The spike in the nation's suicide rate over the past decade has some experts wondering if concerns about antidepressants over the same period might have inadvertently affected treatment of depression.
Overall, the suicide rate in the U.S. rose 24% between 1999 and 2014 for people ages 10 to 74, according to the latest findings from the Centers for Disease Control and Prevention. Middle-aged white people account for a third of all suicides.
But perhaps most startling is that the rate of suicide in girls between ages 10 and 14 has tripled, although these suicides totaled 150 in 2014.
The overall increase is a stark reversal of the declines seen during the 1980s. Some blame the way the primary-care system approaches depression, which, if left untreated contributes to a vast majority of suicide attempts.
Several studies have shown a decline in diagnoses for depression in the years following the Food and Drug Administration's controversial decision in 2004 to include on the label of antidepressant medications a black box warning regarding an associated risk for suicidal thoughts among young people.
Two years after the warning was issued, antidepressant use declined by 31% among adolescents, fell by nearly a quarter among young adults and by 14% in adult patients, according to 2014 study published in the BMJ. The study also noted an increase during the same time in suicide attempts among adolescents and young adults.
Dr. Christine Moutier, chief medical officer of not-for-profit advocacy organization American Foundation for Suicide Prevention, said that the FDA's decision was overhyped by the media at the time, and that the actual data showed no inherent risk of suicide with the use of antidepressants. That influenced a significant number of primary-care physicians to forgo treating depression and instead refer patients to behavioral-health specialists.
“I think primary-care doctors became frightened, and the public became particularly confused,” Moutier said. “I think we are still living with a myth that antidepressants cause suicide.”
Earlier this year, the U.S. Preventive Services Task Force reversed an earlier recommendation and said screening was universally helpful to all U.S. adults over age 18, including pregnant and postpartum women.
In 2009, the panel recommended screenings should be done only by providers who had mental health staff at hand or could easily provide referrals. The task force had also previously believed there was not enough evidence to extend the guidance to pregnant and postpartum women.
This year, the panel said the benefits of treatment, even medication that may affect fetuses, far outweigh any potential risks.
The CDC's newest data found the fastest percentage increase occurred among women, where the rate was 45% higher in 2014 than in 1999.
But the total number of suicides during the study period paints a different picture.
White men between ages 45 to 64 were a third of suicide deaths in 2014, up from about a quarter in 1999. Women between ages 45 and 64 experienced a 63% spike from 1999 to 2014.
There were nearly 43,000 U.S. suicides in 2014. More than 14,000 of them were middle-aged whites — twice the combined total for all blacks, Hispanics, Asians, Pacific Islanders, American Indians and Alaska Natives.
Experts say there must be complex and multiple factors to explain such as widespread increase among almost all racial and age groups.
According to Dr. William Schmitz Jr., past-president of the American Association of Suicidology, the latest findings are frustrating given the many advances that have been made in suicide prevention in recent years.
“Most people don't realize there are treatments that are specific to suicidology that's showing really good results,” Schmitz said.
Suicide is the nation's 10th leading cause of death, and the overall rate rose 24% in 15 years.
The report doesn't try to answer why certain trends are occurring.
But experts speculate that middle age can be a particularly hard time for whites, who—compared with some other racial and ethnic groups—commonly don't have as many supportive relationships with friends, family, or religious communities.
Money was a factor, too, they say. The economy was in recession from the end of 2007 until mid-2009. Even well afterward, polls showed most Americans remained worried about weak hiring, a depressed housing market and other problems.
In a report this week, the CDC found that life expectancy for white women—and for white people as a whole—declined slightly in 2014.
A combination of factors are to blame, including more drug overdoses and suicides.
If someone you know exhibits warning signs of suicide, call the U.S. National Suicide Prevention Lifeline at 800-273-TALK.
The Associated Press contributed to this report.
