In June 2001, a jury in Wyoming determined that the antidepressant drug Paxil caused a man to kill his wife, daughter and granddaughter before killing himself. The jury awarded the surviving family $8 million in damages, according to American Medical Publishing’s Prescription Medicines, Side Effects and Natural Alternatives.

In Portland, Ore., Jay Johnston followed his doctor’s orders and took the prescribed antidepressants Zoloft and Prozac. He then attempted suicide with a shotgun, permanently disfiguring himself. In the same month as the Wyoming jury’s decision, Johnston sued his doctor for not properly monitoring him. The jury found the doctor guilty of criminal negligence and awarded Johnston $5 million, reports Dr. Ann Blake Tracy in Prozac: Panacea or Pandora. Similarly, who could forget Eric Harris, who — along with Dylan Klebold — killed 11 people and then himself in the Columbine school shooting? At the time of the shooting, Harris was being treated with the prescription antidepressant Luvox.

These patients are among the growing statistics of people who committed suicide, or tried to commit suicide, while undergoing treatment with prescription antidepressants.

Antidepressant drugs such as Prozac, Luvox and Paxil are selective serotonin reuptake inhibitors, commonly known as SSRIs. Serotonin is one of your brain’s most important biochemicals; it controls everything from appetite to mood swings. If you’re depressed, compulsively eating or gambling, not sleeping properly or even just moody, you’re probably lacking serotonin. It’s important to note, however, that you can also have too much serotonin.

In Health and Nutrition Secrets, Dr. Russell L. Blaylock writes, “It is also known that these medications increase brain levels of the neurotransmitter serotonin, which, in high concentrations, can also act as an excitotoxin.” When antidepressant drugs raise serotonin to an excitotoxin level, the brain reacts in ways similar to mental illness. According to Burton Goldberg’s book, Alternative Medicine, side effects of SSRIs include uncontrollable facial and body tics, dizziness, hallucinations, nausea, sexual dysfunction, addiction, electric-shock-like sensations in the brain and, of course, homicidal or suicidal thoughts and behavior.

Unfortunately, the doctors prescribing these SSRIs often forget that you can have too much of a good thing — that is, too much serotonin — so they prescribe SSRIs to just about everyone. Now, there are some truly bad doctors out there, such as the psychiatrist whom Dr. Joseph Glenmullen describes in Prozac Backlash:

“Anna was started on Prozac but became severely anxious, agitated and sleepless … Having never been suicidal before, two weeks after starting Prozac, Anna went to her HMO because she felt like killing herself. The psychiatrist on call told Anna the Prozac was indeed making her worse and hospitalized her. But her original psychiatrist disagreed, restarted Prozac, although at a lower dose and added a second, sedating antidepressant (Trazodone), which Anna only took for two days.”

Anna’s original doctor seems to be little more than a licensed drug dealer. However, let’s give the benefit of the doubt to most antidepressant-prescribing doctors and say that they’re just ignorant of antidepressants’ potentially fatal side effects. Based on Goldberg’s figures, physicians — not psychiatrists — write over 70 percent of all prescriptions for SSRIs, so they may very well be ignorant of the antidepressant scare.

Pharmaceutical companies, however, have no excuse. Prozac’s maker, Eli Lilly, frantically fought any change in the prescribing guidelines for antidepressants; even a general warning. Not even public allegations linking the drug to suicides, murders, murder-suicides and mass murder-suicides could weaken Eli Lilly’s staunch defense of the antidepressant. Dr. Glenmullen explains that Eli Lilly’s stance was a result, of course, of financial greed: “Pharmaceutical companies spend hundreds of millions of dollars developing and launching a drug like Prozac. By 1991, Prozac was already the number-one bestselling antidepressant, with sales near $1 billion a year. The stakes were indeed high. So the pharmaceutical industry and drug advocates decided to defend Prozac at all costs, despite the risks to individual and public safety.” In other words, to the pharmaceutical industry, it seems nothing — not the individual lives of depressed people, not the massacre at Columbine — is more important than making $1 billion a year.

You know your life is more important than that; you know that humanity is more important than any financial sum. It’s up to you — not your doctor and certainly not a pill — to find a way to overcome depression. Visit a therapist and do some cognitive therapy; even the staunchest pill-pusher won’t deny that antidepressant medication is no substitute for counseling. If your brain lacks serotonin, there are many safe and natural ways to boost the biochemical. You can find a concise, yet informative article on boosting your mood through diet, right here on NewsTarget.

Prozac, Luvox, Paxil and Zoloft are just brand names for the same recipe for disaster. Every day, doctors prescribe medications that are known to induce suicide and other violent behavior in depressed people who may already be suicidal. This is so ironic that it’s sickening, and only knowledgeable consumers who tell their doctors that they don’t want to be given these dangerous drugs can make it stop.

The experts speak on antidepressant drugs and suicide:

“Legal verdicts on antidepressant drugs and suicide”
A lawsuit contends the manufacturer of the popular anti-depressant Paxil concealed evidence that the drug can be addictive. The lawsuit was filed on behalf of 35 people from around the country who say they suffered symptoms ranging from electrical shocks to suicidal thoughts after discontinuing use of the drug. Paxil is the second largest selling anti-depressant in America. In June of 2001, a jury in Wyoming awarded $8 million in damages to a family of a man after determining that Paxil caused him to kill his wife, daughter, and granddaughter before he committed suicide.
Prescription Medicines, Side Effects and Natural Alternatives by American Medical Publishing, page 30

What’s true for Prozac doesn’t necessarily apply to other drugs classified as selective serotonin reuptake inhibitors (SSRIs). For example, the FDA has ruled that Paxil (paroxetine) should not be taken by anyone younger than age 18 because it is associated with a possible increased risk of suicidal impulses.
Dr Isadore Rosenfeld’s Breakthrough Health By Isadore Rosenfeld MD, page 87

