Patients who take selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine) or Zoloft (sertraline) may experience side effects such as violent behavior, mania or aggression, which can all lead to suicide.
What begins as withdrawing from friends and activities and a loss of interest in work can escalate to harming oneself. In clinical trials and public use, there have been cases where antidepressant users have thought about, attempted or committed suicide.
Antidepressants have also been shown to have other dangerous side effects, including severe birth defects when a woman takes the drug during pregnancy. In fact, dozens of women who took antidepressants during pregnancy have filed lawsuits after their children suffered birth defects.
While antidepressants are designed to decrease the symptoms of depression, they occasionally have the opposite effect and can increase suicidal thoughts and actions.
Antidepressants and Incidence of Suicide
Every year, 30,000 people in the United States die by suicide, according to the National Institute of Mental Health. Among those who are diagnosed with major depressive disorder (MDD), seven out of 100 men and one out of 100 women will commit suicide. For every suicide, there are 11 suicide attempts.
Treating depression with antidepressants may improve the condition, but may increase the risk of suicide. Physicians recommend treatment when the clinical need outweighs the risk.
Prescribing antidepressants has become common practice, with 164 million prescriptions written for antidepressants in 2008. Sales of SSRIs, specifically, increased by 32 percent from 2000 to 2004, to a combined total of $10.9 billion.
Unfortunately, SSRIs, a relatively new class of antidepressants, have been associated with an increased risk of suicide. In tests of Prozac, Zoloft, Paxil, Celexa, Lexapro and Luvox on children with major depressive disorder, obsessive compulsive disorder and other psychiatric disorders, about 4 percent of patients experienced suicidal thinking, behavior or attempts. In the placebo group, 2 percent of the participants experienced similar problems.
Antidepressants have also been linked to akathisia, which is extreme restlessness and an inability to sit still. The discomfort can be so great that suicide becomes a welcome alternative to feeling this type of agitation. Sometimes akathisia is misdiagnosed as worsening depression, so medication dosage is increased, causing the restlessness to persist.
At least one antidepressant can have a stimulant effect similar to amphetamines, which can lead to suicide. A Food and Drug Administration (FDA) official responsible for evaluating adverse drug effects during the approval process of Prozac repeatedly warned that the drug could have this effect.
|There are several precursors to self-harm, including:
|Withdrawal from relationships and activities
||Obsessive thoughts about suicide
||Akathisia (extreme restlessness)
|Stimulant effects can include:
||Central nervous system stimulation
|Frequent emotional changes
Studies Linking Suicidal Behavior and Antidepressants
According to published material, there was only one suicidal act in the trials of Zoloft in children. Yet it was later revealed that the Food and Drug Administration had documented six suicidal acts in the trials, according to the Center for Drug Evaluation and Research. Additionally, 17 children dropped out of the trial because of serious adverse events.
The Medicines and Healthcare products Regulatory Agency (MHRA) in London published data in 2003 revealing that not only was sertraline ineffective for major depressive disorder in children and adolescents, but in one trial it increased the rate of self-harm, compared to placebo.
A 2003 study by the Committee on Safety of Medicines (CSM) in the United Kingdom found that in tests of depressed children with SSRIs, more suicidal events (thoughts, self-harm or attempts) occurred than with placebo.
Two years later, in 2005, MHRA reviewed 477 controlled SSRI trials of adults and concluded that evidence does not rule out either a harmful or beneficial effect of SSRIs on suicide; therefore it is possible that SSRIs increase the incidence of suicide. They recommended larger trials to measure data.
Another study, documented in The Journal of Clinical Psychiatry, found that 8.1 percent of 533 people admitted to the adult psychiatric inpatient service at Yale-New Haven Hospital presented with psychosis or mania related to antidepressants.
In 2000, David Healy, from the North Wales Department of Psychological Medicine, reported on a randomized double-blind crossover study of sertraline in healthy volunteers who were not depressed. He found that many individuals developed adverse mental and neurological effects, including two severely disturbed cases. In one case, a 30-year-old woman's emotions changed, making her irritable and insensitive. She became preoccupied with suicide. In the other case, a 28-year-old woman developed feelings of aggression and threatened a teenage boy.
FDA Black-Box Warning
Over time, the FDA has examined many cases regarding the suicidal risks involved with antidepressants. Based on studies showing some link to suicide, the FDA has made several changes to the labeling of antidepressants.
|FDA Changes on Antidepressant Labeling
||FDA considers risk of antidepressants increasing suicidality in public hearing, but does not find enough evidence to change labels.
||FDA researcher writes to Pfizer to note the increased frequency of reports of suicidality in young patients during Zoloft clinical trials.
||FDA warns doctors that studies cannot rule out increased suicidal thinking in children taking antidepressants.
||British drug regulators advise doctors not to use certain antidepressants in children.
||Former FDA chief safety investigator testifies even before Prozac, Paxil and Zoloft were on the U. S. market, he believed these drugs could cause mania, leading to violence.
||FDA orders all manufacturers of antidepressant medications to add a black-box warning that they may increase suicidality in children and adolescents.
||FDA sends out a public health advisory, warning that all antidepressants increase suicidal behavior in adults and announcing that studies of the effects of antidepressants would be under review. FDA goes on to review 295 individual antidepressant trials of 77,000 adults with major depressive disorder. As a result, health care professionals are informed of risk of suicidality.
||FDA recommends that children should not take Zoloft, as it increases suicidal thinking or behavior in 1 out of 50 young patients. FDA advises doctors to observe pediatric patients taking antidepressants once a week, face to face.
||FDA adds to the black-box warning on certain antidepressants, cautioning that increased suicidal thoughts and behaviors are a possible side effect of the medications for adults ages 18-24 during initial treatment.
||A study of nine years of data, published in 2010, shows that the suicide risk is the same across SSRI drug types.
Intervention to Prevent Suicide
Medication-induced suicide has taken the life of both younger and older patients. Without proper warning of risks from doctors and manufactures, people take antidepressants in hopes of curing their depression. The outcomes can be devastating.
Antidepressants can help treat depression, but comes with high risks. Other medications may be prescribed, and doctors may recommend additional therapy. Cognitive behavioral therapy, where a patient speaks with a licensed mental health counselor, reduces the risk of repeated suicide attempts by 50 percent.
Taking proactive steps like speaking to a doctor or seeking hospitalization can save lives. Friends and family can help by recognizing symptoms or unusual behavior.
|Symptoms that may be early indicators of suicide:
|Loss of interest in activities
||Significant change in appetite
|Withdrawal from family and friends
||Sadness, irritability and indifference
|Extreme panic or anxiety
||Drug or alcohol abuse
|Hallucinations or unusual beliefs
||Neglect of personal appearance or hygiene
||Poor school performance
|Sleeping all day
||Loss of energy
|Difficulty falling asleep