After the 2003 to 2004 suicide warnings, youth SSRI prescriptions fell 22 percent and youth suicides rose
"SSRI prescriptions for youths decreased by approximately 22% in both the United States and the Netherlands after the warnings were issued." US youth suicides rose 14 percent between 2003 and 2004.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Ecological, short (US suicide data only through 2004), and widely debated: later analyses disagree about whether the warnings changed suicide deaths. The authors infer untreated depression as the mechanism; the data cannot show it.
If more prescribing has not lowered the suicide rate, did less prescribing raise it? The regulators' warnings of 2003 and 2004 were a natural test.
Significant findings
Gibbons and colleagues (American Journal of Psychiatry, 2007) examined SSRI prescription rates and suicide rates in patients up to age 19 in the US and the Netherlands. "SSRI prescriptions for youths decreased by approximately 22% in both the United States and the Netherlands after the warnings were issued. In the Netherlands, the youth suicide rate increased by 49% between 2003 and 2005 and shows a significant inverse association with SSRI prescriptions. In the United States, youth suicide rates increased by 14% between 2003 and 2004, which is the largest year-to-year change in suicide rates in this population since the Centers for Disease Control and Prevention began systematically collecting suicide data in 1979."
Their conclusion is that the decreases in prescribing "were associated with increases in suicide rates in children and adolescents."
Worth asking
This is the same kind of evidence as the chart it argues against: two national lines, one year of US data after the warning, and no way to know who the young people who died were or whether they had been taking anything. Youth suicides are rare enough that a Dutch rise of 49 percent is a small number of deaths. What the paper does show is that ecological evidence cuts both ways, and that a warning meant to protect young people changed prescribing fast. The boxed warning rests on the trials, where suicidal thinking was more common on the drug than on placebo. Both are on the record. If you are in crisis in the US, call or text 988.
Source
Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents — Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ (2007)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1176/appi.ajp.2007.07030454
DOI: 10.1176/appi.ajp.2007.07030454
How this was scored
- Study design
- Cross-sectional study / survey
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 55 out of 100 on our published rubric. One caveat travels with that badge: Ecological, short (US suicide data only through 2004), and widely debated: later analyses disagree about whether the warnings changed suicide deaths. The authors infer untreated depression as the mechanism; the data cannot show it. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents — Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ (2007). Published in: Top-tier peer-reviewed journal. DOI: 10.1176/appi.ajp.2007.07030454. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cross-sectional study / survey. Funding: Independently funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.