6/29/01-Portland, OR, $5 Million Awarded In anti-depressant Negligence Case Jay Johnston tried commit suicide after being given Zoloft and then Prozac. He is permanently disfigured from the shotgun blast. He sued his doctor for not properly monitoring him and was awarded $5 million.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 280

A brand-new drug can be like a license to print money. It certainly worked that way for Eli Lilly. When the company launched the antidepressant Prozac in 1987, nobody else had anything quite like it, and Lilly cleaned up. But then other pharmaceutical firms rushed in with their own versions, including Zoloft, Paxil, Celexa and the recently newsworthy Luvox, found in the blood of Columbine High School shooter Eric Harris. The competition has already eaten into Lilly’s market share, and things can only go downhill from here.
“Beyond Depression” by Michael D. Lemonick and Alice Park, Time 5/17/99, page 74

Selective serotonin reuptake inhibitor (SSRI). Drug, such as Prozac, that increases levels of circulating serotonin. SSRIs have the potential for serious side effects, including suicidal thoughts, restlessness, and aggression.
The Memory Solution by Dr Julian Whitaker, page 252

It is also interesting to note that in all the cases of school shootings, the kids responsible for the violence were taking SSRI medications, which are known to produce suicidal and homicidal “side effects.” It is also known that these medications increase brain levels of the neurotransmitter serotonin, which, in high concentrations, can also act as an excitotoxin.
Health And Nutrition Secrets by Russell L Blaylock MD, page 79

Prozac and similar antidepressant drugs, such as Paxil and Zoloft, have seen a significant increase in use over the last decade, with approximately 28 million Americans having used the drugs, and 70% of the prescriptions for them written by physicians rather than psychiatrists. Joseph Glen-mullen, Ph.D., author of Prozac Backlash, considers this trend both dangerous and reckless, pointing out that anti-depressants can have severe side effects. These include uncontrollable facial and body tics (which can be signs of severe neurological damage), hallucinations, dizziness, nausea, anxiety, withdrawal symptoms, sexual dysfunction, and electric shock-like sensations in the brain. Dr. Glen-mullen cautions that a small percentage of people can become homicidal, suicidal, or both as a result of Prozac use.
Alternative Medicine by Burton Goldberg, page 798

“Do doctors prescribe SSRIs too often?”
One of the most compelling stories was that of Anna, who told me Prozac caused her to make a serious suicide attempt while in the care of a previous psychiatrist. As a freshman in college, Anna had been miserably depressed, missing her family and feeling unhappy with her roommates. As the year wore on, she consulted with a psychologist who referred her to a psychiatrist for medication. Anna was started on Prozac but became severely anxious, agitated, and sleepless. She felt “all sped up inside,” as if she were “in fast forward while the rest of the world was in slow motion.” Having never been suicidal before, two weeks after starting Prozac, Anna went to her HMO because she felt like killing herself. The psychiatrist on call told Anna the Prozac was indeed making her worse and hospitalized her. But her original psychiatrist disagreed, restarted Prozac, although at a lower dose, and added a second, sedating antidepressant (Trazodone), which Anna only took for two days.
Prozac Backlash by Joseph Glenmullen MD, page 140

Once she was stable, Anna was admitted to McLean Hospital, where she was described as having had a “paradoxical” reaction to Prozac. A nurse told her one of McLean’s psychopharmacologists, Dr. Teicher, had written about patients like Anna who became suicidal on Prozac. She was put on a different type of antidepressant, which did not precipitate the same reaction.
Prozac Backlash by Joseph Glenmullen MD, page 140

“Many research and case studies demonstrate a link between antidepressants and suicide and other violent behavior”
Women were known to use less lethal means until the SSRl antidepressants hit the market. But on Prozac and Paxil, women committed 40% of the suicides - many were strikingly violent and clearly leaving no means for rescue.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 280

Because suicidal tendencies are a frequent characteristic of depression, perhaps one of the most serious problems associated with antidepressants is the potential for drug overdose. The potential for suicide caused by the very medication prescribed to prevent it, is further enhanced by the synergistic interaction of the antidepressives with alcohol, barbiturates, and other central nervous system depressants. A glance through the PDR indicates that the quantity and the magnitude of the dangers associated with Elavil are equally present with the other antidepressants.
Get Healthy Now by Gary Null, page 215

Just before Christmas Dr Stuart Donovan and colleagues published a crucial article in the British Journal of Psychiatry. Of 2,776 patients taking SSRIs who were treated at the Derbyshire Royal Infirmary over two years. They found that if you look for a statistically significant relationship between taking SSRIs and suicide by overdosing on them, you won’t find much. But they did find a relationship between taking SSRIs and all forms of deliberate self-harm - including overdose, attempted overdose, hanging, gassing, laceration, deliberate road traffic accidents, head banging, swallowing non-medicines - much higher for SSRIs than for the older tricyclics. “The relationship is so strong, Dr Donovan says, that he firmly believes promotional material for SSRIs including Seroxat [Paxil] should be changed immediately so doctors no longer prescribe them to potentially suicidal patients thinking, mistakenly, that by doing so they are protecting their lives.” When Dr Donovan sent the manuscript of this study to SmithKline Beecham [now GlaxoSmithKline] (who partially financed the study along with Eli Lilly) before it was published asking for comments. They did not reply.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 15

There has been a study released focusing on the popular antidepressant Paxil and its role in suicidal behavior in children.
Ephedra Fact And Fiction by Mike Fillon, page 233

