Adults taking popular antidepressants such as Prozac, Paxil and Zoloft are more than twice as likely to attempt suicide as patients given sugar pills, according to an analysis released yesterday of hundreds of clinical trials involving tens of thousands of patients.
The results mirror a recent finding of the Food and Drug Administration that the drugs increase suicidal thoughts and behavior among some children, and offer tangible support to concerns going back 15 years that the mood-lifting pills have a dark side.
Transcript: Epidemiologist Dean Fergusson was online to discuss a new study on adults and popular antidepressants.
The examination of 702 controlled clinical trials involving 87,650 patients is the most comprehensive look at the subject and is particularly telling because it counted suicide attempts and included patients treated for a variety of conditions, including sexual dysfunction, bulimia, panic disorder and depression.
Experts cautioned, however, that the risks should be balanced against the drugs' benefits. They have been shown to be effective against depression and a host of other disorders in adults, a positive track record largely missing in tests of the drugs on children.
Adults with severe depression should continue to be considered for drug treatment, but those with milder symptoms should probably not be medicated, said John Geddes, a professor of epidemiological psychiatry at Oxford University, who wrote a commentary accompanying the studies.
"For a lot of time, these drugs were seen as a panacea for low mood in general," he said in a telephone interview. "We do need to ensure they are only prescribed for patients with clearly diagnosed depressive disorders."
The new study is certain to add to the controversy over the class of drugs known as selective serotonin reuptake inhibitors, or SSRI's. After the arrival of Prozac in 1988, these drugs have transformed psychiatry in the United States, even as persistent critics have warned that their benefits were hyped and their risks ignored. A spate of lawsuits in recent years have claimed that the drugs were responsible for violent and suicidal behavior.
New analyses of clinical trials in children last year prompted FDA to require a prominent black-box warning on labels that the medications could increase the risk of suicide. The warning refers only to children but is given to all patients.
American psychiatrists continue to strongly back SSRI drugs. Groups such as the American Psychiatric Association say that fears of drug-induced suicide are vastly exaggerated and that untreated depression carries a far greater risk of suicide.
"If these medications were really increasing the incidence of suicide attempts, you would think we would be seeing more completed suicides," said David Fassler, an APA trustee and psychiatrist in Burlington, Vt. "In fact, we are seeing exactly the opposite."