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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?
PLease if you want to help, establish a phone number and web site for the family members of suicide victims that were using antidepressants(zoloft). We lost our 19 yr. old son last Jan. He was stressed about school and his college physician gave him Zoloft. She told us she asked him if he was suicidal before she gave him the sample pkg. given her by the Pfizer representative. All of these cases are not reported to anyone that we can tell and we dont know who to contact. NO ONE that knew our son before this incident had seen any signs of depression. He was a freshmen at Wittenberg University majoring in pre-med. He was stressing over a few classes(he was away from us 5 mon.) and decided after christmas break to talk to the Dr. at school to see what was available to help with the stress and to help him sleep. He was on the Zoloft for 10 days. Please contact me with resources of other information on who to contact. Nate was an honor student, playing 3 sports all four yrs. of hi. school with lots of friends and family. Please help.
I attempted suicide and nearly succeeded before I was diagnosed with major depression. Anti depressants have helped me greatly. When I first started taking them, I did think a lot about the act of suicide, but not doing it again. Antidepressants helped me greatly, but excellent weekly therapy helped me equally as much. See a qualified psychiatrist and therapist. Its a total package that makes a difference, not just the drug.
As an adult user of zoloft, I can say first hand that I did experience these elevated suicidal thoughts when first taking the medication, even though I never had such thoughts before. I was actually given the drug for anxiety, not depression, and after my initial bad reaction, after being on it for three years I can honestly say I have no such thoughts and little anxiety so it has really improved my quality of life. However, I know that the suicidal threat is real especially since I experienced it first hand and I was lucky that it wasn't that severe that I acted upon it. I think it's critical to monitor and have constant communication with the patient during the time of going on and off the medication so that these risks can be evaluated.
I was glad to hear they are warning people of the danger of anti-depressants and suicide, because I felt it may have contributed to my husbands suicide, he was on the drug Remeron for only 3 weeks when he took his life at age 66. I saw later, the warning of the drug from Canada that studies had shown a high rate of suicide in teenagers and in older adults. I hope they will continue this study in the United States to warn people of the dangers.
Having been medicated on and off for over 20 years now (my drug of choice is Elavil -- IMO Effexor should be taken off the market -- "medication cessation symptoms," my hinie!) ....

Anyway ... The thing that nobody seems to realize is that as the drugs begin to work, you get on the Nightmare Roller Coaster ride before things stabilize. Before theraby begins -- you live in the pit; granted you don't care, but it's the pit. It doesn't change -- and it doesn't matter if "nobody's home." Once drug therapy begins, you begin to see flashes of being ALIVE again. Unfortunately, those flashes don't last long -- and you disappear back into the pit with the least provication. IMO, the roller coaster is worse than the pit. When you're in the pit, there's nobody home, and you don't care anyway, so what does it matter. When you realize that you might be alive; and that you may have a life again, to be plunged back into the darkness and dispair is almost unbearable.

And IMO (I may be close to a PhD in Botany, but I'm neither an MD or a psychologist) it's once the roller-coaster ride starts that you have your suicides. Unless you *know* that it's coming -- if your only two options are the pit (especially after you've walked in the sunshine) or the roller coaster ... death seems like it just might be an acceptable solution.
I tire of the pro-drug mentality that this article contains (and toward which CNN remains considerably biased).

Depression is not the same type of condition as a bacterial infection, and the distillation of the issue to where treatment = drugs is, in my humble opinion, horrifically shortsighted.

The fact is, the real danger of antidepressants has nothing to do with some small fraction of patients who might react with an increased tendency of suicide. It's the trivialization of "depression" as merely another physical illness that is what's dangerous. We are talking here about *mind altering drugs*, plain and simple. The fact that some are alarmed that certain medications are not perfectly "safe" seems a bit concerning in itself.

There are numerous situations in life where depression is a natural -- and perhaps even logical -- mechanism through which we are forced to examine our life and circumstances. The fact is, most depression has a tangible cause - whether the person, their therapist, or others involved in the process are aware of it or not.

I'm a 32 year old male living in suburban CT, and I find it virtually impossible to meet people who have never been treated with antidepressants. That's a serious issue in itself, but not my main point. I've grown both frustrated and concerned from encountering situations where a person was given antidepressants, and in the end, credits the medication as the primary reason they "felt better". In probably 50 or MORE situations that I've personally witnessed, the person's use of the medication simply covered up a real problem and let the person continue focusing on other areas of life - instead of actually solving what was probably a far deeper issue. That's because in 99% of the cases, drug marketing aside, depression really is caused by life circumstances, not some external pathology.

Our healthcare system and millions of dollars of drug advertising have obfuscated the facts, but believe it or not, there remain some healthcare professions who believe that tossing drugs at the depressed really is akin to clipping the vocal cords of a person who is screaming. Also, since when is happiness an absolute entitlement?

I can't wait for the latest round of drugs for the treatment of "obesity". People will likely herald these newcomers as the panacea for America's most common "disease" and then, a huge fiasco will erupt when 1% of those treated develop some other health issue. The fact is, there IS a treatment for obesity: it's called a treadmill. What percentage of Americans are overweight due to a real, scientifically valid glandular problem? Does ANYONE see my point?
Heh, eventually the truth about these things will become apparent. I had an ex gf that had taken zoloft then paxil and it completely changed her. To point where she ended up killing her twin boys. I knew nothing about the SSRIs, until I hit the web looking for information. All I found was page after page listing all the people who had similar experiences with SSRIs, and what happened. THe only good info links I could find were from the manufaturer or their bedpartners.
I have been taking Paxil for about 5 years, and it has been a life-saver for me, but I am an older adult in my 50s and only take 10 mg. a day. I feel totally normal on it. In my early 30s while going through a divorce, I was prescribed some other antidepressants that did make me have suicidal thoughts, especially Xanax. When I stopped taking them, the thoughts went away. I believe each case has to be decided on its own merits.
There is a difference between situational depression, the kind we all experience in response to a loss or stressful situation, and the condition of a major depressive disorder. Situational depression and bereavement do not usually require treatment with antidepressants. Most people experience this type of depression and are able to work through it with the help of friends and family or therapy. Major Depression, on the other hand, is a medical condition which needs to be treated with either therapy, or a combination of therapy and medication. When a person is suffering from Major Depression, they frequently can't pinpoint a precipitant or explain why they feel the way they do. This is because they have a chemical imbalance in their brain. It should be noted that 90% of people who commit suicide suffer from some form of diagnosable mental illness. Autopsies of suicide victims have consistently shown that there were abnormally low levels of serotoinin within the brain in the orbital prefrontal cortex, which is the decision-making area. Individuals who are diagnosed by a psychiatrist as having a mental disorder such as bi-polar, schizophrenia, or major depressive disorder should follow the advice of their doctor regarding taking medication. On the other hand, family physicians are sometimes all to eager to dispense these drugs to people who are going through the natural, healthy reactions to grief or loss.
My 15-yr old son was having a lot of problems last year related to school and relationships. What I consider to be pretty much a normal part of being a teenager. However, wanting to make sure that I did everything in my power to help him, I took him to a psychiatrist finally to see if I could get him some help. He was immediately diagnosed with moderate major depression and prescribed Zoloft. He was also referred to a psychologist but only because I requested he be seen by one. Although the psychiatrist gave my son and I literature about the potential increased suicide risk, she never discussed it with us. The psychiatrist followed-up with him for about a total of 5 minutes per week for the next month or so. Then, about 4 weeks into taking the Zoloft, he overdosed on the Zoloft leaving his family a suicide note and running away. I had no indications up to that point that he was even considering this. Luckily, he did not take nearly enough, although I had just filled a prescription for 90 tablets, and a good citizen found him curled up outside there house in the middle of winter and called us to come get him. He spent the next week in an adolescent psych hospital where they INCREASED his dosage of Zoloft. I took him for follow-ups with the same psychiatrist and she continued to prescribe him the medication. Then, when he told her he was having trouble sleeping due to nightmares related to the suicide attempt, she prescribed him an anti-psychotic in addition to the Zoloft. After that appointment, I weaned him off the Zoloft and never took him back to the psychiatrist but continued the counseling. Not once in that entire time did they discuss with me the potential increased suicide risk from taking Zoloft. He has since started seeing a cognitive/behavioral therapist which seems to be working well. No, not perfect, and he still has problems, but not anything near what was going on while taking the medication. It is a scary situation to think how many others out there are giving their children these medications without knowing about the increased suicide risk. I work in the mental health field and have quite a bit of lay knowledge but not every well meaning parent has this background. In fact, a lot of people think that if the doctor prescribes it, it must be OK; I know my husband felt that way. I really feel now, more than ever, that pills are given to people like they are candy. When will we learn that medicine is not the first solution when there is a problem???
"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."