GULF WAR VETERANS: Captain Joyce Riley, who has headed the battle in exposing Gulf War Syndrome, has noted that approximately 80- 90% of the Gulf War vets are now on or have been offered one of the SSRI antidepressants. As a result many have had their lives turned upside down with others committing suicide or murder/suicide.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 15

One of the disadvantages of the older tricyclic antidepressants is that they are much more dangerous when taken as an overdose. But a very well kept secret, revealed by considering all the research, is that the actual rate of death from suicide is higher in patients who take the new antidepressants than in those who take the older tricyclics. Even more important, twice as many people taking the new antidepressants successfully committed suicide than did the people who took placebos. The results of all the studies–published and unpublished–showed that of every 1000 people with depression treated with one of the new antidepressant drugs, 4.6 more committed suicide each year than would have if they had been treated with a placebo.
Overdosed America by John Abramson MD, page 117

How do serotonin boosters catalyze suicidal and violent impulses? Does the phenomenon occur because of the drugs’ stimulating, re-energizing effects as with previous antidepressants? Or might something different happen with these new drugs, as Teicher and Cole suggested in their original report?
Prozac Backlash by Joseph Glenmullen MD, page 152

Nine clinical studies show: “SSRIs: Suicide Risk and Withdrawal (Editorial),” The Lancet 361:1999, 2003. See also Gardiner Harris, “Debate Resumes on the Safety of Depression’s Wonder Drugs,” New York Times, August 7, 2003.
Overdosed America by John Abramson MD, page 243

In another case, reported by Frederick Goggans and colleagues, in Medical Mimics of Psychiatric Disorders, a 27-year-old executive was hospitalized after attempting to kill herself by overdosing on antidepressants prescribed by her psychiatrist. The woman’s suicide attempt–her second–followed a year of psychotherapy that had failed to relieve her fatigue, cognitive problems, and despondency. She was distraught that her suicide attempt was unsuccessful, and told her doctors that she would probably try to kill herself again.
A Dose of Sanity by Sydney Walker III MD, page 108

While the FDA had cleared the drugs, my colleagues continued to describe some cases in which they appeared to have caused severe reactions–agitation, paranoia, psychosis, suicide, and violence–in a small number of patients. Rumors within psychiatric circles held that the FDA panel of outside experts had been flawed, beset with conflicts of interest and deeply divided on the issue of Prozac’s safety, in spite of the impression given to the public. Could it be true that a majority of the panel members had conflicts of interest? Had the vote not been unanimous? Was the panel so divided that one-third of its members pressed for a warning and changes in the guidelines for prescribing antidepressant drugs? What was one to believe?
Prozac Backlash by Joseph Glenmullen MD, page 143

“Studies show that Prozac, in particular, plays an especially large role in suicide and other violent behavior”
Treatment emergent suicidality with Prozac has been demonstrated to be two to three times higher than any other anti-depressant. (Jick, et al., antidepressants and Suicide)
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 280

It is apparent that the proportion of people taking fluoxetine and committing suicide is higher by an amount to be of concern to medical examiners and also to health care providers. The present report provides evidence that suicide has occurred more frequently in patients taking fluoxetine than in those taking tricyclic antidepressants, the possibility that fluoxetine has induced the idea of suicide must be considered.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 162

When you understand these problems, it is not surprising that twelve years after Prozac was approved, people were again raising the issue of Prozac-related psychoses, suicides, and violent acts. Recent books such as Prozac Backlash, and The Antidepressant Era have made headlines by citing studies suggesting a connection between Prozac and such reactions. A May 2000 story at Dr. Koop Health News began, “The question of whether Prozac, the most-prescribed antidepressant, can make some patients more likely to commit suicide just won’t go away, despite repeated and categorical rebuttals by the drug’s manufacturer, Eli Lilly and Co. Based on his experience as a suicide counselor and investigator, Dr. Ronald W. Maris, director of the Center for the Study of Suicide at the University of South Carolina, is firmly convinced that a risk exists.”
Overdose by Jay S Cohen, page 48

Dr. James W. Long in his discussion of Prozac in THE ESSENTIAL GUIDE TO PRESCRIPTION DRUGS 1992 explains, “A review of relevant literature on this subject reveals that the development or intensification of suicidal thoughts during treatment (regardless of the severity of depression) has been documented repeatedly for many antidepressant drugs in wide use. It is apparent that suicidal thinking may emerge during treatment with any antidepressant. ” And Fava and Rosenbaum state in a letter to the JOURNAL, OF CLINICAL PSYCHIATRY, in November 1991 that “..emergence of suicidal ideation or behavior has been observed with many antidepressant pharmacotherapies.”
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 49

He prescribed the medication Prozac. One month later, after taking this medication, she committed suicide by hanging herself. What was so strange about this unsuspected action was that she was not behaving like a person who was depressed or suicidal. At first we discounted the significance of this story. Unfortunately, emotionally disturbed people sometimes commit suicide whether they are taking an antidepressant or not. But in February 1990 an article appeared in the American Journal of Psychiatry that shed a new light on this case history. Physicians associated with the Department of Psychiatry at Harvard Medical School reported on six patients who suddenly developed an “intense violent suicidal preoccupation after 2-7 weeks of fluoxetine [Prozac] treatment.” It would be disastrous if an antidepressant medication actually produced “obsessive, recurrent, persistent, and intrusive” thoughts of suicide. This may be a rare occurrence, but the Harvard psychiatrists warn that people who feel fatigued and restless or sleep much more than usual may be at higher risk.
Graedons Best Medicine by Joe Graedon & Dr Terasa Graedon, page 214

