by William E. Hapworth M.D.

In 2004, in an ill conceived and some what hysterical 2004 advisory, the Food and Drug Administration (FDA) warned that suicidal behavior may emerge after antidepressant treatment is begun. This warning was carried in the media broadly and the traditionally psychiatry hating press reported on the dangers of SSRI’s particularly in teenagers. Now in a study that is likely to not receive such media coverage a 10-year population-based study by Simon et al. indicates just the opposite about antidepressant treatment  especially SSRI’s and particularly in teenagers. Among 65,103 patients in a large health plan who filled prescriptions for antidepressants during 1992–2003, the number of suicide attempts fell dramatically after antidepressant treatment began and then declined more slowly. Completed suicides were few and did not vary over the first 6 months of treatment. Adolescents had more suicidal behavior than adults, but attempts decreased by over 60% in the first month of treatment. The FDA advisory names 10 newer antidepressants, but in this study the decrease in suicide attempts after treatment began was actually greater with newer agents than with older antidepressants.
   
    The damage that ensues from rash judgements about psychiatric treatment only emboldens the Tom Cruise contingencies of our society and discredits the hard work that mental health professionals log on a daily basis. I still see patients that believe Prozac makes you want to kill people and will not consider it's prescription because of all the negative implications about the drug. Unfortunately, the public will remember that antidepressants make you want to kill yourself and forget that the above article based on ten years of data indicates the complete opposite.
   
    The FDA owes Psychiatry an apology (like this will ever happen) and should redraft the warning on suicidal ideation to reflect that antidepressant prescriptions should be taken seriously and only dispensed by trained psychiatrists with close follow-up in therapy by mental health professionals who monitor response and continue to explore the  underlying psychology of the suicidal ideas and their ultimate motives.