Suicide rates among teenagers rise dramatically after a 15-year low, sparking debate about the use of anti-depressant warning labels.
Experts in the field of adolescent health are alarmed at new statistics about teenage suicide, especially among young girls.

The Centers for Disease Control and Prevention released a report this week showing that teen suicide has increased for the first time in 15 years.

The statistics were available only as recently as 2004, but the trend was disturbing enough to cause concern.

For adolescents and young adults aged 10-24, the suicide rate rose 8% from 2003 to 2004 – a dramatic one-year increase after suicides had dropped 28% in the previous 15 years.

"In surveillance-speak, this is a dramatic and huge increase," said Dr. Ileana Arias, of the CDC’s Injury Prevention and Control department, to reporters. "Our news today is sobering. It raises great concern for us."

Especially troubling was the news that suicides among girls aged 10-14, while still at a low number overall (56 in 2003 and 94 in 2004, from a total of 4,599 suicide deaths), had risen 68% in one year.

The timing of a second study, also released this week, did not escape experts’ attention. The second study looked at the overall decrease in prescriptions for anti-depressant medication for young people in 2004, a year after the FDA was required to put the strictest "black box" warnings on them. The warnings were required after data revealed a possible causal link between certain anti-depressants and suicidal thoughts and behavior in young people.

"It is true that anti-depressant medication prescriptions in pediatric patients has come down, and that coincides with this one-year uptick in adolescent suicides," said Dr. Thomas Laughren, who heads the psychiatric product department at the FDA, to the press. "Obviously, that is a concern for us."

Dr. Mark Riddle, of the Johns Hopkins Children’s Center’s adolescent psychiatry unit, agrees. "There’s been concern that the black box would lead to a reduction in prescribing and therefore an increase in suicides," said Riddle to reporters. "And my guess is that’s what’s happening."

The concern is that physicians are more reluctant to prescribe anti-depressants with such strong warnings to adolescents, and that some young people are therefore missing out on proper diagnosis and treatment for depression and other mental imbalances that may lead to suicide.

But other experts cautioned that the issue is more complex than a simple causal relationship between anti-depressant drugs and suicide rates. Other factors may be at play, they say. Dr. Arias told reporters, "Suicide is a multidimensional and complex problem. As much as we’d like to attribute suicide to a single source so we can fix it, unfortunately we can’t do that."

Dr. Mark Ofson, a psychiatric expert at Columbia University, concurs. "Before you reach that kind of conclusion, you need to take a careful look [at the warnings]," said Ofson to the press. "There are so many social issues that go into suicide rates and how they’re reported."

Experts say that the studies’ benefit is that they call attention to the issue. Some recommend that school counselors, teachers, parents, and family physicians receive better training for how to identify those at risk for suicide. Others claim that parents and educators have to be able to get past the discomfort of addressing the issue.

"For some, talking about suicide is awkward," said Dr. Arias. "Our goal is to stop suicides, and to do that we need everyone’s willingness to talk about it."

Most of the experts agreed that the possible trend was troubling, and that more data is needed to find out if teen suicides are indeed on the rise.

Said Dr. Thomas Cummings of Chicago’s Children’s Memorial Hospital, to reporters, "We all need to keep our eye on this over time to see if this is a continuing trend."