In the early 1990s most doctors did not know what to make of the Prozac scare. Psychiatrists had long recognized that in the early weeks and months on any antidepressant, patients are at increased risk to act on suicidal impulses. Over the course of just a few weeks, antidepressants can jump-start patients, reinvigorating people who have been without energy for some time. The newfound energy provided by an antidepressant can suddenly enable a patient to act on suicidal or violent urges. Classic papers dating as far back as the 1930s describe the risk with amphetamine antidepressants. For decades pharmaceutical companies and drug proponents adamantly denied the phenomenon, but by the 1970s, when strict limitations were imposed on prescribing amphetamines, their ability to trigger suicide and violence had been firmly established.
Prozac Backlash by Joseph Glenmullen MD, page 141

A small number of people taking fluoxetine have experienced intense, violent, suicidal thoughts, agitation, and impulsivity. Whether their symptoms were induced by fluoxetine or were related to their underlying psychological problems is unclear. As with any other antidepressant, fluoxetine should only be used under close medical supervision. Patients are advised to consider telling relatives and friends about their use of this drug and the risk of suicidal obsession and self-injurious behavior.
Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmD MPH, page 235

On September 20, 1991, the FDA held a hearing to discuss a request that warnings be placed upon the labels of Prozac and other antidepressants, which was made by Ralph Nader’s health research group, The Public Citizen. They felt that problems were serious enough that warning labels mentioning the possible side effects of “violence and suicide” should be put on the bottle to make consumers more aware of the rapidly mounting evidence that Prozac may chemically induce this reaction. Ten professionals sat on the FDA board. Although the FDA had felt that the financial interests held by these ten individuals would not sway their vote, so they had them sign a statement that they would not allow that to influence them. All five who admitted their interests at the beginning of the FDA hearing voted “against” the warning label.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 315

Fluoxetine and the other SSRIs may reduce the risk of suicide in depressed patients. However, there have been a few reports that fluoxetine may actually induce suicidal thoughts in selected patients, although this has not been confirmed. Public Citizen’s Health Research Group petitioned the Food and Drug Administration in 1991 to require a box warning in the professional product labeling for fluoxetine warning doctors that a small minority of persons taking the drug have experienced intense, violent, suicidal thoughts, agitation, and impulsivity after starting treatment with the drug. You should not take this drug for mild depression or anxiety, or as a sleeping pill.
Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmD MPH, page 235

Because of her suicidal and self destructive behavior her dosage of Prozac was increased, and along with that increase came an increase in suicidal ideation and self mutilation. Finally her doctor read Dr. Tiecher’s report, immediately called her and told her he felt her problem was Prozac. She argued that she must “need” this antidepressant because of her odd behavior. Then as the evidence became clear to her, she asked, “You mean to tell me I have gone through this Hell because of an anti-depressant?!!” Rhonda Hala went off Prozac and returned to a normal mental and emotional state.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 216

I continued to check in with Joanne daily. The suicidal preoccupation subsided quickly and was completely gone within a week. Given what had happened, Joanne did not want to try another antidepressant. I wasn’t feeling that bad before I started Prozac.” Indeed, Joanne did fine without medication.
Prozac Backlash by Joseph Glenmullen MD, page 146

“I became obsessed with death, with my sickness. I became obsessed with the idea that I was a sick person who would have to be on antidepressants all my life. I became obsessed with dying. I thought dying was the only way out, and I had never contemplated suicide before that time. ”
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 266

“Eli Lilly’s staunch defense of Prozac”
Presumably Prozac’s advocates were afraid any change in the prescribing guidelines for antidepressants, even a general warning, would have caused further public relations problems for the pharmaceutical industry. Public fear was already running high. Prozac was alleged to be associated with suicides, murders, murder-suicides, and even mass murder-suicides like Joseph Wesbecker’s shooting spree at Standard Gravure. Numerous lawsuits had been filed in deaths associated with Prozac. Given how high profile the issue had already been, any suggestion that antidepressants could cause severe agitation that needed to be controlled with sedatives would only raise more questions. Pharmaceutical companies spend hundreds of millions of dollars developing and launching a drug like Prozac. By 1991, Prozac was already the number-one best-selling antidepressant, with sales near $1 billion a year. The stakes were indeed high. So the pharmaceutical industry and drug advocates decided to defend Prozac at all costs, despite the risks to individual and public safety.
Prozac Backlash by Joseph Glenmullen MD, page 162

Teicher and his colleagues went on to recommend that, “the practitioner be attentive to the possible emergence of suicidal ideation, even in those patients without a previous history of suicidal thoughts or actions. Patients who have previously been treated with other antidepressants or who develop intense fatigue, hypersomnia, or restlessness while taking fluoxetine [Prozac] may be at risk.”
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 154

Healy himself has continued to publish on the subject of suicidality and violence associated with Prozac. He has published numerous articles and several books, including a recent one on the Prozac-type antidepressants. The antidepressant Era, published by Harvard University Press. In court declarations, Healy reports Lilly has been guilty of “bald mischaracterization” of his statements and work. Healy says Lilly’s “refusal to mount or countenance further investigation” of Prozac’s causing suicide and violence “must say something about their perceptions of what the likely outcome would be.”
Prozac Backlash by Joseph Glenmullen MD, page 179

Suicidality was more frequent among patients receiving Prozac than among those receiving older, tricyclic antidepressants. “The relative risk of suicidality was 3.3. Interestingly, the proportion of patients with treatment-emergent suicidality on Prozac in this study was similar to that reported by Teicher” in his original article calling attention to the problem.
Prozac Backlash by Joseph Glenmullen MD, page 163

Although Prozac was reported to have fewer side effects than most antidepressants, and this was the basis for the aggressive marketing that has pushed Prozac to the top of the charts, the FDA lists approximately 575 side effects. Additionally, Lilly admitted to the FDA on April 20, 1990 that they did not include “suicidal thoughts” as an adverse event and therefore, did not look for that as a side effect in their clinical trials on Prozac.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 54

