Emotion or Science?

  • by: |
  • 12/13/2006
According to a report in today's New York Times, "Public health officials, psychiatrists, grieving parents and outraged former patients will fill a hotel ballroom in Silver Spring, Md., this morning to argue the most bitterly divisive question in psychiatry: do the drugs that doctors prescribe to relieve depression make some people more likely to attempt suicide?"

I was at the agency the last time this debate took place. Very emotional. But emotions mustn't get in the way of the facts. Politicians love emotions. The media loves emotions. But science demands facts. Hard facts. Facts that may not tell people what they want to hear.

And anecdotes, even terrible ones, are not science. In June we blogged on a major new study, the first of its kind, finds that rather than boosting suicide rates, SSRIs have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

And before you ask, no, the study was not funded by a pharmaceutical company. The funding came from the NIH and the Dana Foundation. The full study appears in the June issue of the journal PLos Medicine.

For this study, the authors analyzed federal data on suicide rates since 1960, along with sales of fluoxetine (Prozac) since it became available in 1988. Analysis was continued through 2002. Prozac was used as a benchmark for the broader class of drugs.

Between the early 1960s and 1988, suicide rates held relatively steady, fluctuating between 12.2 per 100,000 and 13.7 per 100,000.

Since 1988, however, suicide rates have been on a gradual decline, with the lowest point being 10.4 per 100,000 in 2000. During the same time frame, Prozac prescriptions rose, from 2,469,000 in 1988 to 33,320,000 in 2002.

Using mathematical modeling, the investigators estimated the rates of suicide if the pre-1988 trends had continued, estimating that there would have been an additional 33,600 suicides if the pre-1988 trends had been maintained.

With that in mind, moves to restrict the use of SSRI antidepressantscould have a harmful effect, the authors stated.

“I don’t think these claims that antidepressants increase suicide have a solid base,” said Dr. Julio Licinio, lead author of the study and Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami.

“If you have a drug that’s supposed to be causing something, the more of the drug that’s used, the more of the bad outcome you would have. What we show is the converse.”

While this new science will provide little solice to those who have suffered through a suicide, it will help mental health professionals, their patients — and their patients’ loved ones — better understand the value of available therapies.

I grieve, I truly do, for the parents and spouses, friends, and relatives who have lost loved ones to suicide. And their grief is beyond my comprehension. But warping the science to fit anyone's emotional needs is just plain wrong. Hopefully this hearing will be held and reported on based on the science.

But I doubt it. Let's see what tomorrow's news stories focus on. Will the reports focus on the anecdotes of families or the science of anti-depressants? We shall see.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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