This statistic (20% reduction in prescriptions of antidepressants for young adults) is interesting. It is possible that this 20% would formerly have been written for less than serious depressed young adults, ie as noted above, those who were in the throes of appropriate emotional responses to life issues and circumstances. Trying to scare the unknowing or unwilling to know public into believing that tighter regulation and more appropriate prescription of powerful brain-altering medications are somehow dangerous and may lead to decreased help for the truly afflicted is a scare tactic used in the marketing schemes of the pharmaceutical complex. This type of approach should not be offered by the medical media. I think it is misleading. Bring back emotional humanity and save the medicating for those who truly need it.
Let me start by saying tha my "Dr." is an earned Ph.D. in physics, not medicine. I have suffered from depression and take two antidepressants (Effexor and Wellbutrin), BUT, I also had extensive therapy sessions to learn the techniques of cognitive therapy. I think that the key is both therapy and medications if there really is a problem. Also key is the doctor's and therapist's involvement and level of commitment to patient care. My doctor and therapist told me about the possible side effects of the meds before and after prescribing them. They also ask me every time that I see them about suicidal thoughts. Further, my daughter was having some problems with "depression" (similar to the "normal" teenage responses some others have written about in their comments), so my wife (who is an R.N.) and I took her to my psychiatrist. She said that my daughter may, indeed, have some mild depression, but she did NOT prescribe medication; instead, she referred my daughter to a therapist. That has helped her tremendously!

To reiterate, IMHO the patient and the doctor and the therapist should all work together in this (and other areas of health care as well). Patients should ask questions, state concerns, etc. If the doctor won't listen or dismisses your concerns - FIND ANOTHER ONE! Treat medical care just like you would any other service business. If the doctor seems rushed, insensitive, uncaring, doesn't take you seriously, doesn't explain things in an understandable way, etc. find a new one.

I also have to agree with some of the opinions that "throwing pills at the problem" is not the answer. In my case, it is effective for treating my depression in conjunction with cognitive therapy. I don't blindly take pills for other ailments, nor do I go to a doctor whose only answer is to prescribe pills. Ultimately, it is the responsiblity of each individual to decide what is best and what is working for them. Take advice from the experts; seek second opinions; but think and decide for yourself!
I can only imagine the number of stories similar to the ones listed here and my dad's story. My father commited suicide Dec 2003, before all these warnings come about. There has always been a part of me that wonders if it was the drugs that caused the suicide. He was diagnosed with severe anxiety and serious depression. Right around the time the drugs are suppose to take their full effect (4 weeks) he started having suicidal thoughts. He was hospitalized for a week and "seemed" to have improved. I say "seemed" because he was a very smart man and might have been faking it for all of us. Within a month he was back to days in bed, etc. Many of you are familiar with the drill. The therapy sessions didn't help.

Our society has a LONG way to go before understanding mental illness. I hope the FDA does much more testing on these drugs. It would be great to find a way to help individuals with depression. It is a very difficult illness to watch someone go through. I think there is a lot to learn.
Dear Sanjay,
I have survived bi-polar depression for 28 years and anti-depressants have literally saved my life. Two important points are: 1.The effectiveness of an anti-depressant varies from person to person and an anti-depressant that relieves symptoms in one person my not be effective in another. Sometimes, a person may have to try several medications before finding one that works. 2.To complicate matters, an anti-depressant can take up to one or two months to provide relief so if one medication isn't effective, the patient may have to go through a trial period of many months to find one that works. That waiting period can be excruciating and the patient may feel even more despondent and hopeless while waiting to find a medication that is effective. It is critical for depressed people to be aware of these factors while finding the treatment that works best for them.
Just the other day I ran across a diary I kept during a months-long major depressive episode I suffered nearly ten years ago. I was undergoing both counseling and anti-depressant therapy at the time, and my doctor tried first Paxil, then Prozac, then Zoloft, in an attempt to find something that would provide relief. Each time I would take the new drug for several weeks, then find my suicidal impulses actually increasing, not decreasing. In my diary I say "I think these drugs are having exactly the opposite of the intended effect. I feel more out of control and unstable than I did two weeks ago". I'm a biologist by training, and have a good understanding of pharmacology and neuroscience, but I really couldn't understand this seeming paradox. But in my diary I finally wrote a note to myself: "if ever in the future a shrink offers to put you on an SSRI, say NO!" For me, they were a bad choice.
My son have tried to take his life two times since he started taking antidepressant. The first time when he was 15 and was taking prosac and the second time three months ago when he was taking Lexapro. Now he is taking Efexor and in the hopital. He became very angry and agited since he started taking antidepresants.
Should he stop taking antidepressants?
My 14 year old son was taking Adderall for ADHD. The Adderall caused him to feel depressed so he was prescribed Lexapro. He recently tried to hang himself using his belt. By the grace of God, sometime after he went unconscious, the belt broke. We found him in his room bleeding badly from the mouth as he busted it when he fell. He was terrified and crying uncontrollably when we found him. He couldn't, and still can't, tell us what drove him to do this. He said he felt like it wasn't real and when he woke up he thought it was a bad dream until he felt the blood on his face. I don't know if it was the Adderall or the Lexapro or a combination of the two but I do feel certain that it was the drug(s) that led to this. He spent one week in a mental hospital where we were told by a phyciatrist that the drugs may have been a factor in the attempted suicide. Unbelievably, 10 minutes later he suggested my son continue to take the med's. Needless to say I refused to allow him to continue the medication but he does see a counsler once a week. I'm very upset that his pediatrician and phyciatrist never mentioned the possibility of the medications increasing the risk of suicide, NOT ONE TIME DID THEY MENTION IT. I voiced this to the phyciatrist at the hospital and he said "it's because the benefits out way the risks", not a good answer. My son has been off of the med's for one month now and he is doing fine, sure he is a little hyper but I can live with that.
I have been on antidepressants for the past six years, since I was 19. I desperately wish someone had been able to see my depression and help me get help earlier, before I acquired the self-mutilation scars I will live with for the rest of my life. For the drug-skeptical, I have also been off the antidepressants, to see if I could cope without them. With them, I am a normally functioning person. Without, I can barely leave the house or hold a job.

On the other side of the issue, both of the people I know who have committed suicide had been on antidepressants long-term. One was my age, the other in her late 50s.

I have always been an advocate of antidepressant therapy in conjunction with other treatments for depression. I am also in favor of encouraging doctors to more closely watch their patients who are on antidepressants. My theory is that those who have recently started antidepressants expect to feel better immediately, in spite of the warnings that it can take three to four weeks for the medications to take effect. I remember the feeling of "Why isn't this working?" myself. So these people, particularly the younger ones who have less experience and ability to be patient, despair because they don't feel better and become a higher suicide risk. That's my theory, anyway.
I just heard the lady talk about her husbands suicide and the pain she felt. As a person who has been on zoloft for 14 years it needs to be understood that it saved my life. I only wish I had had these meds as a younger woman. It has helped me to stay level and not so many extreme highs or lows.Plus it has lifted the grey fog and the total negativity my world consisted of.Nothing is perfect but please donot scarepeople away from these mental health drugs. They do work.
What are we to do? Every drug appears to be beta tested on the unsupecting public. Shouldn't FDA allow for more extensive testing and screening before gambling on people's lives? WE as a society seem to rely on too many drugs for too many ailments. I have seen prescribed medicine absolutely heal and help a friend of mine. Then the three major prescriptions were pulled off the market, and my friend has severely compromised health of the internal organs. If it is hit or miss we should be fairly warned. If we are to be experimented upon do we have to pay with our lives and income? At what point do we have medical responsibility? AMA? Pharmacy's? Manufacturers? Mental Health is a very bad stigma in our society. If a person has suicidal thoughts or attempts to end their life, they get dropped from the psychologist's practice like a hot potato. No, alot of people do not get told of the side effects neither do they talk about them for fear of abandonment. Unless its too late. Please find an intelligent solution to a heinous situation.
It takes for antidepressant to fully work days to weeks after taking them. Pills alone do not resolve underlying issues that depressed people are overwhelmed with. Those people often neglect to seek phsychotherapy as a necessary tool in fighting clinical depression. Don't be quick to blame antidepressants, blame the methods of its treatment, the stigma and the resulting ignorance of general public about the issue.
It's nice to read comments from people affected by mental illness, both those that experience it and their relatives. I can only speak from my own experience. When I read news reports about "studies", I often wonder about the methodology. "Thoughts" cannot accurately be measured. Reported thoughts or behavior can. Personally, I have had suicidal thoughts during depression and when coming out of the depression. It is only when coming out of the fog of the depression that I could express anything; and I rarely ever told anyone I was contemplating suicide. Partly because of the stigma, partly because it would burden others, and partly because I did not want to be committed or go to the hospital. Regardless, I think it is unfortunate that the focus has been more on drugs [and warnings and lawsuits] than on comprehensive health care. Rarely does any illness have a simple cure that works for everyone and ALL drugs have sideffects. It is difficult to be a patient overwhelmed by differing opinions and specialists. It is more difficult with mental illness because it is not as easily quantified [although brain scans have come a long way], is still stigmatized, decisionmaking is often affected, and insurance does not often cover much if any treatment. It is better to see both a psychiatrist and a therapist (they are NOT the same!) and to have involved and supportive friends and family; and to have everyone be fully informed regarding the illness and the potential "long haul". It IS often trial and error, hard work, and setbacks. It would have helped me lot to have known this ten or fifteen years ago, but like many people, I only knew there was something desperately and horribly wrong. I didn't know how to fix it and I was ashamed that I couldn't.

