In 1988 an ophthalmologist contacted us because his daughter had unexpectedly committed suicide while taking Prozac. He was convinced that this antidepressant had somehow triggered her sudden violent act.
We could find nothing in the medical literature to support his suspicion and so we dismissed his report as the desperate rationalization of a grieving parent. We assumed that a depressed young woman might take her life, even on an antidepressant.
Some months later an article appeared in the American Journal of Psychiatry suggesting the link might be real. Harvard psychiatrists reported on six patients who developed a preoccupation with suicide within a few weeks of starting Prozac.
We later learned that the ophthalmologist’s daughter had not been depressed. Her doctor had prescribed Prozac off-label for an eating disorder. Why she hung herself remains a mystery.
Over the intervening decades the FDA has debated whether Prozac and related antidepressants could trigger suicide or other violent acts. For the most part, the agency has dismissed such concerns as rare or unrelated to the medications.
Labeling for Prozac states, “The possibility of a suicide attempt is inherent in major depressive disorder and may persist until significant remission occurs.”
Despite such reassurance, British regulators have just taken the unusual step of warning doctors against prescribing many antidepressants for people under 18 years old. The authorities there concluded that antidepressants such as Celexa, Effexor, Lexapro, Paxil and Zoloft could trigger agitation, suicidal thoughts and self-injury. Prozac has not been included in this advisory.
The restriction of so many popular drugs for teenagers and children has taken many American psychiatrists by surprise. The debate in England over the benefit-risk balance is likely to trigger a similar controversy in the U.S.
The FDA is now being forced to reevaluate its position on the use of such SSRI antidepressants. And some physicians are beginning to ask whether some adults may also be at risk while taking such medications.
Readers of this column have shared stories that challenge us. One reported: “A 50-year-old old friend of mine asked his doctor for something to put him in better spirits over the Christmas holidays since he had just broken up with his girlfriend. He started Zoloft and awoke in the middle of the night with a strong urge to kill himself. He overcame the urge and never took another Zoloft. Had he actually killed himself, it would have been written off as due to depression, though he and I are convinced it was the pills.”
While millions have benefited from such drugs, some people cannot tolerate the side effects. Whether such antidepressants actually trigger suicidal thoughts in adults has not yet been determined. But British regulators clearly believe they pose a problem for children.
We have written about these issues in our Guides to Antidepressant Pros and Cons and Psychological Side Effects. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. MX-23, P. O. Box 52027, Durham, NC 27717-2027.
The People's Perspective on Medicine