Wednesday, December 13, 2006
Anti-Depressants and Suicide Risk
One story that has fascinated me the most over the last couple of years is the one about anti-depressants and suicide risk. You may remember that in October 2004, a black box warning label was created for antidepressants used to treat children. This warning, which is located prominently on the package insert, warns specifically of an increase in suicidal thoughts if someone is taking the medication. It was fascinating to me, because it seemed so counterintuitive - I mean, weren't anti-depressants supposed to make someone feel better? And, didn't it make more sense that the depression itself was leading to the suicidal thoughts or behaviors?
Well, that is at the heart of what promises to be a very contentious FDA hearing today. Studies have shown that using antidepressants elevates the risk of suicidal thoughts and behaviors in young adults. So a similar black box warning for antidepressants being used by adults is being considered. There will be testimony from individuals whose loved ones committed suicide while on the medications. And, there will be testimony from the American Psychiatric Association telling the FDA that the risk of increased suicidal thoughts is small and greatly outweighed by the risk of untreated depression.
It is unclear as to why the use of antidepressants and suicide would be linked. It could be that an alteration in the brain chemistry affects some people differently, actually causing a downward spiral, instead of a mood enhancement. Or, it could be that antidepressants elevate someone's energy levels before their mood. So, they have just enough energy to start acting out suicidal thoughts, while they are still depressed. It might just be the natural and sometimes tragic natural history of depression.
It is clear that depression remains a widely stigmatized disease and that too many people don't get the treatment they need. After the black box warnings were implemented in 2004, prescriptions for anti-depressants went down 20% for young adults, potentially leading to even more untreated depression in that group of people. There is a possibility that could happen again, if those warning are extended to adults. So, if you had a chance to weigh in on these FDA hearings, what would you say?
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