he government's warning on Monday that
people newly taking antidepressants can become suicidal and must be
closely monitored grew at least in part from a concern that the
drugs were being handed out too freely and without enough follow-up,
especially in children and teenagers.
Dr. Wayne K. Goodman, chairman of psychiatry at the University of
Florida College of Medicine and a member of an expert panel that
advised the Food and Drug Administration, said, "I think many
physicians, and particularly nonpsychiatrists, have been lulled into
the notion that these drugs are safe."
He emphasized that the drugs carried few serious physical side
effects and a low risk of overdose. But, Dr. Goodman added, "I think
what's been underestimated is this behavioral toxicity, which can
indirectly lead to problems, including possibly suicidal
Yesterday many doctors acknowledged that the new warning was
sound advice and yet said they worried it might discourage doctors
and patients from treating depression.
Dr. Eva Ritvo, an associate professor of psychiatry at the
University of Miami, said: "A depressed patient needs to be watched
closely, particularly in the initial stages of treatment or when the
dosage is raised. This is something we should be doing anyway as
mental health professionals."
But, she added, "Untreated depression is dangerous and takes a
huge toll on people's lives, and we can only hope this warning
doesn't discourage people from seeking treatment."
Patients had mixed reactions.
Some people who suffered depression in the past but shunned
medication said the new warnings reinforced their wariness.
Barry Owen, 51, a magazine consultant in San Francisco, refused
antidepressants during an emotional crisis.
He said his doctor recommended the drugs a few years ago "because
at that point I was pretty severely depressed and having panic
attacks and couldn't eat and sleep." Mr. Owen added: "I decided then
not to take her advice. And while I don't doubt the usefulness for a
lot of people, this new information gives me one more question about
But patients who have done well on the drugs were not troubled by
the new warnings. Paul Festa, 33, a San Francisco artist and writer,
took Zoloft for about a year in 1999, and then Paxil for a year or
so after the 2001 terrorist attacks. He said: "I would never
hesitate to go back on these medications because I already know that
I react extremely well to them. I feel like there should be a
warning for people who are depressed that not taking these
medications could lead to suicide. If you're depressed, you're
putting yourself at risk for all sorts of self-destructive
behaviors, up to and including suicide.
"When I was depressed, the thought of suicide was crossing my
mind more than it ought to have, and the antidepressants got me out
of that loop."
The advisory issued Monday by the drug agency asked manufacturers
to put detailed warnings about a possible increased risk of suicidal
behavior and the need for monitoring on the labels of 10
antidepressants: Prozac, Zoloft, Paxil, Wellbutrin, Luvox, Celexa,
Lexapro, Effexor, Serzone and Remeron. The warning included both
children and adults.
Studies in children taking the antidepressants have not found an
increase in suicide. But studies of some drugs have suggested that
they might increase the risk of suicidal thoughts and behaviors.
Research has also failed to provide convincing evidence that the
drugs are effective in children, making the potential risks even
less acceptable. There is no solid data linking use of the drugs to
suicide in adults.
Dr. Goodman of Florida said that panelists who met last month
were troubled by reports that some doctors were giving patients
samples of antidepressants and saying casually "Tell me how you do,"
rather than scheduling frequent follow-up appointments to make sure
patients were tolerating the drugs.
"That is problematic," Dr. Goodman said, "and probably reflects
people becoming a little lackadaisical about the downside of these
medications in children."