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The People’s Pharmacy: Patients should be made aware of risks antidepressants pose

Can antidepressants lead to suicidal thoughts and actions? This controversial question has been debated for more than 25 years.

Not long after Prozac (fluoxetine) was introduced in 1987, we started hearing about tragic events affecting people taking this drug. In the spring of 1990, a physician wrote to us about his 40-year-old daughter. She was married and had two teenage daughters, and worked as a nurse. He was convinced that she hanged herself because of Prozac.

It was prescribed for her for an eating disorder in January 1988. Just before she killed herself in February, she promised to take care of a neighbor’s cats for several days. He felt that she would never have made such a commitment if she had been planning to commit suicide.

In February 1990, an article was published in the American Journal of Psychiatry reporting on six patients who suddenly developed “intense violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment.”

When we contacted the manufacturer, Eli Lilly, we were told in a letter dated June 19, 1990, that “The incidence of suicidal thinking or acts did not differ significantly among patients treated with Prozac, placebo or tricyclic antidepressants.” The company’s position in those days was that there was no support for the idea that Prozac could cause suicidal ideation or behavior in either depressed or nondepressed patients.

Fast-forward to 2016. Although there are still health professionals who do not believe antidepressant medications like duloxetine, fluoxetine and sertraline could trigger suicidal thoughts, the Food and Drug Administration requires such drugs to come with strong black-box warnings similar to this one for fluoxetine:

“Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. … In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.”

Such warnings were too late to protect many people. One mother wrote in 1991, “I suspect the drug fluoxetine may be implicated in the death by self-immolation of my daughter … fluoxetine intensified my daughter’s anxiety to an unbearable degree and provoked self-injurious and highly dangerous behavior that had not been present before taking the drug and that eventually proved lethal.”

The drug company’s insistence in 1990 that there was “no causal relationship” between Prozac and suicide attempts is consistent with other pharmaceutical manufacturers’ responses to bad news. For the 40 years that we have been studying drug-safety issues, we have often seen initial resistance or denial of a problem that later proved serious.

In the case of antidepressants, no one could imagine that drugs prescribed to prevent suicide could actually contribute to that very outcome. Family members and patients themselves often are able to detect adverse drug reactions long before companies or regulators acknowledge them. Nonetheless, it is crucial for patients and their families to be alerted to this potentially deadly side effect.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: PeoplesPharmacy.com.