OF TWO MINDS Debate rages over whether Prozac contributes to suicide — (The San Diego Union-Tribune)

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The San Diego Union-Tribune (CA)

February 16, 1995

Author: ALICIA DOYLE; Staff Writer
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SEAN M. HAFFEY

The blue waters of the bay rippled 240 feet below as Lisa Osborne stood on the San Diego-Coronado Bridge preparing to leap. Within moments, the 32-year-old mother of three, who had overdosed on a mixture of antidepressant drugs only a month before, succeeded in a second attempt to end her life.    “I still can’t believe she’s gone. I loved her. She was my everything,” said Audra Shearer, Osborne’s best friend. The two lived together in Chula Vista for nine years before Osborne’s suicide Dec. 8.

Still shaken by Osborne’s death, Shearer is tormented by her belief that side effects from a “miracle drug” drove Osborne to commit suicide.   Osborne began taking Prozac, an antidepressant, shortly after it was first marketed in 1987. She was prescribed the drug after a psychiatrist diagnosed her with manic depression, or bipolar disorder.   Shearer said the Prozac seemed to help Osborne at first. But as months passed, Shearer saw a significant change in Osborne’s personality.  “She became paranoid and started  hallucinating,” Shearer said. “That never happened before. I knew it was the Prozac.”

Shearer tried several times to get Osborne to stop taking the drug.  “I even flushed it down the toilet, but she would get more and hide it from me,” Shearer said. “I imagine the drug helps some people, but it didn’t help her. It made her crazy.”   Osborne shocked her friends and family in November when she overdosed on a combination of Prozac and two other prescription drugs.

“She scared me so much,” said Robert Steber, Osborne’s father, who took his daughter to Sharp Memorial Hospital, where she spent three days recovering. She was transferred to the psychiatric ward at UCSD Medical Center.   A week passed, and Osborne checked herself out of the hospital, against medical advice and against her father’s wishes. But for the next several days, her condition improved.   Until Dec. 8.

Osborne appeared on her father’s doorstep before noon, upset about an argument with her grandmother earlier that day.  “Lisa climbed into my lap and clung to my neck, crying her eyes out,” Steber said, his eyes filled with tears. “I talked a long time to her, calming her down. . . . I really thought she would be OK.”   Later that evening, Lisa’s ex-husband, Jeff Osborne, knocked on the door and told Steber the tragic news.

“All I could think was, ‘Why? Why? Why?’ ” said Steber, asking an all-too-familiar question. His ex-wife, Osborne’s mother, had been diagnosed with clinical depression, and, in 1978, she committed suicide — jumping off the Coronado bridge.    “Why, when everything was looking up for Lisa, did she decide to end her life?” Steber asked.   Osborne’s loved ones never will know the answer. But some mental-health experts say her death follows a pattern of suicide cases in which the victim was taking Prozac.

Other experts say the drug has helped millions to stabilize their depressions, and that those who are seriously depressed to begin with are more likely to commit suicide than those who do not have depressive illness.

Mixed report

Prozac, called a “breakthrough drug for depression,” is the world’s best-selling antidepressant and earns more than $1 billion a year for its maker, Eli Lilly & Co. Prozac is the trade name for fluoxetine and was approved for use in the United States in 1987. It is among the 10 most frequently prescribed drugs in the world.

Across the nation, more than 10 million people have used Prozac. Worldwide, nearly 1 million prescriptions are written every month.  While many Prozac users claim that it lifts depression, Dr. Peter Breggin, who wrote the book “Talking Back to Prozac,” said the drug often causes impulsive and suicidal behavior.

“Prozac can increase obsessive-compulsive thoughts and behavior, including preoccupations with suicide,” wrote Breggin in his book, which discusses the potentially damaging effects of the drug.   Breggin speculates that Prozac may have caused Osborne’s suicidal impulse.    “One of the characteristics is that these suicides come out of the blue,” he said.

Lilly representatives deny that Prozac leads to suicide.   “Suicidal thinking and suicidal acts are symptoms of depression — they are caused by the disease, not by the medicines used to treat it,” says a fact sheet on Prozac distributed by Lilly.

Osborne was the 338th person in San Diego County to commit suicide in 1994. Of those, 16 were reported to have taken Prozac at some time before their deaths, according to the county Medical Examiner’s Office.

A contributing factor for two of the cases involved multiple drug use. One person combined morphine, codeine, alcohol and Prozac; the other took Prozac and Darvon, a widely used painkiller.

In 1993, nine of 375 suicide victims reportedly took Prozac before death; and in 1992, 15 of 344 suicide victims had been prescribed Prozac.

While the percentage of Prozac users compared with nonusers is relatively low, many Prozac-related cases may be overlooked because the Medical Examiner’s Office does not routinely test for the drug.