To L Cruz (above): I am not a doctor but I had similar problems as your son. I had trouble with anti-depressants not working or working briefly but causing agitation, anger, anxiety etc. I am actually bipolar II, which typically manifests as depression but is treated very differently. It was a frustrating and devasting process to get where I am now [stable mood, clean & sober, ADD but in law school] but it was worth it. Hang in there & good luck!
As a psychiatrist in clinical practice, thousands of physicians like me make every effort to provide personalized care to people of all ages who suffer from depression. While medication isn't for everyone, it can be a life saver for millions. Having reliable and accurate information is critical, so I recommend DepressionisReal.org as one of the best one-stop resources for depression sufferers and their loved ones.
Just to let you know my brother's only child of 23, on effexor, comitted suicide last week by hanging.
If I had the chance to speak before a committee about antidepressants and the risks associated with them I would simply tell them of my experience with Lexapro. I was suffering from depression so I started to see a counsellor. After a month or so of counselling sessions she recommended I begin antidepressants. I made an appointment with my doctor and did, what I thought was, a thourough review of all risks associated with the drug they agreed I should begin taking. I was told that it could take several weeks before I noticed any improvement and that the drug sometimes reacted differently with some people. I was also told that the risks associated with Lexapro were very minor - I was never told that it could increase suicidal thoughts. The two months that followed were the scariest of my life. At first I didn't really notice much of a change, but then things changed drastically. It was as if I had blinked and turned into a new person - someone who recognized they needed help because of the constant suicidal thoughts I was suddenly having, but I didn't care. I can't begin to describe how I felt, it was like I was being controlled by someone else, I could recognize the changes and know they were bad, but I couldn't do anything to change it. After almost a month I was finally convinced to call my doctor. This was after a very near miss with suicide. I spoke with my doctor and was told to IMMEDIATELY stop the lexapro, and I was NOT allowed to be alone for the time it took for the drug to get out of my system. 3 days later when the drug had been flushed from my system it was again like I blinked and was changed into a new person. I still had the depression, but I was no longer suicidal. It is without a doubt the scariest time of my life. Since then I always try to let people know that antidepressants are very helpful to some, but, if you do start taking them, let those around you know that the risk of increased suicidal behavior does exist and let them know what signs to look for. It may save your life.
here we go again, of course another Dr. taking the side of the pharmaceuical companies. dr. gupta, i dare you to try some paxil if you think it is so safe. Then we'll all watch for your mood to swing and try to live through the suicidal feeling that it causes in the brain. Maybe it will change your cells into corkscrew shapes like the Jefferson college study.
your comment I quoted below is a condescension to all of us that have permanently suffered personally( i lost my peripheral vision on paxil and have permanent muscle problems and migraines (only after taking paxil) as a result) or have lost loved ones as a result of ssri's. And not every one that is prescribed them is depressed. I've seen people given them as a boost to go with their exercise program to fight fatigue, and then they get suicidal thoughts only after taking them, only to never be able to return to work again because the effects were so bad.
"It might just be the natural and sometimes tragic natural history of depression."---From dr. gupta's blog

So please save us your unprofessional opinions. Open your eyes to what is happening in the thousands, and hopefully the dr's will stop taking paid handouts from drug companies like all the other so called experts.
SSRI Antidepressants cause suicide in adults, too. Our 45 year old son had successfully battled depression for a number of years using an older, & less expensive, medication. Then his doctor switched him to CELEXA, an SSRI. Three weeks later, our son shot himself in the head. It takes a perverse kind of "courage" to kill one's self. One must have the WILL, as well as the means. In a small minority of patients, SSRIs can "energize" a person to have the WILL to take his own life. Although antipressants help the majority, for about 5 percent of depressed people, SSRIs can be a prescription for suicide.
Hello, I'm 19 years old and take Paxil CR for depression and obsessive- compulsive disorder.

First, I want to send my condolences to the people who have lost loved ones to suicide. I know that I can't relate but I'm sorry for your loss.

I can only speak on account of my experiences with an anti-depressant (Paxil CR).

The issue of whether anti-depressants are effective or not is not a black-or-white concrete issue but rather a complex one. It must be understood that taking an anti-depressant is a serious decision for a person to make. An anti-depressant can't be treated like a drug for a headache. Anti-depressants affect the chemicals in a person's brain, such as serotonin, in order to, in my case, establish a balance of chemicals in my brain that previously wasn't evident. In my experiences, Paxil CR reduces the level of anxiety that I feel when I have obsessive thoughts and compulsions to do a ritual, such as check a door-lock. The advantages to Paxil CR for me are significant because I used to experience significant panic attacks and intense anxiety on account of just trying to leave my house. And, with Paxil CR, my level of anxiety has decreased significantly in such situations as checking locks. In addition, Paxil CR enables me to be in control of my life and to feel in mental homeostasis in which my temperament is balanced and not extremely low or extremely high. Now, I'm in control of my emotions in which I can feel extremely low or extremely high on my own accord. Paxil CR doesn't control me, but rather just provides me with level and balanced mental homeostasis.

But, I have felt that on rare occasions, possibly the Paxil CR isn't as effective as it has been for me in which I can become significantly depressed for no apparent reason. This is why taking an anti-depressant, such as Paxil CR, is a serious decision to make because in my case possibly Paxil CR can increase my depression.

Although I'm not a doctor or therapist, but on account of my experiences, it is significantly essential that people who take anti-depressants see a doctor and/or therapist frequently to discuss the effects of an anti-depressant on themselves.

Lastly, I want to address the stigma that there is with mental illness. As evidenced by the accounts of people who have lost loved ones to suicide and mental illness, the secrecy associated with mental illness is unfortunate and a serious problem. No one should feel ashamed if they are experiencing depression or a mental illness. It takes courage for a person to recognize and seek to get help for the significant problem of mental illness. People with mental illness, especially adolescents and young adults, must understand that they are by no means alone with their problem. In my experiences with obsessive-compulsive disorder and being at college, I have seen a secret phenomenon evident with students who have obsessive-compulsive disorder. For example, I have seen while walking through a parking lot at a college people checking the locks on their car-doors excessively. But, obsessive-compulsive disorder doesn't only consist of just checking door-locks and washing hands, it consists of significant intruding thoughts of fear about possibly contamination, for instance. Obsessive-compulsive disorder is a serious matter that, along with all mental illnesses, need to be truthfully displayed in the media so that people can see that there is a real problem here in terms of mental illness. Maybe then adolescents and others can feel less fear about acknowledging that they have a mental illness in order to attain help for their problem.

Most importantly, we all need to understand that people with mental illness need support and understanding.
It is as you suggested. The anti-depressants improve the users motivation within days of starting, but it takes weeks for patients to be lifted from their depression. This window is easily recorded and has been used pretty acurately to warn parents against such occurances. I'm 22 and recently started taking anti-depressants, but I never felt that I was any closer to killing myself afterwards then before. I would say that it's more of a rarity for people to do that, but could be mistaken.
My 33 year old daughter committed suicide on Wellbutrin. There were no obvious outward signs, I think she just did it. Doctors need to quit prescribing drugs without a foolproof way to monitor the patients.
This has really been an amazing and thought provoking discussion. The hearings have just concluded for the day and there have been some changes to the labeling of anti-depressants. There has been so much interest on this topic that we decided to talk about it again tomorrow on American Morning.

While I appreciate the spirited comments and the thousands of people who read in, I only ask that we all be sensitive in our comments about a very important, overlooked and often stigmatized disease. Clearly, this blog, like the hearings themselves, invoke strong emotions in many of us.

