Antidepressant Warnings - Should We Be Alarmed?
Wednesday December 20, 2006
by Kimberly Read
Recent news articles have been filled with the ongoing debate centered on antidepressants. In 2004 a black box warning regarding possible increased suicide risk in children and teens was added to antidepressant labels (see What is the "Black Box Warning" for Antidepressants?). Now the U.S. Food and Drug Administration (FDA) has convened a panel to reevaluate the safety of this class of prescriptions and is considering expanding the warning to include adults as well. The basic question: do antidepressants promote or prevent suicidal behavior? The answer: there is little agreement among professionals.
Recent news articles have been filled with the ongoing debate centered on antidepressants. In 2004 a black box warning regarding possible increased suicide risk in children and teens was added to antidepressant labels (see What is the "Black Box Warning" for Antidepressants?). Now the U.S. Food and Drug Administration (FDA) has convened a panel to reevaluate the safety of this class of prescriptions and is considering expanding the warning to include adults as well. The basic question: do antidepressants promote or prevent suicidal behavior? The answer: there is little agreement among professionals.
- " 'Untreated depression causes more loss of life than any of the approved treatments,' says Carolyn Robinowitz, president-elect of the American Psychiatric Association. In her 38 years of practicing psychiatry, she says she has never seen an increase in suicidal behavior, or a suicide, due to antidepressants." USA Today
- "The FDA recently completed a review of 372 studies involving about 100,000 patients and 11 antidepressants, including Lexapro, Zoloft, Prozac and Paxil. When the results were analyzed by age, it became clear there was an elevated though small and short-term risk for suicidal thoughts and behavior among adults 18 to 24, the FDA said." Chicago Sun-Times
- " 'Suicide rates will go up. The loss of days from work will go up. Hospitalizations will go up and suffering will go up [if warning labels are expanded],' said Dr. Alexander J. Bodkin, director of the Clinical Psychopharmacology Research Program at Harvard Medical School and psychiatry professor at McLean Hospital. The Boston Herald
I believe the key here is cautious continuance. Have you been taking antidepressants without issues of suicidal ideation or attempts? Is your child improving on these prescriptions? Then perhaps stopping them would be a poor choice. What is absolutely warranted, and really should always be the case, is close cooperation and communication with your primary healthcare provider. Work with your doctor; talk with your doctor. Keep your scheduled appointments. Get your regular lab work done. Then if a problem does arise, you will be able to catch it early.
Comments
I am inherently sketical of these black-box warning and suspect they are motivated by inadequate research and underlying bias by those that prefer to deny that depression is real, can be incapacitating and are not matters of character but ones of chemistry. People with serious depression kill themselves and suffer from suicidal ideation. So the group of people who would be taking SSRI’s therapeutically
is already skewed towards these results.
I also believe, that depression can be so incapacitating that people are unable to act on their destructive impulses. As they begin to see minimal results on the medication-they are then able to carry out the acts. Antidepressants save lives-its that simple. I suspect that some bureaucrats, who hae underlying bias and prejudices are misusing the research to jusitfy their bias– too many people use these medications for frivolous reasons–mental illness is a weakness of character not a neurological glitch, etc. My fear is that many parents will avoid getting necessary treatment for their children because of 1) their unwarranted but no confirmed fears that the drugs may be harmful 2) their own bias about mental illness and their refusal to recognize it when it is up close and personal and 3) perhaps, unconsciously their own guilt that they may have genetically created their child’s suffering-DENIAL.
This, I think, contributes to such twisted think as “we cant let grandma take opiates in her final stages of cancer, cause she might become ADDICTED!”
The blackbox warnings are dangerous and iirresponsible as is the media coverage thas attended them. Depression kills.
I will admit that after being diagnosed at age 15 with BP, and starting my regime of Wellbutrin among others, I tried (over the course of 5 years) to commit suicide a total of 6 times… but think of how much worse it would have been had I not been taking antidepressants- maybe that number would have been more like 20! It’s all a matter of do we take the antidepressants and risk maybe having suicidal thoughts or do we not take them and more than likely have those same thoughts? I am glad to say that after having my son, there were no more attempts made. Yes, I still have the thoughts to this day but I haven’t tried to carry those thoughts out in a long time.
I have had a bipolar man staying at my house for almost two years. He has been grossly overmedicated. Poisoned on Lithium, Prozac,Zoloft, Paxil, a mix of Seroquel, Cymbalta and Depakote, back to Paxil. I have seen many reactions to his meds, including two suicide attempts. I believe the medications are responsible. He changed so drastically when put on them. Is it possible there is an individual reactiion to these meds? They are poison to one, helpful to another? He becomes another person on the drugs. I fear for his life right now and pray that he can find medical help soon.
Another point to ponder about these same antidepressants is their ability to aggrevate behavoral problems such as over-aggresiveness and rage when high theraputic dosages are administered. This problem seems to be across the board in pediatrics and adults as well.
I was hospitalized for such a reaction (excessive rage and aggressiveness), and the specialists cut the dosage of my antidepressant to half of what I was taking pre-hospitalization. Within a week, I was seeing an improvement; one month even more so.
By the way, I should mention that the med. was Effexor XR, and it was being taken in addition to Seroquel, Gabitril, and Topamax.
When my son was diagonosed with ADHD I sought out the top Doctors in the field. When medications were recommended I conferenced with 3 Doctors each time to ensure that I was following “best” medical practice. With all these safeguards, my son was prescribed with a molotov cocktail- a mixture of dexetrine, paxil, albuterol and steriods. He had an episode at school, thank god he didn’t hurt anyone. He had to be hospitalized and then was put on other drugs, diagnosed with BP. Today he is off all medications, is in college and is functioning well.
When I look back at this, I truly believe that the introduction of the Paxil was his downfall. Yes, all parents have to be very careful with the medicines that are being prescribed and watch carefully for signs in behavorial changes.
I firmly believe in the use of antidepressents. When I was on Zyprexa for my Bipolar Disorder, I became severly depressed one winter. I wouldn’t eat, I lost twenty pounds from this, and suicide was constantly on my mind. I could barely function, work and family gave little satisfaction to me, and the things I usually loved gave me no joy.
I began to take Wellbutrin that winter, and it all changed. The depression eased up, i began to eat regularly, and the joy crept back into my life. It also helped that I stopped taking Zyprexa, it seemed to increase my depressive episodes.
So, I belive that there is a time and a place for antidepressants in the world of BP.
Before PaxilCR was introduced into my drug “cocktail” of Zyprexa, Depakote and Valium, I was a “zombie;” I had no joy in my life, I was just “going through the motions” of living. The PaxilCR brought me “back to life.”
It’s true that “one size fits all” is NOT true when treating bipolar disorder. It is an individual treatment by a psychiatrist with a client who is willing to work with their doctor to discover what drugs will, and won’t, work for them.
All I know is – the PaxilCR, as an antidepresant in my treatment – I am able to be a highly-functioning person with bipolar disorder, and am able to really “think” and “problem solve” today.