Whitely Martin, Raven Melissa, Jureidini Jon
John Curtin Institute of Public Policy, Curtin University, Perth, WA, Australia.
Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
Front Psychiatry. 2020 Jun 5;11:478. doi: 10.3389/fpsyt.2020.00478. eCollection 2020.
In 2004, the US Food and Drug Administration (FDA) controversially issued a black box warning that antidepressants were associated with an increased risk of suicidal thoughts and behaviours in people aged under 18 years. In 2007, the warning was expanded to include young adults aged under 25 years. In 2005, the Australian Therapeutic Goods Administration responded to the FDA warning by requiring Product and Consumer Information leaflets to be updated to reflect the risk. However, there was considerable debate, and at times emotive backlash, in academic journals and the international media. Prominent US and Australian mental health organisations and psychiatrists challenged the FDA warning. They argued that, on balance, antidepressant use was likely to reduce the risk of suicide. Several ecological studies were cited misleadingly as evidence that decreasing antidepressant use increases suicide risk. From 2008 to 2018, Australian per-capita child, adolescent and young adult antidepressant dispensing (0-27 years of age) and suicide (0-24 years) rates have increased approximately 66% and 49%, respectively. In addition, there was a 98% increase in intentional poisonings among 5 to 19 year-olds in New South Wales and Victoria between 2006 and 2016, with substantial overlap between the most commonly dispensed psychotropics and the drugs most commonly used in self-poisoning. These results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people. Causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance. However, there is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them.
2004年，美国食品药品监督管理局（FDA）颇具争议地发布了一项黑框警告，指出抗抑郁药会增加18岁以下人群出现自杀念头和行为的风险。2007年，该警告范围扩大至25岁以下的年轻人。2005年，澳大利亚治疗用品管理局回应了FDA的警告，要求更新产品和消费者信息手册以反映该风险。然而，学术期刊和国际媒体对此展开了激烈辩论，有时还引发了情绪化的强烈反对。美国和澳大利亚的知名心理健康组织及精神科医生对FDA的警告提出了质疑。他们认为，总体而言，使用抗抑郁药可能会降低自杀风险。有几项生态学研究被误导性地引为证据，称减少抗抑郁药的使用会增加自杀风险。2008年至2018年期间，澳大利亚儿童、青少年和青年（0至27岁）的人均抗抑郁药配药量以及自杀率（0至24岁）分别上升了约66%和49%。此外，2006年至2016年期间，新南威尔士州和维多利亚州5至19岁人群的故意中毒事件增加了98%，最常配给的精神药物与最常用于自我中毒的药物之间存在大量重叠。这些结果并不支持使用抗抑郁药增加会降低青少年自杀风险的说法。它们更符合FDA的警告以及抗抑郁药使用会增加年轻人自杀和自我伤害风险的假设。在上市后监测有大幅改善之前，无法确定因果关系。然而，有明确证据表明，越来越多的澳大利亚年轻人在服用抗抑郁药，而且越来越多的澳大利亚年轻人在自杀和自我伤害，他们常常故意过量服用本应帮助他们的药物。
