Drugs, suicide link is not new
Although suicide was linked officially to antidepressant use in children only last week, the connection is not new and the risks may not stop at puberty. Suspicions first raised in the late 1980s never were scientifically established because company data were kept private and because it is tricky to prove why a depressed person committed suicide.
The Food and Drug Administration is considering reexamining whether the antidepressants are linked to suicide in adults. While studies in children show slim or no benefit from the drugs, there is more evidence in adults that the antidepressants can have a positive effect as well.
The link with suicide was first identified in the late 1980s among adults who used Prozac. Germany's FDA equivalent refused to approve the drug because of a 1987 study that showed nonsuicidal patients who took the drug attempted suicide or succeeded at three times the rate of those taking placebos.
A group of Harvard researchers then found in 1990 that violent, suicidal thoughts developed in 3.5 percent of depressed patients.
"The antidepressants worsen, in a small population of people, every single symptom of depression," said Dr. Martin Teicher, chief of the laboratory of developmental psychopharmacology at McLean Hospital and author of the 1990 study. Teicher said the antidepressants have a role, but are not for everyone. "What's happened with children that made this so much clearer is there was more access to unpublished data" than with adults.
At last week's FDA hearing, experts had access to clinical trials performed by pharmaceutical companies that were previously confidential. At a 1991 hearing on the safety of Prozac in adults, doctors had reviewed only the limited number of studies that the drug companies had chosen to publish. That panel voted, 6 to 3, that Prozac and similar drugs were not connected to suicidal behavior.
A spate of news stories and lawsuits in the 1990s described people who killed others or themselves and were thought to be taking Prozac, although the FDA continued to deem the drug safe for use. Last March, however, the agency warned that the antidepressants were possibly linked to an increased risk of suicidal behavior in adults as well as children.
The British version of the FDA, which has already banned pediatric prescriptions of antidepressants other than Prozac, is now reviewing a possible link between antidepressants and suicide in adults, according to Dr. Joseph Glenmullen, a Harvard psychiatrist and author of the critical book, "Prozac Backlash."
He, like many patients, scientists, and lawyers, questions why the FDA ignored the risk of suicide for so long in people of all ages.
"The FDA and pharmaceutical companies swept this under the carpet in 1991," he said. "It was just absolutely junk science, and people have died because of that."
CAROLYN Y. JOHNSON
© Copyright 2004 Globe Newspaper Company.