Connection disputed

Some believe Prozac and suicide have a connection, while other health experts say they can find no relation.  Some report that Prozac and related antidepressants have unprecedented power to lift depression. Others believe the drug can help subdue obsessive thinking and compulsive behavior.   “In general, using Prozac does not change the rate of suicide compared to using other antidepressants or no treatment,” said Dr. Stephen Stahl, a professor of psychiatry at UCSD.

But according to a study published in the American Journal of Psychiatry in 1990, antidepressants occasionally promote suicidal actions in severely depressed patients.  The study targeted six depressed patients who, previously free of suicidal thoughts, developed “intense, violent suicidal preoccupation” after two to seven weeks of fluoxetine treatment.

Their states persisted for from three days to three months after they stopped taking the drug.   “Their suicidal thoughts appear to have been obsessive . . . they emerged without reason but were the patients’ own thoughts,” reports the study, conducted by mental-health experts.

It also reported that of the six patients, two fantasized, for the first time, about killing themselves with guns, and one actually placed a loaded gun to her head. One patient needed to be restrained to prevent self-mutilation. Another patient, who reported no prior suicidal thoughts, fantasized about killing himself in a gas explosion or a car crash.

But Stahl said individuals with depression are more likely to kill themselves than nonsufferers. He said one out of seven people clinically diagnosed with depression commits suicide.  Dr. Peter Kramer, who wrote the best-selling book “Listening to Prozac,” agrees.    “My own impression is that the risk that Prozac will induce suicidal thoughts is small,” said Kramer, whose book suggests that the drug lifts depression.

“I would say that Prozac may, in rare cases, stimulate or worsen suicidal thoughts and impulses. . . . The public worry about this is, however, so exaggerated as to be dangerous, because it tends to discourage people from taking Prozac even where it is very likely to do them good and very unlikely to cause harm.”

Members of the Prozac Survivors Support Group, however, believe the drug is a danger to society. The group, based in Fresno, was founded in 1991 to educate the public about what it says are the dangers of Prozac and other antidepressants. The group claims more than 7,000 members nationwide.

“It’s ruining people’s lives,” said Guy McConnell, the group’s national director. He said he receives at least seven calls a day from Prozac users complaining about everything from severe headaches to suicidal thoughts.

But Victoria Murphy, spokeswoman for Lilly, said there is no clinical evidence of a link between Prozac and suicidal behavior.   “To the contrary, all existing scientific evidence shows that Prozac and medications like it appear to protect against those kinds of behaviors,” Murphy said.

In the United States, there are 74 pending federal cases against Lilly, and about 128 cases in state courts. Most involve suicides or suicide attempts.

Nearly 2,000 suicides associated with Prozac have been reported to the Food and Drug Administration (FDA). Overall, more than 28,000 adverse-reaction reports — more than any in the history of the agency — have been made to the FDA since the drug became available.   Despite the reports, an FDA official said the agency’s data do not prove a causal relationship between Prozac and suicide, because suicidal tendencies can be a manifestation of depression.   Lilly representatives are also unshaken by reports made to the FDA.   “These statistics are startling in any way from Lilly’s perspective,” Murphy said.

A larger issue

Linda and Richard Engstrum filed a lawsuit against Lilly in 1992 after their 18-year-old daughter, Traci, shot herself in the head.  “Traci had never even held a gun, let alone fired one,” said Linda Engstrum, of Los Angeles. She spearheaded a child-loss support group after her daughter’s death.  Traci, a cheerleader and honor student, was on Prozac for four months before she killed herself. She was prescribed the drug after being clinically diagnosed with depression.

While the Engstrums want Prozac taken off the market, they hope their lawsuit will result in another change — getting a warning placed on Prozac labels that states that the drug may cause suicidal tendencies.  At this time, the FDA is not considering revising the label, which briefly mentions the subject of suicide.

The label’s precaution section includes the warning: “The possibility of a suicide attempt is inherent in depression and may persist until significant remission occurs. Close supervision of high-risk patients should accompany initial drug therapy.”   “People are not fully informed about the repercussions of the drug,” said Linda Engstrum. “If Traci never started taking Prozac, she would still be alive.”

1. Unanswered question: “All I could think was, ‘Why? Why? Why?’ ” says Robert Steber, whose daughter, Lisa Osborne, committed suicide in December. With him is Osborne’s stepmother, Jeanine Steber.

2. Lisa Osborne: The mother of three, shown in a studio photo, had tried to commit suicide before. Audra Shearer, Osborne’s friend, believes Prozac “helps some people, but it didn’t help her. It made her crazy.”

3. Earlier days: Lisa Osborne with her ex-husband Jeff Osborne, and their children, Genna (left), Genessa (middle) and Genell (right). Lisa began taking Prozac in 1987 after a psychiatrist diagnosed her with manic depression, or bipolar disorder. (E-4)

Copyright 1995, 2007 Union-Tribune Publishing Co.
Record Number:  UTS1175931