In the mid-1980s, the German food and drug administration notified Lilly that they were not going to approve Prozac “because of their concern with suicidality and agitation,” said Dr. Lord. She continued, “They [the Germans] said that people became agitated before the antidepressant effects came on, and that increased the risk of suicide. They wrote a memo concerning damaging effects, and Lilly then went over there and looked at the data again and pulled out cases that they didn’t think were suicide. How are they to know? The investigator [researcher] thought it was a suicide attempt. They said, well we don’t think it is.” Difficulties in other European countries were handled in a similar way.
Prozac Backlash by Joseph Glenmullen MD, page 169

“Some research studies and government organizations have ties to the pharmaceutical industry”
Britain’s Dr. David Healy mentioned in a lecture at U of T that Prozac may trigger suicide in some patients. This has raised a real stir among scientists as Prozac’s manufacturer, Eli Lilly, is an important private donor to a mental-health research institute affiliated with the university.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 280

One of the latest flaps in psychiatry circles that has spilled into the public press, deals with the safety of the SSRIs. Occasional suicides and violent behavior in children have led to calls by some to follow the lead of the British equivalent of our FDA in banning all SSRIs for children except Prozac, and early in February 2004 the FDA was scheduled to hold hearings on the issue. Days before the hearing, a group of researchers from the American College of Neuropsychopharmacology, headed by two prominent academic psychiatrists, released a preliminary analysis of their Task Force on SSRIs and Suicidal Behavior in Youth. It concluded that antidepressants did not increase the suicide risk in children, and that the benefits of SSRIs outweighed their risks.59 Their report was immediately criticized because nine of the ten panel members allegedly had “extensive ties to the pharmaceutical industry.”60 Some critics labeled their report “junk science”; others were less restrained.61 At the hearing, FDA regulators testified that their analysis did suggest that in clinical trials the risk of suicide in children was increased over those taking placebos with some of the SSRIs.62 So far, the FDA has decided only to require a warning about possible suicide tendencies in descriptions of these drugs.
On The Take by Jerome P Kassirer M.D., page 127

Had the FDA decided to add a warning on suicide and violence to the label of antidepressants, this would have necessitated closer monitoring of patients, markedly reducing Prozac’s unique appeal for primary-care clinicians.
Prozac Backlash by Joseph Glenmullen MD, page 167

All of these drugs by reducing 5HIAA serotonin levels should, therefore, produce any or all of the listed behaviors associated with low 5HIAA serotonin levels, ie: suicide, arson, violence, alcoholism, depression, insomnia, impulsive behavior, etc. These are many of the symptoms which patients are encouraged to take these drugs to alleviate. This has been a most incredible deception. Whatever the reason for patients, many physicians, the FDA, Congress, any of us, to have been kept in dark about the critical similarity of these antidepressant drugs to the psychedelic drugs and their potential to induce these behaviors is absolutely inexcusable.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 109

Acta Psychiatrica Scandinavica
Volume 110 Issue 6 Page 452 - December 2004
doi:10.1111/j.1600-0447.2004.00437.x
Volume 110 Issue 6

Antidepressants and suicidal behaviour in unipolar depression
B. I. Yerevanian1,2, R. J. Koek1,2, J. D. Feusner1,2, S. Hwang2,3, J. Mintz2,3
Yerevanian BI, Koek RJ, Feusner JD, Hwang S, Mintz J. Antidepressants and suicidal behaviour in unipolar depression.
Acta Psychiatr Scand 2004: 110: 452–458. © Blackwell Munksgaard 2004.

Objective: To compare the rates of suicidal behaviour during vs. after discontinuation of treatment with antidepressants, and to determine the comparative rates of suicidal behaviour for patients maintained on tricyclic (TCA) vs. selective serotonin reuptake inhibitor (SSRI) antidepressants.

Method: Charts were reviewed for 521 patients with major depressive disorder and/or dysthymic disorder. Periods of active treatment or discontinuation with SSRIs or TCAs were determined. Rates of completed suicide, suicide attempts, and hospitalization for suicidality were analyzed.

Results: There was greater than a five-fold increase in risk for suicidal behaviour after discontinuation of antidepressant treatment (P < 0.0001). The rates of suicidal behavior during treatment with SSRIs or TCAs were similar.

Conclusion: Suicidal behaviour in unipolar depressed patients treated with antidepressants increases substantially after medication discontinuation. This effect occurred in both patients who were maintained on SSRIs and TCAs. The findings support a possible protective effect on suicidal behaviour for both SSRIs and TCAs.

Despite well-documented evidence for acute and maintenance efficacy for relief of depressive symptoms, controversy still exists around the issue of whether antidepressants increase, decrease or have no effects on the risk of suicidal behaviour in unipolar depression (1). This important question is largely unanswered due to many factors, such as the difficulty in conducting randomized clinical trials on ethical and practical grounds. Investigators have had to rely on other methodologies, including epidemiologic surveys, retrospective reviews of clinical populations or analyses of suicidal outcome in clinical trials of antidepressants. Suicidal behaviour is a serious potential complication of depressive disorders, with suicide rates exceeding that of the general population by at least an order of magnitude (2, 3). Suicide attempts as well as hospitalizations for suicidal potential are major public health issues.

