Antidepressants: pros outweigh cons

Despite recent controversy over the potential effects of antidepressants in young users, the lifesaving benefits of drugs such as Aropax, Prozac and Zoloft far outweigh their risks, a new study suggests.

A comprehensive review of decades of data from Europe and the United States reveals a close correlation between dramatic declines in suicide and the introduction of the selective serotonin reuptake inhibitor (SSRI) family of antidepressants into the marketplace.

"If these drugs were really causing suicide, the reverse should be happening," said study author Dr Julio Licinio, a professor of psychiatry at the University of California, Los Angeles, School of Medicine.

"It's sometimes hard to see the big picture, but I think the overall effect [of SSRIs] is positive," Licinio added.

Dramatic drop in prescription rates
The study's publication coincides with the release Monday of pharmacy-industry data showing that prescriptions of SSRIs to children and adolescents in the United States fell by 10 percent in just the last three months of 2004.

Isolated reports of teens committing or attempting suicide while on antidepressant therapy have sparked Congressional debate and widespread media attention. And late last year, a special US Food and Drug Administration (FDA) panel ordered that "black box" labelling be placed on all SSRI packaging warning doctors, parents and young users of the potential risk.

But has fear pushed the pendulum too far away from a balanced assessment of these drugs?

Many parents now fearful
Gail Griffiths, a member of the FDA panel who voted "yes" to the black box warning last year, said she would vote differently now.

"If I would have known how sharply prescription rates were falling, I would not have voted in favour of the 'black box' warning," Griffiths, a parent whose son attempted suicide while on antidepressants, said in a prepared statement Tuesday. She was endorsing the launch Tuesday of a new online help site to guide parents with paediatric SSRI use.

In her statement, Griffiths added, "I hoped the FDA could help to inform parents, but it seems many parents have simply become fearful of antidepressants, which are so often the life jacket preventing us from being sucked under by depression's powerful undertow."

The results of the UCLA study, published in the February issue of Nature Reviews: Drug Discovery, appear to support Griffiths' view that SSRIs do far more good than harm.

How the research was done
In their study, Licinio's team pored over US and European data on depression and suicide, stretching back to the 1960s. Included in that data were FDA statistics on US suicide rates, as well as studies reporting on the percentage of suicide victims found with traces of antidepressants in their bloodstream.

"To my surprise, I found that the suicide rate goes up in a straight line, year by year, from the 1960s on - right up until 1988, which is exactly the year Prozac was introduced," Licinio said. "From then on, it goes down substantially."

In fact, according to recent figures from the US Centers for Disease Control and Prevention, suicide fell from the 8th leading cause of death in 1998 to the 11th in 2002.

"Also, we find antidepressants in the blood of less than 20 percent of people who died of suicide - 80 percent had no antidepressants on board at all," Licinio added, which he said might suggest that a majority of victims might have killed themselves because of untreated depression.

Benefits far outweigh the risks
Dr David Fassler, a child and adolescent psychiatrist and spokesman for the American Psychiatric Association, said the latest findings "support the growing consensus that, when used appropriately, the benefits of these medications far outweigh the potential risks."

Fassler believes there's now "a real concern in the medical community that the public is getting confused by contradictory media reports [on this issue]. As a result, people may be less likely to get treatment. That would be a real tragedy, because the good news is that we can help most people who suffer from psychiatric disorders, including depression."

Drugs first boost energy
Any reaffirmation of the benefits of SSRIs shouldn't obscure the fact that a minority of users, especially young people, may experience some increase in suicide risk while on these medications. As Licinio explained, that's mainly due to the way the drugs work, with the drugs boosting energy before they ease feelings of gloom.

"Many people who are depressed think, 'Oh, the world would be better off without me.' But they simply lack the energy to act upon that feeling," he said. "At the beginning [of SSRI use], they begin to get that energy, however."

Licinio said that the initial period is when parents and doctors should monitor young users most closely, although he stressed that monitoring must continue as long as therapy continues.

Another intervention that saves lives
Still, available data suggests SSRIs have saved the lives of thousands of people - children and adults alike - so reductions in their use against depression is troubling, he said.

"Of course, suicide is always tragic on an individual level, but I look upon these drugs as I would a vaccine, another intervention that saves lot of lives," Licinio said. "We should be alert here not to throw the baby out with the bathwater." – (HealthDayNews)

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