Stay tuned.
Dr Gupta, we live in medicated society. Isnt there an internative to taking over the counter drugs, to deal with our societal behaviors on a cloudy day? I would suggest comedy clubs, going to the zoo, or even the circus. Am I crazy to think this? Why do the drug manufacter have to be the be all solution?
Maybe the most important factor in the prescription of antidepressants and there expected helpfulness in relation to the specifics of one persons case history. Take for example a 15 year old girl prescribed paxil after a few months of counselling. The paxil work sin this case and alleviates this girls depression, However when the warnings are released the girl is taken off of paxil and an appropriate substitute is not found, Sertraline (zoloft) does not treat her depression and effexor leaves her nauseous and unable to eat. In the mean time the girl begins to slip into depression more severe then the first time and because antidepressants are now unavaliable as an option she has very little treatment routes avaliable. Eventually time progresses as does her illness she continues to self harm and at age 18 is admitted to a psychiatric ward for 3 days. All because people were busy mass labelling all antidepressants as negative, Wonder how negative thye were to that girl?

I am that girl now a 19 year old freshman in university and still yet to find a treatment combination for my depression that worked as well as paxil and counseling. Why should I be forced o suffer for the misatkes of others ? Not all medications are suited for all people it is a fact of life. Chemotherapy can kill people as well does that mean that we should stop using it to treat cancer ?
I've been on anti-depressants off and on for 15 years because of my diagnosis of SAD. I find that while they do elevate my mood, I continue to have some negative thoughts although they don't cause me to feel I'm in the depths of despair.

The detatchment from my emotions is what could lead to suicide. When I'm not on anti-depressants I get suicidal but don't want to cause pain to those I'm close to. On medication, I think that they wouldn't really feel too bad about my death because I don't feel too deeply about anything.
Was there any discussion in the FDA hearings about WHO gets to prescribe the mind-altering drugs that have numbed our society? True, there are many people suffering from clinical depression that can greatly benefit from these drugs, but shouldn't they be diagnosed by a professional psycho-therapist before their brain chemistry is altered? How much time does your average HMO doctor spend with each patient before discovering that a chemical experiment is necessary for treatment?
The drug companies seem to spend alot of money marketing anti-depressants directtly to the public, much like Coca-Cola and McDonald's (equally popular with the masses). This obviously makes self-diagnosis a dangerous and available way to a)keep patients moving through quickly,saving $$ for insurance companies b)raise the stock prices of drug companies and c) create a nation of Stepford Wives/Husbands/Children and PRESCHOOLERS!
it is completely unfounded that antidepressants cause individuals to commit suicide. Depression is the numder one cause of suicide. i am on antidepressants and have found that while it may be difficult to find the right medication that works for you when you find the right medication depression is beatable. The reason that people taking antidepressants commit suicide is because they are depressed, not because they have taken the medication. Some people take the medication,dont see immediate effects or any effect at all, think tht their case is hopeless and decide death is the only way to find peace. Hopelessness and depression cause suicide, not antidepressants.
The FDA should know that depression and all the other forms of mental illness are poorly diagnosed and treated in the USA. Aside from the societal stigma on mental illness the health care industry does not treat patients properly. That is the root of the problem. No one should be prescribed medication and not closely followed. I have chronic depression and anxiety. The first Psychiatrist who treated me gave me drugs and sent me on my way. Was I suicidal, you bet and with the meds I also had a means. If it weren't for my wife I would have succeeded. Trying to get this "doctor" to understand the problem was another story. I took me 7 years and 5 "doctors" before I found the right solution. For the last 7 years I have been back to work and functioning fine. The medications are not the sole problem and a warning label will not fix the problem. This country needs to make a stand and say that there is no difference between a physical illness and a mental illness. We need to get the HMO's and health insurance providers to have the same coverage for both. Doctors need to treat both the same. And for the love of mankind, don't give drugs to patients who are already at risk of committing suicide without beign sure they have a support network and someone who can watch over them and see the changes before it's to late.
Antidepressants are a godsend! I have had boughts of depression and rage attacks (holes in walls, broken car windshield, smashed keyboards, scared family members) for years. As long as I stay on small doses of Zoloft I never have rage attacks and other related moodswings are bearable. I started my first round of therapy (with older antidepressants) when it got to the point I would wake up early feeling intense anxiety, worthlessness and sick to the stomach and go to the toilet and vomit the contents of my empty stomach.

After several cycles of starting and ending treatment and restarting when I detected a relapse, I made the association between the antidepressants and the cessation of the intense rage attacks; thus I am staying on Zoloft as long as they keep it legal.

The one bad thing about antidepressants--often you feel worse during the first 2-3 weeks. This is because the side effects (sleep disturbances + others) kick in immediately, while the benefits take weeks. Of the ones I have tried, Paxil was the worst (and likely chosen due to drug company marketting!). During one downswing, a doctor put me on Paxil and the next night a could not sleep. During the day I was falling asleep standing and miserable. I later read that Paxil is more likely to cause that problem due to it short lifetime in the blood.
Is it so difficult to see that the anti-depressent is not causing the suicidal thoughts? suicidal thoughts are a hallmark of severe depression, a symptom of the disease that the anti-depressents are treating? It sounds completely ludicrous to assume that since people on anti-depressents commit suicide, that the anti-depressents caused the suicide? Logically, wouldn't it be THE DEPRESSION???
I started taking fluoxetine when I was 21. I was going through a very stressful time in my life after just getting married moving away from my family and friends and have bristh control mess with my natural chemistry. While I was on it, I felt normal again. I no longer had crazy thoughts like "what if I hit that retainer wall on the interstate?" or "what if I fell down these stairs" I would go on it again if I had the need.
I began taking Zoloft for anxiety/mild depression several years ago in combination with several therapy sessions. It has helped and most times my symptons are under control and I feel good. I didn't begin the treatment though until I felt like I hit rock bottom. When you begin the drugs they don't work immediately. It is a process of a couple weeks where you begin to feel better. I could imagine that someone could begin taking them b/c they are very low and when they see no immediate change they attempt suicide. I wonder if that has been looked at? There's a lot that is not understood about these drugs so it will be interesting to see what is discovered.
I feel deeply sympathetic for those who have lost a family member to depression, whether or not that is a result of them taking anti-depressants or not. Our American culture continually looks for an easy way out of problems through medication, for depression, obesity, etc. This is mostly fueled by drug companies who profit...if only we could be more aware of that! I am not completely opposed to antidepressants. My mother used them for several months to help her through a very difficult period in her life. But what happened to the tried and true prescription: EXERCISE? Exercise has no side effects, it enhances health, self-esteem, mood, depression, sleep, and a host of other things. If physicians could talk with their patients about alternatives to medicine and if people would take the time to schedule exercise into their days, this country would spend a lot less on healthcare and lose a lot less people to heart disease, cancer, depression, suicide, etc etc etc
As a psychiatrist of 25 years at a university student health service, I think a black box warning is going to do more harm than good.
A risk that no one really talks about when they prescribe or being taking these drugs is the chance of addiction. My mother was very depressed after both her parents died within a year of each other. Her addiction to presecription medication started with Zoloft. From there it has spiraled through every kind of medication on the market.

I hate to pull a Tom Cruise here, but these kinds of drugs are dangerous. From my stand point, as the relative of someone addicted to these things, the reality of what these drugs do make the possiblity of helping with depression not worth the risk. Now, I wish my mother had gone to see a therapist. Instead, her doctor just gave her a bottle of pills. That's never the best answer.
Correlation does not prove causation. We do not know the mechanism behind these suicides. It seems plausible and perhaps even probable that SSRIs are simply doing what they're supposed to do. Suicide takes energy. Highly depressed individuals have very little energy. SSRIs, in the process of alleviating depression, also increase energy, thus increasing risk of suicide. Now this is not to imply that people should not be aware of this. My only point is that the drugs themselves are most likely not directly causing suicide as has been implied in various forums.
Following a PE at age 45 my doctor prescribed PAXIL for me. I'd admit I was depressed at the time because I felt the PE was a result of an over doseage of hormones for perimenopause symptoms. But what this email is actually about is once on PAXIL I realized just about every woman I knew who was around my age or just a little older had been prescribed PAXIL or Zoloft. I quit taking the drug after about 6 months because I started wondering who was benefiting from me renewing a prescription every month - ME or the Drug companies or possibly doctors that benefited financially by prescribing anti-depressant drugs to woman at such an alarming rate.
Dear Dr. Gupta:

Many years ago in nursing school (circa 1981), we were taught that persons who were depressed were MOST at risk for suicide once their depressive symptoms started to subside and they developed the "energy" and "motivation" to develop a plan for suicide. We were taught the period immediately following low point of depression - on the "upswing" if you will, was when the patient was most at risk. I kept this in mind for my entire career, and wonder if other health professionals have missed this teaching point. It would seem to apply to the treatment and management of depression regardless of what drugs are used to combat the condition.
At over a hundred dollars a month the effexor that my wife takes seems to work occasionly. She still has strees filled times that are brought on by decisions she makes. This is an addicting drug. she tried to ween herself off to fast (three weeks)and was starting to feel closed in and had to go back up in dose to be somewhat sane again. I figure it will take 6-10 months to get effexor. And forgot to mention the weight gain. Side effects are numerous for any presciption drug. Its a crapshoot to find what will show up at any given time. Can't wait to see to drug that the FDA shows up with for road rage!
I was diagnosed with depression and anxiety/panic disorder years ago, and given medication for both. Because of what I've heard about the anti-depressants, I chose to take only the Xanax for anxiety/panic, and only at the onset of an attack.