Many epidemiologic studies have found reduction of suicidality in regional populations in association with antidepressant prescription. Isacsson found that an increase in antidepressant prescribing in Sweden during the period 1991–96 was associated with a reduction in suicide rates compared with the period 1978–90 (4). Carlsten et al. reported that suicide rates in Sweden declined for the 20 years between 1977 and 1997 but that the rate of decline accelerated after selective serotonin reuptake inhibitor (SSRI) antidepressant introduction in 1990 (5). In Australia, Hall et al. demonstrated that between 1991 and 2000 there was no overall change in suicide rate. However, rates of suicide in older men and women did decrease substantially in association with exposure to antidepressants (6). In Hungary, Rihmer reported a decrease in suicide rates following the introduction of the SSRIs in that country (7). Ohberg et al. (8) found that suicide mortality declined in Finland over the years 1990–95 and prescription of SSRIs increased during the same period. One study in Italy by Barbui et al. found no association between national suicide rates and the introduction of SSRIs, but significant regional variation made interpretation difficult (9). Similarly, Levi et al. found significant geographic variation in trends in overall suicide rates during the period of 1965–99 using a WHO database covering 47 countries (10).

Both retrospective clinical studies and toxicological studies indicate that a low proportion of suicide completers were taking antidepressants at the time of suicide. Andersen, in a retrospective analysis of completed suicides derived from national registers inDenmark, demonstrated that the percentage of these cases treated with antidepressants was low compared with what would be considered indicated for depression (11). In addition, depression may be inadequately treated with antidepressants both before and after attempted suicide (12). Toxicological evidence from several postmortem analyses also suggests that most suicide completers had not taken antidepressants; a range of only 8–20% of suicides were reported to be positive for antidepressants (13–16). A large study in Sweden examined forensic toxicology results for 200 different substances from a total of 15 400 completed suicides from 1992 to 2000. Only 20.1% of these individuals were positive for antidepressants (17). In a pharmacoepidemiologic study, Isacsson found that depressive patients treated with antidepressants had a 1.8-fold lower rate of completed suicide than untreated patients, suggesting that antidepressant treatment may diminish suicide rates (18).

In several controlled trials of antidepressant treatment, the relationship between antidepressants and suicidality has been addressed as a secondary consideration. In a study of recurrent brief depression with suicide attempts, fluoxetine neither raised nor lowered the suicide rate as compared with placebo (19). To determine the difference in effect on suicidality between paroxetine and amitriptyline, Möller et al. (20) analyzed data from a 6-week double-blind controlled study. A marked reduction in suicidal thoughts occurred in both groups; at baseline, approximately 80% of subjects had suicidal ideation, while at week 6 this decreased to approximately 20%. There were no significant differences between the two medications (20). Szanto et al. found complete remission of suicidal ideation in 395 elderly depressed patients after 12 weeks of either nortriptyline or paroxetine (21).

In a meta-analysis of nine trials of various drugs from an FDA database covering 1985–2000, Khan et al. found no difference between patients treated with SSRIs, placebo or newer non-SSRI antidepressants on measures of percentage of death from suicide as well as incidence of suicide per years of exposure (22). In meta-analyses of clinical trials data, placebo groups had significantly higher rates of emergent suicidal ideation than groups given fluoxetine (23) or paroxetine (24). Data from controlled trials, as recently reviewed by Möller (25), overall suggest a greater benefit of SSRIs compared with placebo, and possibly compared with other antidepressants, in reducing suicidal ideation. Differences between antidepressants of different classes in reducing suicide attempt and completion rates are as yet unclear (25). The non-generalizability of findings from controlled trials to clinical care situations has been discussed previously (25–27). In particular, most are of short duration (4–12 weeks), and thus do not address the effect on suicidal behaviour during maintenance antidepressant therapy. In addition, controlled trials typically exclude patients with significant suicidality at baseline.

There is less information from larger, carefully followed clinical populations regarding the effect of antidepressants on suicide. A study using data from the National Institute of Mental Health Collaborative Depression Study examined 643 subjects treated with fluoxetine, other antidepressants or no antidepressants, followed prospectively for an average of 4.4 years (28). Treatment with fluoxetine and other antidepressants was associated with non-significant reductions in the likelihood of suicide attempts or completions. This reduction occurred despite the observation that those who received fluoxetine reported significantly more prior episodes of depression at intake than those who received no antidepressants.

While the epidemiological data and observations from controlled trials largely suggest a protective effect of antidepressants, several important details deserve further exploration. For example, suicides and suicide attempts that appear to occur in the course of antidepressant treatment may actually represent suicidal behaviour following unreported or unsuspected discontinuation of medications. Discontinuation itself may occur for various reasons. The patient may feel he/she is in remission and does not need the medication. Intolerable side effects, non-response to medication, or substance abuse may be other reasons. Worsening of depression, with hopelessness and 'giving up' (i.e. suicidality as a cause rather than effect of medication discontinuation) may often occur unreported. Patient compliance and sudden discontinuation may have important effects on suicidal behaviour that are difficult to assess in epidemiological surveys.

To address this difficulty, a more thorough analysis of patients' clinical status is necessary. In a previous investigation, we developed a chart review method by which we were able to compare rates of suicidal behaviour in patients with bipolar disorder during periods of treatment with a mood stabilizer (lithium, divalproex or carbamazepine) to periods after discontinuation of such medications (29). All patients were carefully followed by a single clinician throughout the period of study, and medication compliance was documented. Patients were treated naturalistically and the data reviewed retrospectively. Using the same method, in this study we examined data from a carefully followed clinical population of patients with unipolar depression in order to better clarify the details of antidepressant effects on suicide.

Aims of the study

(i) To compare the rates of suicidal behaviour for patients maintained on antidepressants vs. rates of suicidal behaviour after discontinuation of medication. (ii) To determine the comparative rates of suicidal behaviour for patients maintained on tricyclics (TCAs) vs. those maintained on SSRIs.

