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Suicides and Suicide Attempts

Mental Health and Disorders

Drugs (Pharmaceuticals)

Medicine and Health

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Overprescribing Prompted Warning on Antidepressants


Published: March 24, 2004

The 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 behavior."

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 them."

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."

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. Student, 19, in Trial of New Antidepressant Commits Suicide  (February 12, 2004)  $
. Stronger Warning Is Urged on Antidepressants for Teenagers  (February 3, 2004)  $
. Panel Says Zoloft and Cousins Don't Increase Suicide Risk  (January 22, 2004)  $
. British Warning on Antidepressant Use for Youth  (December 11, 2003)  $
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