Panel Says Zoloft and Cousins Don't Increase Suicide Risk

NY Times ^ | January 22, 2004 | GARDINER HARRIS

[neverdem]

Adding to the debate over using antidepressant drugs for depressed teenagers and children, a group of prominent researchers issued a report yesterday saying that Zoloft and similar medicines did not increase children's suicide risk.

The group, drawn from members of the American College of Neuro- psychopharmacology, also found that the drugs were effective in treating children's depression.

"Depression in children and adults is the major illness that underlies suicide, and we believe that the S.S.R.I. class represents the medication with the greatest efficacy against this very serious condition," said Dr. J. John Mann, a professor of psychiatry at Columbia University who was co-chairman of the reporting panel.

Those conclusions are hotly contested, and the report does not settle the debate on giving children the medicines, selective serotonin reuptake inhibitors, or S.S.R.I.'s.

Citing associations between antidepressants and suicidal thoughts or tendencies in children, British drug regulators told doctors last month not to prescribe those drugs for children, with the exception of Prozac.

The Food and Drug Administration plans hearings on the question on Feb. 2.

In the new report, the panel reviewed 15 clinical trials, some unpublished, that included more than 2,000 teenagers and children as subjects. The trials used varying methods and had disparate outcomes, but showed that S.S.R.I.'s — Effexor, Paxil, Prozac, Zoloft and others — "are effective in treating depression in children and adolescents," the report said. It recommended that clinicians continue to use the drugs for depressed youths, although it said clinicians should "ask depressed patients about suicide, suicidal thinking and plans for suicide."

Dr. Jeffrey Lieberman, professor of psychiatry at the University of North Carolina, said he found the report persuasive.

"What the report said is that the risks of not treating patients with severe depressive illness outweighs the risk of treating them with S.S.R.I.'s," Dr. Lieberman said.

Dr. Richard Harrington, professor of child and adolescent psychiatry at the University of Manchester in England, said he was not sure that drugs were effective for teenagers and children.

"Maybe they work," Dr. Harrington said. "But if so, they don't work very well. And I'm still troubled by the suicidality."

Critics pointed to weaknesses in the report. The panel did not have access to some information that British regulators used to come up with opposite conclusions.

The report did not undertake a sophisticated and difficult meta-analysis, in which figures from many studies are pooled for examination. Other researchers are conducting that analysis.

Critics of the medicines noted that 9 of the 10 task force members had significant financial ties to the pharmaceutical industry, although such ties are common among prominent researchers. The panel said no industry money financed the report.

"Of course they concluded that these drugs are safe," said Tom Woodward, who said he believed the drugs led his daughter, 17, to commit suicide. "All these guys are tied to the pharmaceutical industry."

Worries that they might cause a small number of patients to become intensely suicidal have swirled about the drugs since shortly after Prozac was introduced. The question seemed to have been put to rest in 1991, after a Food and Drug Administration panel said there was no convincing evidence to link the drugs to increased suicide risk.

Millions of people have taken the medicines. Although sporadic complaints continued to link drugs to suicides, those reports were widely dismissed as anecdotal, isolated events that could not be relied on to assess the medicines. But later studies raised new questions.

[neverdem]

God bless psychiatry, please quickly.

[isom35]

its depends on who your cousin is. like if the clintons or kennedys were my cousins, I'd be depressed and taking plenty of zoloft or whatever...

[neverdem]

Ping

[Travis McGee]

My son has Asperger's Syndrome. He takes adderal and prozac, and it's made his life manageable. The wild rages, violent outbursts, self destructive moods are about 80% diminished. It's very likely he would have had to have been institutionalized without them. I only pass along this personal information to help other parents who might be struggling with similar situations. Don't give up, keep trying.

[rmlew]

The first day I had to deal with autistic camper, i needed a drink. His sister seemed aged beyond her years with the burden.
I hope that your son's condition becomes manageable through medication and therapy. I know that I would need an anti-depressant in your position.

[CobaltBlue]

People with depression tend to be suicidal anyway, so it's not surprising if they commit suicide. I can't imagine anything more devastating than the suicide of a child. You'd blame yourself, you'd look for some rational explanation, and there is no rational explanation for suicide. It's not a rational act.

[KangarooJacqui]

lol I was going to make a similar remark along the cousins line...

But seriously, when I was put onto Paxil for depression, I got progressively more moody, paranoid, and probably suicidal (I don't really remember). In less than six weeks, I'd been taken off them.

Then again, recently I had a chance to look through some old diaries. The date I started taking Paxil? September 10, 2001...

My point being I guess is that there's always outside influences at play, as well as the drugs (which to be honest not that much is known about.)

[Indrid Cold]

"Critics of the medicines noted that 9 of the 10 task force members had significant financial ties to the pharmaceutical industry, although such ties are common among prominent researchers. The panel said no industry money financed the report."

Why am I not surprised?

[Indrid Cold]

The theory is, or at least it was, that people suffering from unipolar depression don't have enough energy and motivation even to kill themselves. The antidepressants apparently bring them "up" just enough so they can accomplish it.

[CobaltBlue]

Unfortunately I've known several people who committed suicide - none in a couple of decades, thank God. Prozac, Zoloft and all these new drugs weren't available back then. Could they have saved my friends?

Who knows? It's so hard to prove causation. It's impossible to ethically set up a double-blind test for this.

I just know that a lot of people are ashamed to get therapy or take medication because they listen to selfish, stupid, self-absorbed people who tell them that they just have a bad attitude and need to pull up their socks and get with the program, and other such nonsense.

Depression runs in my family. Several people in my family take antidepressants regularly. I take them once in a blue moon - that's what I call it - I get the blues every year or two for a little while - and the pills help a lot. Last time was when my mother nearly died and was in the hospital for a month and then recuperating for a couple of months. For some reason it really hit me hard.

Time before that was when I was finally accepted that my rheumatoid arthritis was never going to go away.

I am not ashamed to admit it, and I urge people with depression to get medical help.

[r9etb]

People with depression tend to be suicidal anyway, so it's not surprising if they commit suicide.

Well, yes. But there are those who will claim that these drugs cause people to commit suicide.

I've never quite understood their argument, but it seems to stem from an ideological opposition to the use of medication to handle mental issues. I don't know how many of them also deny the existence of ADHD, but their approach to the topic seems similar.

[CobaltBlue]

I suspect that you're right that there's an ideological element to the opposition of the use of antidepressants. I can't fathom it, myself.