Subjects

This study is a retrospective review of the clinical records of 521 patients followed for various durations of treatment by the senior author between 1978 and 2002, in the US, spanning the era of TCAs as well as the SSRIs after their introduction in 1987. Patients were in clinical care with the senior author, and all data were generated for the purpose of monitoring and management according to clinical need. The present study was designed after completion of care to provide an assessment of the influence on suicide of antidepressant treatment of unipolar depression in adults in a naturalistic setting.

Patients were included in this study if they met the following criteria: (i) Diagnostic and Statistical Manual (DSM)-III/IIIR/IV criteria for major depressive disorder and/or dysthymic disorder; (ii) minimum 6-month follow-up by the senior author; (iii) antidepressant monotherapy, started under the care of the senior author and lasting a minimum of 1 month; (iv) charts contained specific inquiry regarding suicidal thoughts, plans, attempts, hospitalizations and completed suicide.

Patients requiring multiple antidepressant/mood stabilization/antipsychotic regimens were excluded for purposes of this study as were patients with active alcoholism and substance abuse. Benzodiazepines were the only adjunctive psychotropic allowed. Thus, this was a relatively homogeneous population of outpatients. Patients were treated in various university, clinic and private settings.

The duration of medication treatment, in months, was recorded as well as the number of months following discontinuation. No attempt was made to distinguish between rapid and gradual discontinuation. Compliance was assessed routinely during visits by clinical inquiry. Patient characteristics are summarized in Table 1.

Dependent and independent variables

Dependent variables. Three categories of events were recorded as the dependent variables: (i) completed suicide; (ii) suicide attempts, defined as self-induced physical damage with expressed intent to die; and (iii) hospitalization for serious suicidal thought or intent.

Dependent variable events in the present report were only those that happened during time under the author's care, to ensure reliability of event reporting. No historical suicidal events are reported.

A hierarchical system was constructed such that for any episode, the more serious event was recorded. Highest on the hierarchy was completed suicide, followed by suicide attempt, and then hospitalization. Thus, for example, hospitalization following a serious attempt was recorded as a suicide attempt and not a hospitalization event.

Independent variables. Time was recorded as total time observed rather than time to event. For most patients this included time before and time subsequent to any suicidal event. As many patients changed medication over time, any individual patient could be recorded for months of exposure to more than one antidepressant.

The absolute numbers of events for each ON and OFF medication period was recorded. The rate of events/100 patient-years were then computed for each medication group ON and OFF medications.

Statistical analysis

Because of concerns about the distributions (many zeros), the unbalanced design (some cases contributing data to multiple cells) and numerical problems that arose in some cases due to zero cells, the parametric analyses were supplemented using robust bootstrap replication analyses. These were carried out without reference to parametric statistical methods. The method involved creating k = 100 bootstrap samples by randomly sampling n = 521 cases (the total sample) with replication from the data set itself. In each of these independently derived samples, the simple rates of attempts, suicides and hospitalizations (e.g. sums divided by total months at risk) were computed within each cell of the design. Appropriate differences of interest (e.g. differences in rates on and off TCA) were calculated as well by simple subtraction of the rates in each replication sample. The mean of these values across the 100 samples estimates the rate, and the robust standard errors are given by the standard deviation of these values calculated across the samples. Normal curve Z-tests and two-tailed probabilities were computed by dividing these rates (means) by their standard errors (standard deviations in the bootstrap samples).

Table 1 shows the clinical and demographic characteristics of the group of 521 patients. Suicide outcome data are depicted in Tables 2–5. In each table, ‘Month’ refers to the total number of months on treatment, observed across all patients. ‘Attempt’ refers to the number of suicide attempts. ‘Suicide’ refers to the number of completed suicides. ‘Hosp.’ refers to the number of hospitalizations for suicidal ideation or intent. ‘All’ is the sum of ‘Attempt’ + ‘Suicide’ + ‘Hosp.’

ON vs. OFF antidepressants (Table 2)

Rates of all suicide events increased more than five-fold during periods after discontinuation, compared with during antidepressant treatment for all antidepressants combined (P < 0.0001). There was almost a seven-fold higher rate of suicide attempts during the OFF antidepressant period compared with the ON period (P = 0.003). There was similarly a greater than four-fold rate of hospitalizations during the OFF period (P = 0.0001).

Effects of ON vs. OFF periods for TCAs (Table 3)

Rates of all suicide events were more than five-fold greater during the OFF TCA period, compared with the ON period (P < 0.0001). There was more than a five-fold greater rate for both suicide attempts and hospitalizations during the OFF period (P = 0.009 and 0.0003, respectively).

Effects of ON vs. OFF periods for SSRIs (Table 4)

For SSRIs rates of all suicide events were more than four-fold higher during the OFF period, as compared with the ON period of treatment (P = 0.014). This was likely accounted for by a nine-fold higher rate of attempts during the OFF period (P = 0.05). There was a non-significant trend towards a higher rate of hospitalizations during the OFF period.

Comparison of effects of ON periods of SSRIs vs. TCAs (Table 5)

The rates for all suicide events considered together were just significantly higher (less than two-fold), during ON treatment periods with TCAs than they were during treatment with SSRIs (P = 0.046). When each category of suicide attempts, completed suicides, and hospitalizations were considered individually, there were no significant differences.

The results of this longitudinal study indicate that the rate of non-lethal suicidal behaviour in unipolar depressed patients treated with antidepressants increases substantially after medication discontinuation, and that this effect is similar for patients who were maintained on TCAs compared with those maintained on SSRIs.

There were few completed suicides observed in this study. Although the direction of the results in this category is consistent with the findings in other categories, the small numbers preclude meaningful statistical analysis.

