I won’t be contributing to this blog regularly this month—March is the start date. But I can’t resist a thought about a page one story in today’s New York Times. It concerns an upsurge in suicides at midlife noted by the Centers for Disease Control and Prevention. In the age decade from 45 to 54, the CDC found a 31 per cent increase in suicides by women for the period 1999 to 2004, and a 15.6 percent increase for men.
The Times reporter, Patricia Cohen, lists proposed explanations for the change. These begin with a lack of support systems, including public health resources for suicide prevention, in this age group. (Suicide rates were fairly stable for young adults and the elderly in the same period.) Other theories involve the sudden drop in use of hormone replacement therapy for women during and after menopause; increased access to other prescribed medications (Ambien and Viagra are named); a generational peak in the depression rate; and a statistical fluke. The truth is, no one knows why the suicide rate should have jumped for this one cohort, the middle-aged.
The unexplained can serve as a Rorschach. It will be interesting to see how the many commentators on antidepressants respond to this new data. My guess is that, in the absence of evidence, the finger will be pointed at SSRIs. This speculation, if it arises, will be telling. Suicide, is, of course one of the great subjects of sociology. Émile Durkheim virtually founded the field with his study relating suicide rates to changes in levels of social integration. A scientific discussion of secular trends in suicide would likely start here. In general, the attacks on antidepressants—and this movement strikes me increasingly as political and philosophical, rather than medical—begin with the premise that we should pay more attention to social pressures and existential truths, and less to biology, when we approach such phenomena as mood disorder. But the same authors who take that position, to choose meaning over the flux of neurotransmitters, are quick to blame negative social change on medication use.
To trace my own views: In 1993, in Listening to Prozac, I wrote that I thought the new antidepressants likely do, in rare cases, foment suicidal thoughts in people who had not been troubled by them before. In 2005, in Against Depression, I referred to trans-national evidence that the introduction of SSRIs was followed by a decline in suicide rates. My belief remains that the best evidence points in those two directions. How the medications function over longer periods of usage is unknown—an ignorance that points to flaws in our research establishment. Whether the prescribing of SSRIs has affected trends in suicide at midlife is, for now, unknown and unknowable. But I wonder if we will soon learn something else: how various thinkers project their prejudices onto the news.
