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Overprescribing Prompted Warning on Antidepressants


Published: March 24, 2004

(Page 2 of 2)

Most antidepressants are now prescribed by primary care physicians, whose patients may never see a psychiatrist, because of concerns about cost or the perception of stigma attached to mental illness. Prozac, Paxil and other modern antidepressants became hugely popular in part because drug companies convinced family physicians that they were safe enough to use without a psychiatrist's intervention. Antidepressants are the third biggest selling category of drugs in the world behind cholesterol and heartburn pills.

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Some psychiatrists speculated yesterday that their family-care colleagues might lose confidence in the drugs and become reluctant to prescribe them.

"We're hoping that doesn't happen, because primary care physicians have a major role to play in combating depression," said Dr. James H. Scully Jr., medical director of the American Psychiatric Association. "We hope they won't be scared off."

Dr. Robert Lee, a San Francisco physician of holistic medicine who sometimes prescribes antidepressants, said: "I don't think people already taking them will be concerned. But a lot of people who I think would benefit from these meds already won't take them because of various stigma reasons, so I'm a little concerned that this will raise that barrier even higher."

Dr. Lee said the new warning would not make him hesitate to prescribe the antidepressants.

He said, "People can get agitated from them, but I've never seen somebody get suicidal from them."

Dr. Joseph Gonzalez-Heydrich, chief of psychopharmacology at Children's Hospital Boston, said: "I've heard anecdotally that a lot of antidepressants were being prescribed by pediatricians without a lot of training or experience. I think the warning is appropriate. If it makes prescribers more vigilant or parents more vigilant, that's a good thing."

Dr. Gonzalez-Heydrich said that a sizable minority of children became more agitated and irritable on the antidepressants in question. "If we see it, we take them off it or reduce the dose," he said. "Doing it that way there are a lot of kids we feel do benefit from these medications, especially long term. But they're not for everybody."

Dr. Harold Koplewicz, director of New York University's Child Study Center, said, "The fear I have about this warning is that many teenagers will not get the medicine because it will build resistance among their parents, and that's really a tragic outcome." He noted that suicide rates in teenagers had gone down in the United States and Sweden as use of the drugs increased.

Several primary care doctors said that they had prescribed antidepressants with success for so many years that it was unlikely the F.D.A.'s new warnings would lead them to stop. Still, the warnings have given them pause, they said. They may think a bit harder before prescribing them to patients who are simply stressed, they said. And they will watch how the warnings play in the legal field, some said.

"We're going to continue to use these drugs pretty freely until we start seeing the ads in the newspapers from lawyers saying, `Have you or your family member been prescribed these drugs? If so, you may have a case,' " said Dr. Phillip Kennedy, a family practice physician in Augusta, Ga. "When the big L word, liability, raises its ugly head, that's when things will really change."

Spokesmen for drug companies said that they would emphasize to physicians that the F.D.A.'s warning did not conclude that antidepressants cause suicide. "My hope is that people won't make a link with the drugs," said Jennifer Yoder, a spokeswoman for Eli Lilly & Company, maker of Prozac. "I think the message will be that suicide is an inherent part of the disease of depression, and physicians should carefully monitor their patients."

Critics of the medicines said the F.D.A.'s warning was long overdue.

"These warnings are not as strong as I would like, but they're an important first step," said Tom Woodward of North Wales, Pa. Mr. Woodward's teenage daughter, Julie, hanged herself six days after starting therapy with Zoloft.

David Tuller and Terry Aguayo contributed reporting for this article.


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