of antidepressant prescriptions at the county level. He also looked at the reports of suicide detailed by U.S. doctors after medication use.

Brown found that suicide attempts were dramatically lowered once antidepressant medication began, indicating an overall benefit of these newer medications. Also, very few people who died from suicide had been taking antidepressants.

He also found consistent reductions in suicide across counties as well as across countries during the time when there was increased use of antidepressants. Now that the overall level of antidepressants have decreased since the FDA warnings, there is very early evidence of an upturn in youth suicides.

“With the FDA warnings there has been a rapid lowering of antidepressant prescriptions, and there has been a corresponding increase in youth suicides” noted Brown. “We found similar results in the Netherlands once the warning was broadcast there as well.”

Brown said sometimes health policy decisions are made on limited information, and it may be that the FDA warnings about suicide in youth treated with antidepressants could have unintended consequences of placing more youth at risk. The FDA is now reviewing policy decisions in the light of these data and at some point may withdraw or revise its warning.

Brown’s other work involves some of the first rigorous evaluations of additional therapies and corresponding successes of teenage suicide prevention, including community-based prevention plans. One such program, Sources of Strength, was developed in North Dakota and appears to be very helpful for rural, under-served communities and Native-American communities.

“There are valuable treatments available and ways that people can cope and thrive with adversity, rather than just survive in this world,” Brown said. “There are ways for people who have suicidal thoughts and attempts to get help.”

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Fibromyalgia syndrome (FMS), which consists of chronic widespread pain and tenderness, with other symptoms including fatigue and sleep difficulties, has an estimated prevalence of 0.5 percent to 5.8 percent in North America and Europe. “Patients with FMS experience disability and reduced health-related quality of life (HRQOL). Fibromyalgia syndrome is also associated with high direct and indirect disease-related costs. Effective treatment of FMS is therefore necessary for medical and economic reasons,” the authors write.

Winfried Häuser, M.D., of Klinikum Saarbrücken, Saarbrücken, Germany, and colleagues conducted a meta-analysis to evaluate the effects of treatment with antidepressants on FMS-related symptoms. The researchers identified 18 randomized controlled trials, involving 1,427 participants, for inclusion in the study.

Overall, there was strong evidence for a reduction of pain, fatigue and depressed mood and improved sleep and HRQOL with the use of antidepressants by patients with FMS.

The researchers found large effect sizes of tricyclic and tetracyclic antidepressants (TCAs) for reducing pain, fatigue, and sleep disturbances; small effect sizes of selective serotonin reuptake inhibitors (SSRIs) for reducing pain; small effect sizes of serotonin and noradrenaline reuptake inhibitors (SNRIs) for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of monoamine oxidase inhibitors (MAOIs) for reducing pain.

“Before treatment is initiated, [accompanying] diseases related to potential adverse effects of the drugs and patients’ preferences should be considered. Goals of pharmacological therapy should be defined (no cure, but possible symptom reduction). Since evidence for a long-term effect of antidepressants in FMS is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects,” the authors write. “The identification of patient characteristics associated with positive and negative therapeutic outcomes are needed to better target antidepressant therapy for FMS.”

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Researchers compared birth outcomes among babies born to 329 women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy, 4,902 women who had a history of psychiatric illness but did not take SSRIs during pregnancy and 51,770 women with no history of mental illness.

Compared with women who had no history of mental illness, those who took SSRIs during pregnancy gave birth an average of five days earlier and had double the risk for preterm delivery. Babies of mothers who took SSRIs during pregnancy were significantly more likely than infants in the other two groups to have a five-minute Apgar score of seven or lower (seven is the general indicator of good infant health) or to be admitted to the neonatal intensive care unit. Exposure to SSRIs did not affect birth weight or head circumference.

The researchers also found that SSRI-exposed infants admitted to the neonatal intensive care unit had symptoms including seizures, jitteriness, infections, respiratory problems and jaundice that may have been caused by withdrawal from SSRIs or adverse effects from them.

The findings appear in the October issue of Archives of Pediatrics & Adolescent Medicine.

“The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants,” the researchers concluded. “However, treatment of depression during pregnancy may be warranted, and future studies need to distinguish between individual SSRIs to find the safest medication.”

It’s estimated that more than 10 percent of pregnant women have depression. The authors noted that SSRIs have been shown to cross the placenta and be present in the umbilical cord blood of infants whose mothers took the drugs during pregnancy.

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These were the conclusions of a study recently released at the Annual Convention of the American Psychological Association.

University of North Dakota psychologists Holly Dannewitz. PhD, and Tom Petros, PhD, recruited 60 people to participate in a driving simulation in which participants had to make a series of common driving decisions, such as reacting to brake lights, stop signs or traffic signals while being distracted by speed limit signs, pylons, animals, other cars, helicopters or bicyclists. The simulation tested steering, concentration and scanning. Thirty-one of the participants were taking at least one type of antidepressant while 29 control group members were taking no medications with the exception of oral contraceptives in some cases.

The group taking antidepressants was further divided into those who scored higher and lower on a test of depression. The group taking antidepressants who reported a high number of symptoms of depression performed significantly worse than the control group on several of the driving performance tasks. But participants who were taking antidepressants and scored in the normal range on a test to measure depression performed no differently than the non-medicated individuals.

“Individuals taking antidepressants should be aware of the possible cognitive effects as [they] may affect performance in social, academic and work settings, as well as driving abilities,” the researchers wrote. “However, it appears that mood is correlated with cognitive performance, more so than medication use.”

