SSRI Ed note: Influential medical columnists discover to their surprise that SSRIs really do cause suicidality despite failure of FDA to issue timely warnings.

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Long Beach Press-Telegram (CA)

December 29, 2003

Author: Joe and Teresa Graedon

In 1988 An ophthalmologist contacted us because his daughter had unexpectedly committed suicide while taking Prozac. He was convinced that this antidepressant had somehow triggered her sudden violent act.

We could find nothing in the medical literature to support his suspicion, and so we dismissed his report as the desperate rationalization of a grieving parent. We assumed that a depressed young woman might take her life, even on an antidepressant.

Some months later an article appeared in the American Journal of Psychiatry suggesting the link might be real. Harvard psychiatrists reported that six patients had developed a preoccupation with suicide within a few weeks of starting Prozac.

We later learned that the ophthalmologist’s daughter had not been depressed. Her doctor had prescribed Prozac off-label for an eating disorder. Why she hanged herself remains a mystery.

For years the Food and Drug Administration has debated whether Prozac and related antidepressants could trigger suicide or other violent acts. For the most part, the agency has dismissed such concerns as rare or unrelated to the medications.

Labeling for Prozac states, “The possibility of a suicide attempt is inherent in major depressive disorder and may persist until significant remission occurs.”

Despite such reassurance, British regulators have just taken the unusual step of warning doctors against prescribing many antidepressants for people under 18 years old. The authorities there concluded that antidepressants such as Celexa, Effexor, Lexapro, Paxil and Zoloft could trigger agitation, suicidal thoughts and self-injury. Prozac has not been included in this advisory.

The restriction of so many popular drugs for teenagers and children has taken many American psychiatrists by surprise. The debate in England about the benefit-risk balance is likely to trigger a similar controversy in the United States.

The FDA is now being forced to re-evaluate its position on the use of such SSRI antidepressants. And some physicians are beginning to ask whether some adults might also be at risk while taking such medications.

Readers of this column have shared compelling stories with us. One reported: “A 50-year-old old friend of mine asked his doctor for something to put him in better spirits over the Christmas holidays, since he had just broken up with his girlfriend. He started Zoloft and awoke in the middle of the night with a strong urge to kill himself. He overcame the urge and never took another Zoloft. Had he actually killed himself, it would have been written off as due to depression, though he and I are convinced it was the pills.”

While millions of people have benefited from such drugs, some cannot tolerate the side effects. Whether such antidepressants actually trigger suicidal thoughts in adults has not yet been determined. But British regulators clearly believe they pose a problem for children.

We have written about these issues in our Guides to Antidepressant Pros and Cons and Psychological Side Effects. Anyone who would like copies, please send $2 in check or money order with a long (No. 10), stamped (60 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. MX-23, P.O. Box 52027, Durham NC 27717-2027.

Q: I have been taking Pravachol to lower my cholesterol for a year. Yesterday for the first time my refill came with a warning to avoid grapefruit.

I have received a large box of Texas grapefruit and would like to enjoy it. How can I do that safely?

A: We are puzzled. According to the research, Pravachol is a drug that should not be affected by grapefruit. We think you could enjoy your grapefruit safely, but double-check with your pharmacist and physician to make sure.



In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features Syndicate, 888 Seventh Ave., New York NY 10019, or e-mail them at or via their Web site:

Record Number: 0401120115   Copyright (c) 2003 Press-Telegram