While certain medications like selective serotonin reuptake inhibitors (SSRIs) used to treat depression or stabilize moods have been proven to help many people reduce suicidal thoughts and behaviors, they can sometimes double suicide ideation in others, particularly children and adolescents, according to the FDA.
“These widely prescribed antidepressants come with black box warnings for individuals up to age 24,” said Philip Cromer, Ph.D., chief executive officer with the Mental Health Association of Indian River County. “There’s been a lot of discussion about it, and it remains very controversial when their increased risk of suicide is due to the medication, like a paradoxical effect of depression itself. For example, antidepressants might enable those who are severely depressed who would normally be paralyzed by their depression to be more alert and act out on suicidal urges.”
The potentially tragic paradox of these medications has been debated by doctors and scientists for years but takes on new significance now in a time of increased mental illness among young people and society at large.
The Centers for Disease Control and Prevention (CDC) reported a 33 percent increase in suicide rates from 1999-2019. The upward accelerated from 2020 on, with 2022 data showing that suicide was among the top 10 leading causes of death in the United States, resulting in one death every 11 minutes.
Shockingly, suicide was the second leading cause of death among individuals between the ages of 10 and 34. It was the fourth leading cause of death for people 35 to 54 and the eighth leading cause of among people 55 to 64. There were nearly two times as many suicides (48,100) in the United States as there were homicides (26,031) in 2022.
“Suicide rates are the highest they’ve been since 1941, after the stock market crash followed by the Great Depression,” said Dr. Cromer. “Obviously, we didn’t have the Great Depression, but we did have the pandemic. People are wanting to get over the pandemic but the height of the pandemic, particularly trauma and crisis, doesn’t happen when the pandemic is occurring. It happens after the pandemic, which is why we have the highest rates right now.
“It’s not business as usual after such a traumatic incident,” Dr. Cromer continued. “It really isolated a lot of people, and it continues to do that. Everything changed. But some things that haven’t changed are the groups that tend to have higher suicide rates than others. The highest rates are among American Indians, Alaska Natives and non-Hispanic white populations. Other Americans with higher-than-average rates of suicide are veterans, people who live in rural areas and workers in dangerous occupations like mining and construction.”
According to FLHealthCharts, nationally there are about 14.3 deaths by suicide per 100,000 each year. Florida’s suicide rate is slightly lower with 14.1 deaths per 100,000. Surprisingly, Indian River County has a higher suicide rate with 18.4 deaths per 100,000.
“To put it in perspective, places like Wyoming and Montana have extremely high rates, into the 20s,” Dr. Comer explained. “That’s due to a couple of factors. First of all, isolation, their [lack of] access to mental health care and their culture. They are a gun culture and when we talk about how people are dying from suicides, more than half die from firearms and 90 percent of attempts with a gun result in death. So, when get to a state where you’re isolated, you have a lot of guns around and issues like alcoholism and mental illness have a high prevalence, it’s just a bad mix. Statistics show that states with stricter gun control laws have fewer suicides.
“I would say Indian River County’s high rate is due to older demographics. The highest rates of suicide are among those 85 years and older. They have chronic pain and illnesses. They feel isolated. They may have financial stresses. And they have increased access to opioids.
While men tend to choose more violent means of suicide, women choose poisoning or asphyxiation. They just can’t stand the pain anymore and want to end it.
“I’m a psychologist so I’m trained in traditional talk therapy. I want to see what we can do without medications first. I have met some kids that have really benefited from certain medications. But I encourage parents to try other methods first. Antidepressants are the most commonly prescribed drug in this country, but they come with risks. They actually change the chemistry of the brain. Healthcare providers need to monitor their patients very closely because these medications affect everyone differently and come with many side effects.
“When going to see a therapist or psychologist, one of the most important questions you can ask is – is your treatment empirically supported,” Dr. Cromer advised. “Therapy shouldn’t just be a loose association of ideas and interventions. It has to be grounded in science.
“Cognitive behavioral therapy is highly effective to treat a variety of depressive and anxiety disorders on any severity level. When coupled with a medication, if needed, it could be the best intervention you can get. We use a multidisciplinary approach at the Mental Health Association. Each week our therapists meet with me and our psychiatric provider to discuss difficult cases and formulate a treatment plan. We try therapy first and move on to medications if needed.”
The Mental Health Association (MHA) of Indian River County has numerous programs to help patients with crisis intervention, depression, anxiety and suicidal thoughts. The no-cost walk-in center is open Monday through Friday from 8:30 a.m. to 5 p.m. Just walk in and you’ll be seen by a mental health professional quickly. If you’re concerned about a family member you can walk in for a consultation. They also offer free support groups and both in-person and online mental health screenings. MHA has programs to fund both insured and uninsured individuals with no barriers to access services. Remember, it’s OK to get help!
Philip Cromer, Ph.D., received his master’s in counseling and a doctorate in counseling psychology from West Virginia University in Morgantown, West Virginia.