This, together with a healthy diet and exercise, keeps the depression under control. I get bouts, but I recognize them. Suicidal thoughts sometimes come along with the bouts, but I don't want to risk escalating them by taking anti-depressants, so I recognize what's happening, increase my exercise, vitamins, fruits/vegetables, water, etc. and self-treat that way.

This all started when I was 12 years old, and I'm 46 now and still alive, so far so good.
Our son is on Xanex and we believe he takes them sporadically, at age 41, he has social phobia and is very hard to go out in public(even grocery store!)Says he doesn't take his medication every day, mainly when he goes "out". Prescription reads 3mg per day but also drinks vodka and smokes constantly, you can't imagine what kind of problems all of this brings on. When he goes out, we (my husband and I)believe and son has admitted to taking extra Xanex so he can face public, therefore giving the appearance of drunkeness(or zombie look)just to go out the door, then at times depression is there when we talk over phone to each other and he gets extremely emotional and cries easily. Says he can't understand why he was born this way and will speak of suicide. Out of 4 children, he was the brightest sibling in school, one point short of graduating with honors-college,I think this has worsened with the years. Has extremely abused alcohol, and I am sure the Xanex, he would like to just be normal. We are at our wits end and have sought many avenues of help!!!Thanks for this site.
My first emotional breakdown took place in my first year of college, which is probably fairly common for people who are going to have breakdowns. That was in 1959, and I was given tranquilizers, which helped. I was better, but continued to have bouts of depression, undiagnosed. I saw a psychiatrist sometime around 1977, wondering whether I might have inherited bi-polar disorder from my grandfather. I was told that I hadn't, and that I was strong enough to cope with depression without help. So I continued untreated, but feeling progressively worse. For twenty years I had a daily death wish, and I prayed for the courage to commit suicide. I described my symptoms to a general practitioner, who simply said he had never heard of the ones I was having at the time, and didn't recommend any other doctor, so I continued to be almost constantly depressed and anxious. Finally in 1998 I had such a severe breakdown that I decided to try again to get help. This time I saw an excellent psychiatrist and was given Paxil in gradually increasing doses, with the warning that I needed to call him immediately if I began to feel euphoric. About two years later he added Buspar to enhance the affect of the Paxil. I have never felt normal and able to think straight in my life until I got these meds, and I pray that they will never be taken off the market or made unavailable to me. I have a daughter who has ADD, and I have thought since she was less than a year old that medications work the opposite way on her -- for instance, paregoric, which was supposed to be calming, made her hyperactive, and stimulants make her sleepy. This may have something to do with the reaction of people who have increased suicidal thoughts from antidepressants. She doesn't have suicidal thoughts from them, but she says they don't make her feel better at all, and she is better off with Zanax or Ritilin.
My husband was put on zoloft for 30 days and then effexor for 30 days by our family physician for anxiety. During the time he was using both medications, he was not suicidal, but murderous. He litterally had our eldest son pinned to the wall with his hand around his throat. He was saying things like "I could kill you right now, and not even care". I called our physician, and took my husband in to see him immediately. The doctor said my husband obviously didn't need the medication, and took him off from it cold turkey on Christmas eve. This is when the real fun began. My husband went into a major psychotic state. He would hold his head and screach and scream, he begged me to kill him and put him out of his misery at the few times he was cognitive. Eventually he became totally unaware of his surroundings. He thought he was back in the Gulf War for a while, and then he picked me up (he is over 6')and dropped me onto the floor. This is when I called 911. They did not send an ambulance, but cops. Even though I tried to explain the situation, they treated him like a junkie and arrested him stuffing him into the back of a cop car, and took him to the psych center. There, they medicated him to knock him out. We spent 4 days going through this. Every time he would wake up, it would be a little better, but within minutes at first then gettting longer in between, he had to be medicated (knocked out) again. What a merry Christmas we had that year. My kids had to witness this! And even now, years later, my husband still has problems related to this. Days where he has difficulty with thought and the ability to function proper
I was hospitalised with depression 14 years ago..I had double depression, long term with major on top of it..
I was at a point that I was barely funcioning, almost devoid of any emotion other than anxiety and anger..
Suicide was a thought because I could see no end or way out of the misery..
I came home with medication and it took another few weeks before I felt better..

Depression is a miserable thing to come out of, and the process includes alot of ugly emotions..
People need someone close to them watching them assureing them that they will feel better...
I do not agree that the medication causes the thoughts, but I do believe that we put too much hope in the medication solving the problem 'fast'..The truth is as we start to feel better we fluctuate for awhile..feel good then suddenly not good..
That is when we need help to hold on and wait for the medication to do the job...
The medication is a tool..I think people expect it to totally solve the depression and do it completely all in a few weeks..
And the truth is that for many it is not that quick..
But antidepressants are life saving in most cases...
They offer hope, especially when we feel good for awhile, we can see that "yes we can get better", But it's hard to go through the up and downs of it at first..
Families need to understand that they can not relax and figure all is well just because someone is starting medication..There is sometimes a longer healing period..
This is going to sound terribly callous. Congress ought to reconsider the public testimony part of these kind of hearings. I understand the passion of the survivors of those who have committed suicide while taking these medications. But, there is an inherent bias in this method of hearing people.

Understandably, people are looking for someone or something to blame when a suicide occurs. I'm not passing judgment about whether survivors have or have not justly focused on antidepressants. I am saying that it is not a surprise that many people whose family members have killed themselves want to go to Washington to tell their stories. On the other hand, if a family is living in Milwaukee or some place, and a depressed member of their family is taking Zoloft and doing very well on it--there's simply no way THOSE people are going to fly to Washington to say that. So, grieved people are going Washington to tell very emotional stories which are going to sway officials.

The science is complicated and deserves objective scrutinty. That's where we need to continue to explore this issue.
In May 2004 I was diagnosed with diabetes � Type II. Soon after I started to experience depression. I went to a psychologist. After a couple of weeks, she referred my to a psychiatrist at Kaiser Permanente in West Covina, CA who prescribed Fluoxetine (Prozac). It took a couple of weeks to get to full dosage. Almost immediately I began having horrible nightmares. Very graphic, like nothing before. Real horror movie-type stuff. Couldn�t sleep more than a couple hours/night total. And I had terrible thoughts of suicide. Not casual, �I really don�t see much future� type thoughts, but more like �If I could put a gun in my mouth ,what are the chances it would kill me vs leaving me a vegetable.� I could not get through a day without considering some way of killing myself. I was preoccupied with my own death, and kept calculating and even researching the odds of any various method resulting in sure death. Every time I got behind the wheel of my car I would wonder, "What if I drove under that truck, or ran that light, or ran into that bridge post? What is the likelihood of actually dying?" I even went to a gun shop to look at guns for the same reason. The only thing that stopped me, I'm sure, is that I couldn't be sure it would work. After several weeks, I made the connection to the drug, and reduced, then eliminated it. I still fought the urge and the urgency to die for several weeks afterward. Please understand, after many years of on and off depression, I am very familiar with the pattern of my own depression. I know approximately how it starts (quit controlling my own life, and begin reacting to it), I know the symptoms , and I know how I generally get it to pass (begin exercising, planning my days, etc), and I am generally able to remind myself that it�s temporary. This was not a normal case depression. That was the scariest period of my life. I believe I'm only alive because the analytical part of me kept open the possibility of failure. I told several people of the dreams at the time, and of the depression to my wife. And after I'd gotten through that period I told several others, and my wife and parents, about the suicidal focus, and my belief about the drugs. Then I started hearing about the connection between these drugs and teens. I'm not a teen, but this drug almost killed me. My doctor never called me to see how I was doing when the depression stopped me from going to my appointments. And I couldn't tell anyone about the depth of the depression for fear of being committed. That�s the worst part, the time I most needed the help was the time I was least able to ask for it.
all drugs, be it antidepressents to water pills, hold some type of side effect. unfortunately there are doctors that prescribe medications without explaining the possible side effects to the patient, or the patient negates to do the research on their own as to the posssible side effects of a medication that they are putting on the bottle. there needs to be better communication between the physician and the patient in all aspects of treatment, especially with depression since the sad fact remains that people that are depressed often DO attempt suicide, or suceed in their suicide attempt. this is an example of failure in the chain starting with the drug companies and ending with the patient. the needs of the many patients that need and benefit from antidepressent therapy far outweigh the one who attempted suicide, and unfortunately suceeded.
People don't seem to understand that depression is a chemical imbalance. While normal people can feel depressed about tragic things such as death, loss, or perhaps a failing grade, people with depression are always depressed. Simple things such as getting out of bed become so difficult.

