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Suicide Warnings on Anti-Depressants: Why?

It’s going to be rarely that I write a post on this blog because of a pet peeve. But in this case, I can’t help it.

I’m really annoyed.

In recent months, manufacturers of anti-depressants have had to add “black-box” warnings about potential suicidality among children using the medications. I think a warning is wise, but a black-box warning seems like overkill. Just a few weeks after a common-sense analysis showed that the benefits of using antidepressants in youth may well far outweigh the risk of suicide (untreated depression, after all, can lead to suicide), now the FDA is considering more black box warnings about suicidality in young adults during the initial stage of treatment (summary article here).

Thereby, continuing to scare off people who may well need the medical intervention of an anti-depressant to prevent things like…well, suicide.

OK, fine, there may be some small percentage of people who have an increase in suicidal thoughts and behaviors after starting an anti-depressant. But there are two things to consider here:

– the patients may well have had such thoughts beforehand, and careful monitoring is the key element in care for these cases

– how many more who are treated have a subsequent DECREASE in suicidality?

What’s the cause of all this black box mania? It’s the irrational perspective that we somehow need to have risk-free, side-effect-free medicines. It’s a fantasy, though one that lawyers, media types, regulation-huggers love to indulge. And even if a medication does good for a huge percentage of people, and perhaps has negative effects on a few, everyone has to cover their backside by issuing (perhaps extreme) warnings.

We hear warnings about drug companies being guilty of disease-mongering. But what is the human cost of fear-mongering, so that people aren’t helped who need to be? If black box warnings scare off 100 seriously depressed people from using a medication that might keep them from jumping off a building in despair, for the sake of one who might have an increase in suicidal thoughts – is that a good trade-off??

Yes, I have a dog in this fight, because I have been successfully treated – probably the word “transformed” is more accurate – with an anti-depressant. And it irks me that people parlay scary scenarios touching a few, into major headlines that may negatively impact far more.

Pretty soon we’ll be sticking black-box warnings on babies in their hospital cribs. After all, life is dangerous, and full of side-effects…

(Image credit: FLickr)

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