This research is important in light of the rapid increase in the number of Americans taking antidepressants. Americans’ use of antidepressant drugs such as Prozac, Paxil or Zoloft, nearly tripled in a decade, according to the 2004 Health United States report, issued by the National Center for Health Statistics. Among women, one in 10 takes an antidepressant drug, according to the government.

Presentation: “The Effects of Antidepressants on Cognitive and Driving Performance,” Holly J. Dannewitz, PhD, and Thomas Petros, PhD, University of North Dakota; Poster Session 4110,  Aug. 17, Boston Convention and Exhibition Center.

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In an analysis of more than 900 patients with established coronary artery disease, Duke University Medical Center psychologists found that those with both type 2 diabetes and symptoms of depression were more likely to die than heart patients without those conditions.

The study showed that among type 2 diabetes patients, having high depression scores increased the risk of dying by 20 to 30 percent compared to patients with similar depression scores but no type 2 diabetes.

“We found a trend showing that the probability of death increases as the level of depression increases in diabetic patients with coronary artery disease,” said Duke researcher Anastasia Georgiades, Ph.D.  “Our data appear to show an important interaction between type 2 diabetes and depression, meaning that physicians should closely monitor their heart patients who have both of these disorders.”

“There is some sort of synergistic effect between type 2 diabetes and depression that we don’t fully understand,” Georgiades said. “In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association.” The research was supported by the National Heart, Lung, Blood Institute.

The researchers followed 933 heart patients for more than four years and correlated the 135 deaths that occurred during that period with the presence of type 2 diabetes and depression alone and together.

Georgiades said there are some possible explanations for the link between depression and diabetes.

“Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise and numerous appointments with their doctor,” she said. “It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk.”

Depression has also been linked to other cardiovascular risk factors such as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity.

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The use of antidepressants is likely to account for only 10 per cent of the fall in suicide rates among middle aged and older people, suggests a large study in the Journal of Epidemiology and Community Health.

Globally, more than 800, 000 people commit suicide every year. Rates have been falling in many countries, a factor that has been associated with better recognition of depression and the increasing use of antidepressants, particularly the newer selective serotonin reuptake inhibitors (SSRIs).

But research involving more than 2 million Danes aged 50 and above and living in Denmark between 1996 and 2000, throws this into question.

The researchers assessed changes in the numbers of middle aged and older people committing suicide during this period and the types of antidepressant drugs they had been prescribed.

Only one in five of those committing suicide was actually taking antidepressants at the time of death.

Suicide rates in older men fell by almost 10 per 100, 000 of the population during this timeframe, but among recipients of antidepressants, the fall was less than one. For older women, only 0.4 of the 3.3 fall per 100, 000 of the population was accounted for by those being treated with antidepressants.

Overall, treatment type made little difference, although rates among men taking SSRIs were slightly higher than among those taking tricyclics.

Suicide rates were five to six times higher among those taking antidepressants than those who were not.

Previous Scandinavian and US research has suggested that a fivefold increase in the use of antidepressants could lead to a 25% decrease in suicide rates, with SSRIs having saved as many as upwards of 33, 000 lives, say the authors.

Sales of antidepressants in Denmark have soared from 8.4 per 1000 of the population in 1990 to 52.2 in 2000.

And suicide rates among older people have more than halved from 52.2 in 1980 to 22.1 per 100, 000 of the population in 2000.

The authors conclude that current antidepressant treatment accounts for only a fraction of the falls in suicide rates among older people.

But they nevertheless suggest that more should be done to pick up and treat depression among older people.

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Conventional anti-psychotics include the following:

* Haloperidol (Haldol®, Peridol®)
* Molindone (Moban®)
* Thioridazine (Apo-Thioridazine®, Mellaril®, Novo-Ridazine®, PMS-Thioridazine®)
* Newer antipsychotics, classified as atypical antipsychotics, include the following:
* Clozapine (Clozaril®)
* Olanzapine (Zyprexa®)
* Quetiapine (Seroquel®)
* Risperidone (Risperdal®)
* Sertindole (Serlect®)
* Ziprasidone (Seldox®)

Haloperidol (Haldol®, Peridol®) is a conventional antipsychotic with a lower incidence of weight gain than the newer agents clozapine (Clozaril®), olanzapine (Zyprexa®), and sertindole (Serlect®).

A retrospective study showed that clozapine (Clozaril®) and olanzapine (Zyprexa®) had the greatest associated weight gain, followed by intermediate weight gain with risperidone (Risperdal®).

Patients treated with sertindole (Serlect®) had less weight gain than those treated with haloperidol. Another study linked clozapine (Clozaril®) to significant weight gain and lipid abnormalities, suggesting increased risk for diabetes.

Among the conventional antipsychotics, thioridazine and chlorpromazine have greater potential for weight gain, while molindone (Moban®) is the only antipsychotic shown not to increase weight on a consistent basis.

Studies show that antipsychotic agents have an effect on the reproductive hormones. Women receiving antipsychotics tended to display hyperprlactinemia and tended to be hypoestrogenic. Women with primary obesity did not have hyperprolactinemia and tended to have normal or elevated estradiol serum levels. These differences have pathogenic and therapeutic implications besides the effects on gonadal and adrenal steroids. Prolactin alone promotes appetite and insulin resistance that may underlie the excessive body weight observed in hyperprolactinemic conditions detected in both animal and clinical studies.

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