As a 19 year old being treated for depression, I know how debilitating depression can be. Anti-depressants are not mind-altering drugs. They're not 'uppers'. They just make people with chemical imbalances EQUAL to normal people.

Anti-depressants do, however, regulate the amount of serotonin in the brain. They also act differently for different people. There should be warnings to adults because while one drug might make someone perfectly fine, it might make another person have suicidal thoughts. People should be aware that every brain is different and that everyone could have a different reaction to these drugs.
I'm 22 and I've been on Paxil for two years. It has ultimately done more harm than good, and I am 100% in support of the decision to add black box warnings for adults. When I was originally given Paxil, my doctor handed me a monthsworth of samples in a crisp foil package from GSK. Absolutely no warnings or anything similar were printed on the package. The only text was "Paxil CR, 12.5 mg" and directions for how to push the pills out of the foil packaging.

Had I known the risk involved with taking an antidepressant, I would have never done so. I just completed Cognitive Behavioral Therapy to combat my panic attacks and anxiety, and it's worked like a charm. Had I been aware of such treatment two years ago, I would have tried that first and only used the drug as a last resort. But, unfortunately, we tend to trust our doctors because of how successful they've been in the past in treating our common ailments like strep throat and bronchitis. Why NOT trust them? They've done good before.

Antidepressant medication turned me into a letharic & unmotivated human being. I slept 12+ hours per day in my initial month of taking the drug, and thereafter suffered from every side effect in the book. Worse yet, when I (and my doctor) decided it was time that I come off the drug, I couldn't. The withdrawal side effects are debilitating, and I'm now on my third attempt to quit. It has taken me six months -- yes, that's SIX months -- to reduce my dosage from 10 mg per day to 1.8 mg per day. I have another few months to go, and the inadequacy of my medical insurance forces me to cut expensive pills with a razor blade, and I've even resorted to using a nail file to make "accurate" dosage cuts. My withdrawal side effects currently include dizziness, nausea, headaches, fatigue, depression & tiredness, panic, anxiety, "the zaps" (electric-shock sensations that originate in the neck), disequilibrium, and vertigo.

We need to become competent consumers of prescription medications by fully investigating the benefit/risk ratio before starting an SSRI. It is unlikely that the pharmaceutical industry will stop spinning their research to make their drugs look safe, so we must learn to question the validity and reliability of research findings.

And to Kathy, from Rochester, PA:

The "chemical imbalance" theory has not been proven. There exists no hard and fast test to determine one's serotonin level; thus, this idea is speculatory. If anything, SSRI's create a chemical imbalance. To quote Laurie Yorke:

"Think about it. The body strives for homeostasis constantly. If you alter that balance by artificially raising the serotonin level, what is the body going to do? Initially, it will raise adrenaline in response to the elevated serotonin -- this makes you feel better. Now, what happens to dopamine (another neurotransmitter in the brain)? That will go down in response to the now elevated serotonin. You now officially have a chemical imbalance."
Prozac, in conjunction with talk therapy, exercise, and a healthier diet saved my life.
In 2005, my beloved nephew took his own life at age 21. He was at an Ivy League university, from a loving family, had lots of friends - the list of positive things in his life goes on. Sometimes, there is no "tangible" reason why depression sets in. Some people who seem to (and by most people's standards, do) have everything going for them find themselves unable to see it. I suspect he probably had an imbalance in serotonin levels. My nephew was not on anti-depressants; it is too late for us to know if they would have helped him.

I do think, however, that it is probably the case that different treatments work for different people. I don't advocate merely prescribing drugs and expecting that that is the answer to your prayers. What I would like to see is perhaps more research on why there seems to be elevated suicidality in patients that are on anti-depressants. I read awhile ago that there was thought that some people have greater difficulty metabolizing the drugs. Wouldn't it be great if there were some pre-screening tests available that could help identify which patients are at greater risk? I'd like to hear more about that.

The black box warnings seem to be a good idea. Patients who are taking these drugs have a right to know what the risks are. And the doctors who prescribe them have an obligation to disclose those risks. What complicates matters is that we live in a litigious society, and I suspect that there are physicians that will limit the population of patients to which they prescribe anti-depressants. That doesn't have to necessarily be a bad result; in an ideal world patients for which antidepressants are helpful and make the difference between life and death would still get their prescription.

Problem is, we don't live in an ideal world and I bet there will be some patients that would respond well to anti-depressants that will not get them. Best case scenario is that we are able to find a balance. Problem is when end up the loved one who has lost someone to suicide, there is no balance and there is no second chance. I do think that the more we learn, the more we do, the better it has to get.

Also, I would like thank Dr. Gupta for his coverage of this story. I agree that depression and suicide are still stigmatized today, and pieces like this one that educate the public serve to help de-stigmatize the issue. Depression is an illness, like cancer and HIV, that has reached epidemic levels. It deserves our attention, and our country's attention.
What happened to personal accountability? I take two antidepressants (Lexapro and Welbutrin), and have also tried Prozac. An SSRI (selective seratonin reuptake inhibitor) does just that... it increases the amount of seratonin in the brain. On the occasions that I have not taken my pills (for example, a prescription ran out and I couldn't get it filled for a few days), I can see a difference. SSRIs work for people with low levels of seratonin. People who take them for other reasons are not going to be helped. They aren't caffeine pills, or "happy" pills. They raise the levels of seratonin in the brain of someone with low levels to a normal level. This will result in increased energy and mood in a person with an abnormality, but for a person who is otherwise healthy, it isn't going to help. If you don't have high blood pressure and start taking a medication for high blood pressure, it is probably going to affect you negatively. The problem is because depression isn't diagnosed with x-rays or blood tests, people don't treat it as a REAL medical condition. This is also where the stigma associated with mental illness comes from. It isn't all in our heads, it is a real medical problem. It took me a long time to get over the stigma associated with these disorders and actually seek help. It's disappointing to think how much better those years could have been if I had felt comfortable admiting that I had a mental illness and needed help.

Some of you spoke of the normal highs and lows of life. this is NOT depression. People who are depressed often can not find a particular reason for feeling "down." It can be just as PHYSICAL as any other medical condition. Between my first experiences with prozac (which didn't seem to have an effect, so I stoped taking it), and when I started back on antidepressants two years later, I was back into a major bout of depression. I physically could not find the energy to do anything. I couldn't pull myself out of bed some days. It wasn't all mental, it manifests itself in physical ways as well.

When you are given a drug at the pharmacy, they ask if you have any questions about the drugs. they also include information abotu the drugs. If you aren't willing to read it, then it's YOUR fault that you were unaware of the side effects of a particular drug. It isn't the doctors, it isn't the pharmacists or the "evil" drug company, it is on you. If you are willingly putting a substance into your body, shouldn't you WANT to know everything you can about how it's going to effect you? I know that suicide warnings have been included in medication literature for AT LEAST 7 years (since I first started taking Prozac).

Many people have mentioned that their loved one never mentioned suicide before being put on antidepressants. I can't speak for everyone, but I know that I rarely spoke of suicidal thoughts that I was having because people didn't understand that it wasn't ME, it was a DISEASE. I didn't want to be thought of as trying to get attention, or to be put in a hospital. Also, if you are REALLY thinking of commiting suicide, would you go around telling a bunch of people? They say that people who speak of suicide are really asking for help. Perhaps some of these people who attempted or commited suicide WERE thinking about it before but, as some of you have suggested, didn't have the energy to try before. OR they were really considering it before, but once they realized that someone believed them and wanted to help them and that maybe there was a cure, they felt comfortable talking about it. I know for me, I thought about suicide and attempted it before I started antidepressants, but once I started feeling better, I still thought about it but knew that I wouldn't act on it.

