Suicide Caution Sought for Antidepressants

AP via Yahoo ^ | 3/22/04 | LAURAN NEERGAARD, AP Medical Writer

[Nov3]

Suicide Caution Sought for Antidepressants

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By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON - Patients on some popular antidepressants should be closely monitored for warning signs of suicide, the government warned Monday in asking the makers of 10 drugs to add the caution to their labels.

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Although the Food and Drug Administration (news - web sites)'s investigation into the possible suicide connection initially focused on children given the drugs, its warning is aimed at both adult and pediatric use of the pills to alleviate depression.

It isn't clear yet that the drugs actually do lead to suicide, the FDA stressed. After all, depression itself can lead to suicide.

But until that is settled, advisers to the FDA called last month for stronger warnings to doctors and parents that the antidepressants may cause agitation, anxiety and hostility in a subset of patients who may be unusually prone to rare side effects.

On Monday, the FDA followed its advisers' recommendation and issued a public health advisory putting doctors, patients, families and other caregivers on notice to be particularly vigilant for signs of worsening depression or suicidal thoughts at the beginning of anti-depressant therapy or whenever the dose is changed.

The drugs of concern are all newer-generation antidepressants: Prozac, Paxil, Zoloft, Effexor, Celexa, Remeron, Lexapro, Luvox, Serzone and Wellbutrin. Most are known to affect the brain chemical serotonin.

British health authorities sounded the alarm last year, saying long-suppressed research suggests certain antidepressants might sometimes increase the risk of suicidal behavior in children and teenagers. Because only one drug, Prozac, has been proven to alleviate pediatric depression, Britain declared others — drugs called SSRIs and their close relatives — unsuitable for depressed youth.

The FDA issued a caution on pediatric use last year, but Monday's action — especially the addition of the warning to drug labels — goes significantly further.

Dozens of anguished parents pleaded with FDA in a meeting last month to add such warnings, citing preteens and teenagers who hanged themselves or slashed their wrists shortly after starting the antidepressants. Parent after parent described children who had become extremely agitated or anxious shortly after starting the antidepressants, and seemingly sudden impulses that turned deadly.

Among 25 studies of the suspect medications involving 4,000 children and teens, there were no completed suicides. But 109 patients experienced one or more possibly suicide-related behaviors or attempts, the FDA says.

The studies varied dramatically in what was considered suicidal behavior, making a clear link difficult, FDA scientists have contended. For example, among 19 patients classified as cutting themselves, almost all were superficial, with little bleeding.

Worse, the youths most likely to commit suicide weren't allowed into those studies, so existing data likely won't settle the issue, the FDA's scientific advisers have warned.

Depression occurs in up to 10 percent of youth, and 1,883 10- to 19-year-olds killed themselves in 2001. Some 1.8 million teenagers attempted suicide that year, a quarter of them requiring medical attention, according to Columbia University scientists who are helping the FDA's probe.

In 2002, almost 11 million prescriptions were dispensed to patients under 18 for SSRIs and other newer antidepressants, to treat depression and a host of other conditions, FDA said.

[Nov3]

WOW! What a surprise!!!< /sarcasm>

Anyone who has seen someone go through the hell these drugs can cause knows of these side effects. For many these drugs are a godsend - for some they are the beginning of a descent into hell.

[egarvue]

I can attest to that...several years ago, when I was a high school teacher, we had a fellow teacher who was new to the school and area was proscribed Prozac for depression. One week later, he hung himself while his wife and kids were at Sunday school. It was a descent into hell, not only for his family, but for all those who knew and loved him. I hate these mood-altering drugs.

[Nov3]

These drugs work for many, but the horrible side effects for some have been hidden and blamed on the patients. People have died because of the agitation described in this article. People close to me.

[B-Chan]

These medicines are wonderful when properly prescribed and used as directed, but they are not a cureall for depression. Those who eat drugs hoping for a magic bullet and who neglect the clinical care that comes with the RX are setting themselves up for a fall. Those who take these pills as a part of a complete program of psychiatric medical treatment will most likely find themselves able to live a normal life.

As a person suffering from MDD myself, I find that these therapies are immensely helpful. However, my religious faith, not my brain state, provides the psychic bedrock upon which I base my sanity. Depression is a three-part problem: the Happy Pills that I take and the clinical counseling that I receive are there to help alleviate the hardware (brain chemistry) and software (psychological) problems, but the bugs in the part of me that is beyond the reach of talk and drugs — my “OS” — can't be fixed by anything man can put in a bottle. For that, the ministrations of the divine Author are the only sure cure.

Pills and counseling are therapies, not cures, and should not be substituted for hope and faith. Sanity does not come in tablet form.

[John H K]

Seriously depressed people often don't have the energy to carry out and plan a suicide. When they are slightly less depressed they often do have the energy.

People on heart medication often still have heart attacks; I don't think there are warnings on bottles of heart pills that you may have a heart attack.

