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Monthly NewsNote
May 2004
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ANTIDEPRESSANTS, SUICIDAL THOUGHTS, AND THE FDA
There has been a great deal of publicity recently related to the potential
of antidepressants to cause suicidal ideas or even suicide. This, of course,
has created a great deal of anxiety in parents when an antidepressant is recommended
for their child. Therefore, I will use this note to put the subject into perspective
and thus hopefully, reduce the anxiety.
Not long ago the British concluded that SSRI antidepressants (Prozac, Zoloft,
etc.) could increase the likelihood of suicide, and recommend against their
use. The one exception was Prozac. I don’t know where this stands in England,
but here’s the situation in the U.S.
We were told by the FDA not to start patients under 18 on Effexor or Paxil.
However, anyone currently on either of those medications could continue to use
them. At that time the FDA indicated concerns about the other antidepressant
medications, but nothing was done. In fact, Dr. Thomas Laughren, Chief of the
FDA Pharmacology Group said, “We don’t know if there is a link between
antidepressants and suicide.”
However, the FDA has now asked the drug companies to include a warning in the
package inserts for all commonly used antidepressants. This now includes both
children AND adults.
What does this really mean? We treat many serious conditions with these medications,
leading to an improved life, a better mood, and a higher level of functioning.
Those of us who use these medications regularly know that they occasionally
cause “dis-inhibition” That means that a patient may become more
agitated or aggressive because of the medication, in which case it will have
to be discontinued. We also know that as a suicidal patient begins to get better
there is a danger zone through which they pass on the way to getting well. This
means that now, as before, there needs to be good follow up of the patient,
particularly during the first two weeks.
We have always been careful. Perhaps we will be more careful. But I think we
must be careful not to jump to conclusions before the research is complete and
the facts known. If you remember, a few years ago there was a storm over Prozac,
almost leading to it becoming unavailable. When the FDA studied the material,
it was found to be lacking in credibility, and the storm passed. And now, Prozac
is the recommended drug.
When we treat patients it is for a good reason, and certainly antidepressants
have prevented an untold number of suicides. These medications are also approved
for PTSD, Obsessive Compulsive Disorder, and Generalized Anxiety Disorder. These
are all serious problems.
Therefore, I recommend that the medications be used as clinically indicated,
perhaps with some extra care, until research material is available. These are
very important medications, and in most cases it will hurt the patients if their
use is curtailed.
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