Opinion
 

A killer combination?

Treating depression may not be as easy as simply taking a pill, psychiatrist says

by Dr. Kenneth S. Arfa

Do antidepressants cause suicide, the same tragedy they are prescribed to prevent?

Since the new generation of antidepressants became popular in the 1990s, critics have worried that they pose some risk of actually causing suicide. Fourteen years ago, "a Harvard psychiatrist wrote a paper suggesting that some of his patients became acutely suicidal after taking Prozac," recalls The New York Times. "But a 1991 scientific advisory panel concluded that there was no convincing evidence."

On March 22, the Food and Drug Administration warned that patients can become suicidal in the first weeks of treatment, and physicians should watch patients closely.

According to the Times, no studies have shown a convincing link between the drugs and suicide. Suicide is such a rare side effect that data is difficult to interpret. This did not keep the FDA from issuing the advisory for adults, based partly on anecdotal stories that arose during hearings in February about antidepressants and suicide in children.

The FDA advisory is expected to cause manufacturers in the $12 billion antidepressant industry to post bolder warnings on suicide.

Antidepressants are popular and critics say physicians prescribe them too freely. Patients and their doctors need to look at alternatives to pills for treating depression. 

However, the dangers of not treating depression are high. Depression and its partner, irritability, can damage family, school, work and social life. It robs patients of life's pleasures. Fifteen percent of people with depression commit suicide and 15 percent of people dealing with substance abuse take their own lives.

Suicide is the eighth leading cause of death in the United States. It is the No. 3 cause of death in people between ages 15 and 24.

Doctors at Harvard Medical School list other statistics. Each year, 31,000 people commit suicide. For every attempt which is successful, 18 fail. Two-thirds of those who commit suicide visit a physician in the month before making an attempt. Ninety percent of patients who commit suicide carry at least one major psychiatric diagnosis. Major depression is a factor in about half of suicides. 

The bottom line is that antidepressants are a key tool but not the only way to fight depression. Antidepressants need to be prescribed carefully, with close follow up. Patients can use psychotherapy, spirituality, exercise and lifestyle change as a supplement or alternative to pills. Patients need to choose psychiatrists or primary-care doctors who are very familiar with prescribing antidepressants.

As the newspaper notes, antidepressants prevent many more deaths than they cause, but patients should not take them casually.

Arfa, a psychiatrist at the University of Houston Health Center, 
can be reached at karfa@uh.com or (713) 743-5149.