The combined period represents 10 311 months (859.25 total years) of close clinical observation spanning 24 years in the clinical practice of a single experienced mood disorders specialist. The rates of completed suicide and attempted suicide while on antidepressants (0.12 and 1.4 per 100 patient-years, respectively) are in keeping with the rates in treated patients with major depression in the literature (18) and are higher than the general population [about 0.0166 for completions and 0.299 for attempts, per 100 person-years in the US (30)].

Antidepressants may have a different impact on suicidal behaviour depending on their pharmacologic profile as well as other properties including specificity for subgroups of depressed patients, side effect profile, patient acceptance and differential prescription by clinicians based on safety considerations of medication type in suicidal patients. For example, SSRIs may differentially be prescribed to more severely suicidal patients because SSRIs are safer in overdose than tricyclics. This would introduce ‘confounding by indication’. Donovan et al. found a higher risk following prescription of an SSRI than a TCA (31). One possible explanation they offered was that the apparently higher risk for SSRIs may be attributed to the prescription of safer-in-overdose antidepressants for those felt to be at a higher risk. Several authors have suggested that there may be true differences in effects on suicidality of different pharmacological classes of antidepressants. Montgomery et al. postulated that noradrenergic medications such as maprotiline, desipramine and nortriptyline may have a suicide-provoking potential, while serotonergic antidepressants appear to be neutral or protective (32). The hypothesis that antidepressants with certain biochemical modes of action present a suicide-inducing risk has not been supported by controlled studies (24, 33).

In this study when compared directly to the ON SSRI period, there was a slightly higher rate for all suicidal events during the period of ON TCA treatment. This could reflect a true difference between the two antidepressant classes in effect on suicidal behaviour. Alternatively, it could be accounted for by the fact that, when suicidal, patients treated with TCAs are more likely to be hospitalized because of the risks of toxicity.

The principle finding of this study is that discontinuation of antidepressants, irrespective of category, is a time of high risk. The fact that after discontinuation of antidepressants the rates of suicidal behaviour rise suggests that antidepressant treatment may have had a protective effect against suicidal behaviour. This interpretation must be made with caution, as in this study all OFF medication periods were after discontinuation and not ‘OFF’ periods prior to treatment. The apparent heightened risk period following discontinuation could be due to several factors, including: (i) discontinuation-associated reemergence of clinical depression; (ii) a pharmacologic rebound effect of worsening suicidality; (iii) a physiological discontinuation syndrome; and (iv) hopelessness, leading to treatment discontinuation.

As antidepressant discontinuation appears to be associated with a substantial increase in risk of suicidal behaviour, a major clinical focus of pharmacological intervention should be on the long-term monitoring of treatment adherence. In addition, from a research perspective, caution should be taken in interpreting studies of the suicidal or anti-suicidal properties of antidepressants where careful analysis of treatment adherence is not a part of the methodology or there is a lack of close observation of the patient.

For Your Health and For Your Life - Dangerous Side Effects of Paxil You Must Know About

Concerns are growing about the side effects of Paxil. Recent studies have found that the drug is relatively ineffective in children, and suggested that they are prone to becoming suicidal in the early stages of treatment. Some psychologists believe that this is due to the way the drug begins to work in many patients. The first effect most people notice is a decrease in the lethargy and amotivation they experienced during their depression. This effect happens before the depression itself improves, so children may end up with enough “energy” and motivation to act on suicidal tendencies they may have already had.

Side Effects Include:

• drowsiness • sleepiness • nausea • upset stomach • dry mouth • constipation • diarrhea • decrease of sexual desire

• delayed orgasm or anorgasmia • rash • restlessness or akathisia • itch • sodium depletion • changes in urination • usually increases or suppresses appetite

It is also important to note many people who are prescribed Paxil are suicidal to begin with. However most studies have compared suicide rates in patients using Paroxetine against a control group of depressed individuals not being treated with paroxetine and the paroxetine group was reported to be twice as likely to commit suicide.

Although the manufacturers say there is no reliable clinical evidence that the drug can cause violence or aggression, a wrongful death suit was filed against GlaxoSmithKline in June 2001 by the surviving family of Donald Schell, a Wyoming man who had killed his wife, daughter and grandchild after two days on the drug. During the investigation of the clinical records, it was reported that, although paroxetine is safe and effective most of the time, in a minority of cases the drug can cause unpredictable side effects such as wild mood swings or suicidal thoughts. The jury ultimately awarded damages of $8 million against GlaxoSmithKline.

In June 2004 New York attorney general Eliot Spitzer began civil proceedings against GlaxoSmithKline over allegations that the company had suppressed five internal studies between 1998 and 2002 on the effects of the drug on both children and adults which suggested that, at best, the drug had little more effect than a placebo and at worst induced suicidal tendencies in its users. The company responded shortly later by making the results of the studies publicly available.

In March 2005, the United States Food and Drug Administration ordered the seizure of millions of tablets of Paxil after 3 years of GlaxoSmithKline’s unresolved manufacturing problems. These problems involved Paxil CR, a time-release version of the drug. Some capsules were found to break in two, potentially resulting in the user taking only the active element of the drug without the time-release portion, or vice versa.

In September 2005 the Therapeutic Goods Administration (TGA) of Australia issued a warning about the potential for increased birth defects in the babies of pregnant women taking the anti-depressant Paroxetine. Early results from pharmaceutical giant GlaxoSmithKline suggest an association between taking the drug in the first three months of pregnancy and birth defects. The risk of cardiovascular defects may double from 1 to 2 per cent in babies of women taking Paroxetine. A recent Dutch study suggests a 60 per cent increase in defects. The TGA is urging women not to suddenly stop taking the SSRI as withdrawal may cause harmful side effects.

Individuals experiencing any of the following symptoms should contact their doctor immediately:

• jaw, neck, and back muscle spasms
• fever, chills, sore throat, or flu-like symptoms
• yellowing of the skin or eyes