The key is to find a doctor/psychiatrist who will listen to you and diagnose you properly. Starting with a low dose of antidepressants, if they deem necessary, and building up if you see an improvement but don't feel 100%. This COMBINED with therapy. People who are feeling down should start with therapy, and if that isn't working, seek the help of a psychiatrist. sometimes, for the normal ups and downs of life, talking and working through your problems is enough. Medicine is NOT one-size-fits-all, and no one, doctors or patients alike, should treat it as such.
I testified at the FDA Hearing. Having lost my son to Lilly's Zyprexa,and almost lost my daughter to the SSRI Lexapro (neither drug had a warning) I honestly believe that the FDA is in total cahoots with the pharmaceutical industry. I hope this comment will be considered appropriate.
Wake up, America! These drugs are bad news and have killed thousands of people. They don't cure anything and they cause damage to the brain, liver, heart, and immune system. They are way overprescribed, for reasons like menopause, PMS, IBS, headaches, insomnia.

No one knows how SSRI's work but they are altering chemicals in the brain and there is nothing "selective" about them. The argument that it is the depression that causes the suicide is invalid, because many of the people that committed suicide did not go on SSRI's because of depression. If a non-depressed, non-suicidal person begins taking an SSRI for headaches, for example, and commits suicide, it is clearly the drug. The idea that these black warnings can do more harm than good is ludicrous. It is estimated that 10 million people in the US alone are on these drugs. It is estimated that 4 out of every 1000 people taking these drugs will have suicidal thoughts. That's 40,000 suicides. How would a warning do more harm that good if it could save 40,000 lives?
As a nurse and mother of a child who almost died from an adverse reaction to paxil(never suicidal prior to paxil, massively death obsessed/suicidal on paxil, never suicidal since successfully going through withdrawal) here's my two cents on this issue. No one is trying to take away a drug that is working for someone. Those who testified in Washington have NOT called for a ban. What we have called for is complete disclosure of negative adverse reactions, that if known by the patient could prevent a tragedy. This is the only category of drugs where an adverse reaction is treated with a secondary drug without removing the offending drug. Can you imagine breaking out in a rash from an antibiotic, and being told, well just keep taking it, but take this drug to cover that reaction. I wouldn't happen, but it happens daily with ssri's.
Not warning for potential risk goes against everything medicine is about. A potential life saving cardiac surgey carries the risk of dying and patient is told this risk. Even if the surgeon feels it is absolutely necessary for health, it's the patients right to make that decision. The same applies with these drugs.
Now, the "energized" theory. An old concept that is constantly brought up. If this is such a risk, then no patient should be given a prescription and a follow up appointment for 3 months later. But this is what we see. You can't claim a "known" potential risk as an excuse, yet not change follow up methods to minimize that risk.
The study that was presented at the hearing was for depression. The suicide signal was there, even with the faulty data collection. The risk was evaluated on a word search for specific words. Not included in this search were the words, akasthesia,mania,aggression... known precursors to suicidal behavior. So, once again... a study can show anything that they evaluator of that study chooses to look for.
"depressed people kill themselves"....then how do we explain those who killed themselves who were NOT depressed? These drugs are prescribed for a multitude of problems. Anxiety,IBS,headaches,school phobia,insomnia. Yet we see the suicide reaction across of the board of diagnosis.
Bottom line... it is every patients right to know ALL the potential risks of any drug that they put in their body. If they choose to accept those risks, being fully informed, that is their choice. At least they will know what behaviors to look for so an adverse reaction can be recognized. Ignorance is not bliss... it can be deadly.
Dr. Gupta, it is unclear why a suicidal reaction would occur with antidepressants, because it is unclear how they work. I would invite you to www.paxilprogress.org to see thousands of stories about withdrawal from antidepressants. We even have a "researchers" thread to make it easier for you to see exactly what paxil/ssri users are experiencing.
To those on antidepressants who have good results. We do not want to take away your medication of choice. We do want accurate reporting of adverse effects, so that an informed decision can be made about their use.
What truly amazes me bout this entire thing is how skillfully the pharmaceutical industry spin Dr's have shifted the focus.

First of all, not everyone that committed suicide because of these drugs was depressed. 2 cases that demonstrate his are Tracy Johnson a healthy volunteer that hung herself in the Lilly Lab during a clinical trial for Cymbalta. Secondly Diane Rothier who was given Welbutrin for abdominal pain shot herself in the basement of her home. These are but two of many.

Perhaps the most telling thing is that clinical trial participants are not your average person off the street. They are screened in an effort to present the most favorable outcome possible. That being said, in the trial data SSRI's like Prozac, Paxil and Zoloft and SNRI's like Effexor and Cymbalta help about 50% of the people who take them. On the other hand in those same clinical trials an inert placebo made of flour or sugar achieves the exact same result in 4 of 10 people treated. In reality the same action responsible for improvement in the placebo group is happening in the medication group as well. Hence in reality the medication may actually help 1 out of 10 at best.

I believe it fair to say that while the promised benefit is questionable at best the only thing you can really count on is the side effects. A few examples are as follows.

In a retrospective study done in Japan just fewer than 10% of the patients treated with Paxil became manic. A study in Germany revealed that uncharacteristic sexual promiscuity and actively seeking pornography was a risk with SSRI's. The side effects are very real!!!

Lastly why do we suppose every school shooting for years has one of these drugs involved? In a normal statistical distribution they would be proportionally split among medicated and non medicated but there are no non medicated incidents. Do we as a society actually believe we have somehow managed to simply medicate everyone that is at risk for this kind of behavior? I think not!

Contained in the Effexor prescribing information way back around page 38 of about 45 pages homicidal ideation (thoughts and actions) is listed as a potential side effect.

To close this lengthy post, I attended the hearings and there were people there defending the drugs along side those seeking adequate warning. I don't know anyone that believes these drugs should simply be banned and the sooner the better. What we want is to know the potential problems so people know what to watch for if they decide the potential risk is worth the potential benefit.
Dear Sanjay

I decided to write after much hesitation. As one of the commentators from connecticut has pointed out, we in this society have trivialised depression in to a physical condition that can be treated by take "2 Prozac and call me in the morning", if you are still alive that is. It is not so simple. I sympathize with the medical community that they have to deal with this condition and help the patient. Hopefully as medicine progresses to a point where we can diagnose those who have this condition with certainty and treat with chemicals from one's own body chemistry. Un til then we need to examine the life situations that create the milieu that fosters depressive symptoms in the populations and change them. We are a group of volunteers who are advocating simpler living and in harmony with nature to combat various illness that plague our society.
Hello Dr. Gupta,

As a medical student fighting with depression I cannot understand for the life of me why so many physicians (including psychiatrists) are baffeld by the FDA's inclusion of a Black Box warning on SSRI's. The proof is in the pudding. One of the many mantras preached at medical school is - always listen to your patient - they know best what is happening with them. In this situation thousands of patients are relating averse events to their physicians who look at them with blank stares and tell them - it's not the medications fault.

Let me share my story with you. I have had 2 major depressive episodes in my life. Both times I was initiated on Paxil - both times I became suicidal. Just to give you some background, before taking these medications thinking of taking my life was not something i would have considered doing in a million years. The first time around i was minutes from completing the act and was saved by divine intervention. i continued on Paxil and eventually recovered from my depression and was even weaned off. 3 years later my depression re-appeared. The physicians looked in my dossier and saw that Paxil worked the first time so they prescribed it again. Deja vu. My anxiety became much worse and within a month I was having suicidal thoughts. I checked myself into a hospital and was thankfully switched to another medication on which I immediately felt better. I can personally say that I know at least one other physician who has experienced the same thing.

My take on the entire situation is this. No two people react to medications in the same way. So a product that works for me, will not necessarily work for you. Furthermore it is well within reason that a medication can make your condition deteriorate before it improves. That is what is happening with these SSRI/SNRI's.

The solution is - as many have already correctly stated - a combination of excercise, therapy, support and above all - extremely close monitoring in the first few motnhs that a new therapy is being attempted.

The writing is on the wall - so stop doubting it. And by the way - in my disucssions with people - there definitely does not seem to be an upper ceiling to the age at which people experience suicidal thoughts on SSRi's - so the only confusing thing for me is why they just don't apply the warning to all ages instead of expanding the warneing every few yuears like they are currently doing (first it was adolescents, then late teens, now young adults - see the pattern?)
For those who have lost family members due to psychiatric abuse of antidepressants or antipsychotics, the Citizen's Commission on Human Rights, a mental health watchdog group, has a website and a hotline to report abuse and take action.