[sharktrager]

If he was only on Prozac for a week, it's hard to say the drug is to blame.

[Nov3]

Seriously depressed people often don't have the energy to carry out and plan a suicide. When they are slightly less depressed they often do have the energy.

People on heart medication often still have heart attacks; I don't think there are warnings on bottles of heart pills that you may have a heart attack.

That is the red herring that has been passed off for years as the cause of these problems. It is BS. Wait until you see it with your own eyes. These drugs cause a state of unbelievable agitation in otherwise normal people that is not a "lifted depression".

[birbear]

If he was only on Prozac for a week, it's hard to say the drug is to blame.

Exactly... most Selective Serotonin Reuptake Inhibitors (SSRIs) have about a 2-4 week period before they are clinically effective.

[Nov3]

If he was only on Prozac for a week, it's hard to say the drug is to blame.

It may have been to blame. Hopefully you will never witness this agitatation in someone you love. If you do the psychiatrist will say it unmasked a bipolar condition and start to stack major depressants and mood stabilizers turning them into a zombie.

[birbear]

Pills and counseling are therapies, not cures, and should not be substituted for hope and faith. Sanity does not come in tablet form

Nice setiment.

How do I find hope and faith when everyplace I look is hopeless.
I have generalized anxiety so bad that the choir at church makes me want to rip my face off when they start.

What is the "Cure"?

At least with the meds and therapy, I dont have an overwhelming desire to die.

[Nov3]

Not if you are the subset thay are talking about in the above article. The side effects can take place in a matter of days. The side effects are not the antidepressant effect.

[birbear]

I've seen people in the agitated state that you're talking about... those people are at high risk for suicide anyway, and should be hospitalized.

as with a lot of medications, sometimes the symptoms get worse before they get better. I've been hospitalized twice for mental illness and I've seen the reactions that a lot of people get when new meds are tried... but usually, within a couple of weeks, the meds have a positive effect.

[sharktrager]

I am on anti-depressants, and have taken mood stabilizers and anti-anxiety meds in the past.

While it isn't easy to get the right mix of meds, the medicines can be very valuable.

I have taken Prozac. It does not have that kind of immediate dramatic impact on mood. It takes 4-6 weeks just to see any results. His actions are the result of his problems, and are his responsibility. I have been hospitalized for being suicidal, and I credit the help I got from friends and medical professionals as having been very valuable. But the problems that got me to that point are my responsibility.

[Nov3]

I've seen people in the agitated state that you're talking about... those people are at high risk for suicide anyway, and should be hospitalized.

as with a lot of medications, sometimes the symptoms get worse before they get better. I've been hospitalized twice for mental illness and I've seen the reactions that a lot of people get when new meds are tried... but usually, within a couple of weeks, the meds have a positive effect.

We won't argue the general effectiveness of these drugs and whether the vast majority of the people for whom they are prescribed need them or benefit from them. I will say this - for some they are a godsend. As to the side effects they are real and have been systematically hidden by the drug companies. Anyone who has watched a loved on go through it will hate them for their lies. This agitated state doesn't take place in a controlled atmosphere. It takes place in their homes and lives. It can and has caused death. It is inexcuseable.

[Nov3]

It does not have that kind of immediate dramatic impact on mood.

Till you can separate the side effects from the theraputic effects we can't really discuss this. They are two different things.

His actions are the result of his problems, and are his responsibility.

That is a statement of ignorance.

[Nov3]

FYI

[Crawdad]

If I see one more article like this, I'm going to... oh, never mind.

[sharktrager]

Did you actually read what I posted?

I can assure you that I could tell you stories, mine and others, that would break your heart. And not all of them have happy endings.

But we are only better because we work at it, and if we fail, the responsibility is ultimately ours.

The potential immediate side-effects of antidepressants are readily apparent. And if those around him saw them so clearly, they should have acted. And, frankly, the patients notice them as well. If a patient is so far gone that he can not see these changes, it is not the drug's fault but his doctor's and, usually, the patient's, for failing to act in time.

But suicide is only the responsibility of the patient. I am quite tired of hearing how the death of someone who commits suicide is tragic. The loss of a son, father and husband is tragic, because of the terrible impact on the family and friends of a suicide. But, my sympathy for the person who commits suicide is limited to any actions that affected their development and health. That sympathy ends at the point where they take an action which so clearly impacts those around them far more than it does the person taking the action.

Trust me when I tell you I know much more about these subjects than you can imagine.

[Nov3]

Trust me when I tell you I know much more about these subjects than you can imagine.

I seriously doubt that you have seen what they are describing. I have seen mild agitation in several friends but when you see the real thing and how fast it onsets . . . . . You don't have a clue. When you see someone turn in a matter of hours from a mildly depressed person to a 105 pound maniac with super human strength you may get a clue.

[Jeff Gordon]

Balderdash!

These stories about the bad effects of SSRIs are being planted by trial lawyers. There only goal is to siphon money from the pockets of drug makers into their own pockets.