Despite an Ocean of Medication Teenage Suicides Soar

One of the paradoxes of child and adolescent psychiatry is that, at a time when teens are prescribed more medications than ever, teenage suicides are soaring. Antidepressants and antipsychotics are supposed to decrease suicide, not increase it.

A report of the Centers for Disease Control (CDC) of March 6, 2015, says that suicides per 100,000 population among persons aged 10-24 increased from 1.8 in 1994 to 3.1 in 2012, an annual increase of 3.0 percent. This is almost doubling over that 18-year period.

Doubling is big.

Male rates are far higher than female, and suicides among male adolescents rose annually by 2.2 percent. But here is the shocker: suicides among female adolescents rose from 0.5 per 100,000 in 1994 to 1.7 in 2012, an annual change of 6.7 percent.

Hanging (“suffocation”) has soared among young women, and the CDC report noted a grim landmark: “Suffocation surpassed firearm as the most common mechanism of suicide among females in 2001.”

I don’t have a ready explanation for this dramatic increase in teen suicide. “Oppression of women” is unlikely to be the answer as there has never been a cohort of young women whose prospects have been more brilliant than the current one.

The very limitlessness of horizons for women today? Somehow demoralizing for those who don’t rise quite to the peak? Don’t know. Many factors enter in.

But I do know one thing. Whatever medications these young men and women receive are not working. A truly alarming increase in the consumption of psychopharmaceuticals has taken place at the same time as the increase in suicide. For example, the prescription of antipsychotic medications for patients under 20 rose from 300 per 100,000 population in 1993-95 to almost 1500 in 2002. (New York Times, “Beyond Ritalin,” June 6, 2006, 18)

Many observers are inclined to see a causal link here: the flood tide of medications may be causing teen suicides. I’m not so sure. What we’re seeing is probably not a paradoxical effect of medication but the undertreatment of depression.

Many teens who suicide are suffering from serious depressive illnesses. In melancholic depression at all ages, suicide is a constant worry. It is therefore crucial that serious, melancholic depression be effectively treated, and in many teens it is not.

But the buckets of medication? Indeed, they’re swallowing all manner of anxiolytics, anti-ADHD drugs, and so-called “antidepressants” (Prozac, Zoloft). But these are not ideal treatments of severe depression where suicide is an issue.

There are three effective treatments for severe depression, and most teens get none of them. One is electroconvulsive therapy (ECT), and in some states it is illegal to prescribe ECT for those under 18. This prohibition results from a spasm of misunderstanding about convulsive therapy dating from the antipsychiatry movement of decades ago (“One Flew Over the Cuckoo’s Nest,” released in 1975, was doubtless responsible for countless deaths from inadequately-treated suicidality.)

The second is a class of antidepressants that has gone out of favor today because many patients dislike the side-effects. The class is called the tricyclic antidepressants (TCAs), and, yes, they do cause dry mouth, blurred vision, and constipation. But c’mon, we’re talking about suicide. (When I was lecturing to a group of psychiatry trainees the other day, one of them reminded me that TCAs are a bad idea because they can be accumulated and used for suicide. This is the kind of argument the pharmaceutical companies used to knock the TCAs out of the box and bring in the Prozac-style drugs. It was also used to knock out the quite effective barbiturates and bring in Valium. There is no shortage of means of committing suicide.)

The third is lithium. Lithium is an effective anti-suicide agent, but is often not prescribed for young people because of theoretical fears of kidney damage. But many patients are on lithium for decades without sustaining kidney damage, and, what, we’re going to let people commit suicide because we fear that two decades from now they might sustain kidney damage? This is the sort of risk-benefit analysis that many physicians actually do rather poorly.

To combat teenage suicide, we need more effective treatment of depression, not another useless expansion of the family medicine chest.