Debate on Suicide Warnings for Antidepressants Intensifies

The news media announced this week that the Food and Drug Administration has convened a hearing to consider an added warning to the labeling on antidepressants. In 2004 the FDA decided that there was enough evidence to include a label warning regarding the possible increased incidence of suicide for children and adolescents taking antidepressants. The current panel discussion will involve extending that warning to include adults possibly being at risk as well.

The debate will be intense on both sides. Impassioned pleas from bereaved families and medical experts convinced of the evil nature of psychotropic drugs (and perhaps some supporters of Tom Cruise and Scientology?) will state their case. There will also be expert opinion that the positive affects of this class of powerful pills far outweigh any of the negatives. Of course, the possible negatives in this case do not include just a hand-tremor, for example. They include death.

The discussion, I believe, is even more complex than it seems. The one positive we can likely agree on is that it brings the issue of treating mental illness out into the open. I believe it may also aid many that are suffering in silence and in shame to come forward for help.

In Britain, antidepressants are largely banned from being prescribed for children. In the United States, parents - overwhelmed and frantically searching for answers themselves - are all too accepting of a pill that will fix everything. No pill will fix everything. Even plain aspirin can be fatal if not taken as recommended. Parental and physician monitoring, individual counseling, family counseling, community support groups, prayer for those who believe, self-education, and proper overall health care are all critical to the recovery of anyone suffering from an emotional or mental disorder.

As a country we have been "pill happy" for some time. I believe it started in the 1960's when the older generation began to see the eradication of diseases that had ravaged their families for decades. The rush to pill use was also fueled when we lined up like soldiers going to war to receive our oral vaccine to prevent polio. In the late 60's and early 70's, social changes, wider production and availability of medicines (including "THE" pill - birth control), all contributed to our obsession and subsequent addictions. Our pill use reached the level of mockery for drugs such as Valium - which seemed to be prescribed at a patient's whim. In the elevator scene in Woody Allen's film, "Annie Hall" in 1977, when asked if anyone had a Valium, everyone in the elevator full of people pulled out a bottle.

After Prozac debuted in the 1980's, it led to a near avalanche of prescriptions being doled out to patients. The new pills were effective drugs and far superior in many ways to the ones they replaced. However, the critical key ingredient that was often left out was follow-up and counseling. Psychotropic drugs are not antibiotics. There are no exact scientific statistics. "Individual results may vary" is a gross understatement.

Society has continued its forward lurch toward a populace more stressed, more isolated and more in need of tools to help themselves to not self-destruct. This societal situation and inclination must be considered while the debate is on about the labeling. Even the deadly skull and crossbones on cigarette packages will not deter some people from consuming them, but a warning on an antidepressant will cause many in real need to shy away from not only from the drugs, but also from treatment all together.

Finally, there's the money. It disturbs me greatly to see ads on television and in magazines for specific drugs. Why is this allowed? It throws serious, possibly self-destructive behavior into the same arena as indigestion. I can tell you with certainty if my stomach is upset and I need something to settle it. But what makes the drug companies think that the public is competent to self-diagnose emotional and mental disorders? I consider businesses and the government irresponsible for allowing this kind of "pitching" to the public. Drug advertising and tons of free samples have helped fuel the stampede. The already obnoxiously rich pharmaceutical companies fund these ads in full.

Perhaps the most important point I would like to make is that antidepressants can be effective for certain patients, but the patients need to be followed closely. One of the main effects of the drugs is that it allows the fog of depression to lift and the patient actually feels and must face and express his/her emotions. It is the emotions - often intense, frightening, confusing, and overwhelming - that can cause an individual to consider suicide. But that ability to feel and face the trauma of the emotions - and process them through counseling - is critical for recovery.

At the very least, whatever is decided, I would like to see a full disclosure of all members of this FDA panel for the slightest connection any one of them may have to the people or companies who make and profit from the drugs. I would also like to see a disclosure of their stock portfolios. Have any of their secretaries taken questionable phone calls? Perhaps Martha Stewart would like to oversee that investigation.