by John M. Curtis
(310) 204-8700

Copyright September 16, 2004
All Rights Reserved.

aving in to public pressure, the Food and Drug Administration finally agreed to issue warning labels on antidepressants but only for children, citing internal and outside research linking antidepressants with suicidal thoughts. Britain's drug control agency went one step further in Dec. 2003, banning antidepressants for children. In 1989, The Church of Scientology raised red flags, accusing Prozac of inducing Joseph T. Wesbecker to mow down eight people with an AK-47 before taking his own life. Prozac, Eli Lilly & Co.'s popular “selective serotonin reuptake inhibitor” [SSRI], was introduced in 1988. It remains the only antidepressant approved for children, yet has been associated—rightly or wrongly—with suicide and violence. Eighteen-year-old Eric Harris, one of two killers in the Columbine massacre, was taking Prozac when he went ballistic April 20, 1989.

      Recent FDA actions make no mention of the effect of antidepressants on adults, citing only compelling risks to children. Passing from childhood to adulthood represents a blurred line at best. If antidepressants cause suicidal or violent behavior in children, you can expect the same with adults—certainly young adults whose lives are frequently topsy-turvy. Since the advent of SSRIs—beginning first with Prozac in 1988—drug makers have categorically rejected any link with suicide or violence. Demanding warning labels for children is a major concession, making a small dent in the multibillion-dollar antidepressant trade. Childhood prescriptions account for only 7-8% of total drug sales. While recommending “black box” warning labels is a good start, current FDA warnings don't go far enough, alerting adults about the risks of antidepressant medications.

      Drug makers argue that the benefits of SSRIs far outweigh possible adverse risks associated with suicide or violence. They indicate that patients with violent or suicidal tendencies are routinely prescribed antidepressants under the belief that they suffer from major depression. Physicians and drug makers think that patients are easily misled into believing that antidepressants create suicidal or violent thoughts. They continue to believe that suicidal and violent patients blame problems on antidepressant medications. “We have very strong evidence of harm and really not very good evidence of efficacy,” said Dr. Thomas Newman, a member of the FDA's pediatric advisory committee and professor at the UC San Francisco School of Medicine, exaggerating the risks and ignoring the widespread benefits. Despite the risks, millions of children currently get help from antidepressants.

      Warning labels don't discourage physicians from prescribing “off label” uses of antidepressants. Prozac is currently the only antidepressant drug approved for children. Both a Columbia University and FDA studies indicate that antidepressants increase suicidal thoughts by about 2%. But no one knows the risk of restricting or banning antidepressant medications for children. Without prescribing antidepressants, it's also possible that suicidal ideation or behavior might jump precipitously, prompting the FDA to hold off on an outright ban. “I'm not ready, given what we know, to ban antidepressants,” said Dr. Wayne K. Goodman, a psychiatrist and chairman of the FDA's psychopharmacologic drugs advisory committee. Popular antidepressants, like Prozac, Zoloft, Paxil, Effexor, Celexa, Lexapro, Luvox, Wellbutrin, Serzone and Remeron, have many other useful applications.

      In the current medical literature, there's no diagnosis for suicidal or violent behavior. Those actions are considered side effects of other conditions like bipolar disorder, schizophrenia, transient stress, situational psychosis, antisocial behavior, obsessive-compulsive disorder, panic and anxiety. While antidepressants are sometimes prescribed for these conditions, it's difficult to know what actually causes, or, for that matter, best treats suicidal or violent behavior. Treating only depression ignores other key causes of suicide or violence. Antidepressants might push otherwise controllable impulses over the edge, especially with adolescents where ordinary restraints aren't full developed. So far, the FDA has only concluded that antidepressants increase suicidal or violent thoughts, not actual behavior. Researchers must still explain the differences between children and adults.

      Posting “black out” warning labels on antidepressants represents a setback to drug companies—and maybe patients. Neither the FDA nor any psychiatric group knows for sure whether depression causes suicidal or violent behavior. Linking antidepressant use with a two percent increase in suicidal ideation gives little insight into the real causes of suicidal or violent behavior. In some patients with suicidal and violent propensities, it's possible antidepressants trigger aggressive impulses, leading to erratic behavior. If antidepressants lower the threshold for violence in children, it's likely it does the same in adults. While there's nothing wrong with posting warning labels, more research is needed to pinpoint the actual causes of suicidal or violent behavior. Restricting prescriptions or banning these drugs might boomerang, increasing the risk of suicide or violence by far more than two percent.

About the Author

John M. Curtis writes politically neutral commentary analyzing spin in national and global news. He's editor of OnlineColumnist.com and author of Dodging The Bullet and Operation Charisma.

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