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March 29, 2004
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Utah may feel effect of drug labels


By Carey Hamilton
The Salt Lake Tribune


    Few places in the United States will be more affected by the national debate over antidepressants than Utah, where a good many medicine cabinets are stocked with depression busters.
    But it may take more than a pill to cure the headaches caused by the Food and Drug Administration's decision last week to ask manufacturers to put suicide warning labels on 10 antidepressants.
    Utahns who say antidepressants are dangerous lauded the move. Local psychiatrists, however, warned the labels could scare off people who need the drugs.
    "There are many physicians that think there's a great benefit from these medications," said Fred Reimherr, an associate professor of psychiatry at the University of Utah.
    The FDA wants the pharmaceutical industry to add or strengthen suicide-related warnings on their labels, although the FDA said it is unclear whether the drugs lead to suicidal thoughts or whether the problem is the mental illness itself.
    "The FDA acted with some hysteria after hearing anecdotal reports," argued Michael Kalm, a psychiatrist and spokesman for the Utah Psychiatric Association. "The bottom line is these medications help -- they are life savers. But prescribing must be done by qualified professionals and they must monitor their patients. Our concern is that patients will be frightened away from treatment by unnecessary scares."
    Manufacturers didn't immediately say if they would comply with the FDA's labeling request.
    Questions about the link between suicide and some antidepressants came up last summer when the British government banned Paxil for use in children, saying it was potentially dangerous for adolescents. The FDA followed the Brits' lead and started its own investigation.
    Ann Blake Tracy, the executive director of the Salt Lake City-based International Coalition for Drug Awareness, has been fighting for years to get Paxil and similar antidepressants, called selective serotonin re-uptake inhibitors (SSRIs), recalled for adults and youth. In February, Tracy, who wrote the book Prozac: Panacea or Pandora? Our Serotonin Nightmare, testified before the FDA in Washington, D.C.
    She was pleasantly surprised by the FDA's request, considering they are taking on the largest drug companies in the world and that there is sure to be public backlash over labels on such popular drugs.
    "Of course I do believe the drugs need to be banned altogether," Tracy said. "They are clearly deadly. But those on them need to be weaned very slowly instead of what they did to all those on Fen-Phen and Redux. Those poor people suffered horrific withdrawal leading many to turn to antidepressants, which work so similarly, in order to handle the withdrawal."
    Tracy has been hired as an expert witness in several cases where plaintiffs have sued drug companies over the supposed link between SSRIs and violent crime or suicide.
    She worked as a consultant for the family of Brynn Hartman, who killed her comedian husband, Phil, and then shot herself. Brynn Hartman was taking Zoloft and her family filed a wrongful death lawsuit against the drug's maker, Pfizer Inc., which was eventually settled out of court.
    The FDA is continuing to study a potential suicide link. Meanwhile, doctors are fielding calls from patients who were spooked by the label news.
    Reimherr said the FDA overstepped its bounds.
    "If the FDA thinks people aren't being monitored closely enough when they're prescribed antidepressants, they should just say that," he said. "This is likely to create conflicts in patients who are using them."
    chamilton@sltrib.com
   
   Antidepressant capital
   
    Utah has the highest per capita usage of such drugs, with 16 percent of the population taking the medications, according to Express Scripts, a company that assembles a yearly drug trend report. The second highest use is 14.4 percent in Maine.
   
   The medicines
   
   * Prozac
   * Paxil
   * Zoloft
   * Effexor
   * Celexa
   * Remeron
   * Lexapro
   * Luvox
   * Serzone
   * Wellbutrin
   
   
   
   

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