Go to www.cchr.org, or call 1-800-869-2247.
NON-CLINICAL RESPONSE
the reason why antidepressants do not work is that they prevent people from leading psychologically fullfilling lives.we need psychological feeds-in other words we need to feed our minds through our responses to life. We need a sense of: achievement, nurturance, and to avoid shame responses (interior and exterior), at all costs. the medicine acts to inhibit the nervous system. so we shut down, we do not want to achieve, or do, so we turn nurturance away, and then feel shame. I have experience with Zoloft. That is what i experienced. As my dose increased my psychological feeds decreased. There has got to be a better way!
I'm in my late 30's and have been taking anti-depressants for almost a year now. They were recommended by a therapist after a year of talk-therapy that took me to a plateau in understanding my situation. It became obvious I needed assistance in thinking more clearly and elevating my mood a bit in order to explore more deeply the root of the depression, as the meds act as "emotional shock absorbers," allowing a cushioned revisiting of old wounds and self-realization. The plan is to stay on the meds long enough to learn healthy new thinking and coping skills before beginning a gradual departure from them.

I had suicidal thoughts before the meds and I still have them because that's part of this disorder but now I know to tell myself as much - that my life isn't hopeless; it looks & feels that way because unfortunately my emotional outlook parallels the skewed reflection of a carnival mirror. I learned this perspective from my therapist.

Though I still feel suicidal sometimes, I prefer staying on the meds to help me reach the ultimate goal of recovery or at least a very manageable level of existence.

I say all this because my response to this horrible state of being has been crucial. I've learned it's vital to partner medication with consistent therapy so that suicidal thoughts can be expressed and dealt with by SOMEONE WHO TRULY UNDERSTANDS what I'm going through and how to move forward. I realize that sometimes, those "playing by the rules (meds with therapy)" have still taken their own lives...it's a rocky, messy, exhausting, isolating, debilitating, blinding and confusing disorder and it's often very difficult not to give in to the undertow of hopelessness that always seems to be tugging at me. My heart goes out to those victims and their families.

If depressed people can educate themselves about what's real in their thinking and what isn't, it's a great start to navigating themselves through the dark thoughts while on medication or not.

Though it is extremely difficult, staying alive depends on my response to my suicidal thoughts: PRAY, GET OPEN, write it out, find the right therapist and be willing to try a few types of medication and decide if it's helpful or not.

I've also learned to cancel plans without feeling guilty if the day comes and I'm too drained or down to participate. People understand...and if they don't, they don't. I can only do what I can do until I can feel better.

My workload became less at my job when I was honest with my bosses; not in great detail, just enough to explain that my decline in job performance is due a medical issue and I'm getting help with it. That way, their expectation of me is adjusted and I'm not working under unrealistic expectations, always worried I'll lose my job or someone will find out I'm not well.

I've told a few friends about my depression and have designated people to call in the super-low moments.

Being real has helped me slow down to a manageable pace, lessening the pressure to keep up with others' "normal" daily life and has made me live more authentically.

Be yourself. You're having a hard time and it's ok - it's life. Cut back where you need to cut back and don't pressure yourself to act like everything's fine. That alone makes dealing with depression a bit easier.

Lastly, get lots of rest, take walks, eat good things.

This input may be more addressed to us depressed folks than to the FDA so thanks for indulging me!

I wish everyone a realistic, self-accepting Holiday Season.
The psychological community had better "wake up and smell the coffee." My daughter's child psychiatrist put her on Zoloft, along with Clonopin, because of Explosive Behavior Disorder. It didn't reduce the extreme tantrums, but it DID reduce her energy, her desire to care for herself and, worst of all, she attempted suicide--twice: one at age 8 and the second time (while in a treatment facility) at the age of 9. Her child psychiatrist gave us the APA line of "the risk is very small," but I wanted her off. The psychiatrist said no--and wouldn't admit her to the psych ward when it was necessary; when she posed a danger to herself and others.

Today, I am pleased to report that once the Zoloft was eliminated, within 24 hours, she was FINE. She is now on Neurontin and Abilify for her conditions and she is one of the most cooperative kids in school. And, her GPA in middle school is A-. Not long ago, I was concerned that she'd never live to SEE middle school.

The FDA needs to put a general black box warning to all the SSRs for all people, regardless of age. It is clear that any anti-depressants are not for everyone. It is because the brain chemistry is different; I am on anti-depressants, but the brain chemical I am deficient on is dopamine versus serotonin (where SSRs come in). That's why so many people have to keep changing medications to get a "best fit." However, it should not be that way with adolescents and teens. We all want them to live to be productive in society. We just want to know what we are giving them is safe and adequate warnings are on the medications.

As for child psychiatrists: get with the program! The risk is NOT small about suicide or suicidal thoughts. My daughter would have been a statistic if it weren't for excellent medical help--and strong parental intervention.
About eight years ago I was going through a major depression and prescribed Zoloft and Xanax. I took it for about a year with minimal (if any) improvements. Then I got pregnant and my OB/GYN told me to immediately quit taking both medicines. He never once mentioned weaning myself off and I didn't know enough about them to understand that I should slowly stop taking them. So I quit immediately. One month later I attempted suicide. Luckily, I survived with the help of my best friend calling paramedics. And the baby was fine as well. I really feel the drugs along with stopping them cold turkey aided in my suicidal thoughts. I was 33 years old at the time. Please be aware that you can't just stop taking these drugs without ramping down off of them. I wish I had known! Be careful taking these drugs...I will never touch them again!
I'm one of the lucky ones: when I lapsed into severe, psychotic depression in 1999, my primary care physician prescribed Zoloft and sent me on my way. It was what I wanted to do. With my last shreds of sanity and understanding I'd read up on the various SSRI's, the risks and the benefits.

Fortunately, I began to experience relief within days. That is, the voices quieted down and stopped. That alone was an improvement. Of course there were side effects like nausea, tremor, drowsiness and dizziness, but they weren't nearly as bad as the trolls under the overpasses who kept telling me to roll my car.

I think it was at about three weeks that I began to feel very agitated and irritable. I could see where someone might resort to suicide at that stage, but I chose instead to just hang tough and get through it. I could get through it because I knew there was a risk of this kind of side effect.

In the end, Zoloft worked well for me for close to 6 years. I've changed to a different SSRI now, and it works fairly well.
Antidepressent medication has given me a life. I have been taking medication for 25 years. Changing the brand eversoften as necessary at my Doctor's direction. Depression is a medical condition, not a mental illness. But still, it is something I do not talk about for fear I will be labeled as having a mental illness. Antidepression medication has allowed me to learn how to deal with the emotional nature of human life. To laugh and love, to participate in life with other people. Without medication, I would not leave my home, my anxiety leads me to belive that I am not worthy of life. Without medication, perhaps I would in a very, very low moment act on the desire to exscape the pain of depression. With medication, I know it is my illness that causes this pain and not me. I do not belive that Antidepressents cause suicide. Depression does that. With your doctors guidance, change your meds if needed. Increase research to see if there is a sequence issue. Please don't take away this lifeline from those who so desprately need it most.
I have discovered the NATURAL antidepressant. One that controls my depression, one that takes away that angry, road rage feeling that I've suffered since I was young always believing it was a hormonal thing because it was always there at that 'PMS' time. The natural herb/herbs is called '5 HTP'. Do the research. Its safe with no known side affects, but because there is no studies done beyond 10 years of taking the herb, it is suggested to go off of it for a few weeks every few months but having your doctor prescribe an alternate antidepressant in the meantime. THAT I did not do because the whole idea was a NATURAL treatment! I did go off for 4 days and went back on at 1/2 the dose for 2 weeks. I was fine. I swear by 5 HTP. Doctors do not want to hear it. Its an INEXPENSIVE over the counter,natural herb. Simply go to Google, do the research, find a ton of sites that sell it at the best prices. I took 1/100 mg. capsule 3x day for months, but I'm only doing 1/50 mg. capsule 3x day now and I'm fine.
It is unclear as to why the use of antidepressants and suicide would be linked. [Confusing statement]

Presence in the blood is a good indicator in so many of the homicide/suicides since the advent of antidepressants and is also the link.

Lack of clarity would be understandable if antidepressants were not present in the blood of the suicidal/homicidal person.

Clearly school shootings in particular were not as prevalent.

Totally ignoring the whole situation seems to indicate all that should be known isn't known.
I was given Effexor my last year of college for mild depression. It was my senior year, I was stressed from the workload and was having trouble with my obnoxious roommates. The school doctor thought the drug would help me deal with the circumstances and boost my concentration; which was also suffering at the time. I was not suicidal. After a few days of taking the drug, with no major change in circumstances, I had a near suicidal breakdown. After getting off the drug I was fine. I graduated and moved out. I had never had a break down like that before, or since. I completely believe that Anti-Depressants aren't fully understood, that only select findings from a few of the many studies that are conducted are actually shared with the mainstream public, and that they do indeed increase the risk of suicide in many (young and old) people. Drug companies, doctors, and people who have not experienced what I and MANY others have, have an easy out: discrediting people with health issues that kill themselves by saying they were suicidal to begin with. That is truly a tragedy to me.
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