The drug controversy

The recent negative publicity about antidepressant drugs (in particular, studies linking paroxetine, Seroxat, to increased suicide…

The recent negative publicity about antidepressant drugs (in particular, studies linking paroxetine, Seroxat, to increased suicide risk in young people) has, according to Prof John Geddes, professor of epidemiological psychiatry at the University of Oxford, caused "the routine stigmatisation and trivialisation of mental disorders".

Writing recently in the British Medical Journal, Geddes argued that "doctors must not become reluctant to use antidepressant drugs in patients with clearly defined depressive disorders, but they should also monitor patients carefully in the first weeks of treatment."

Prof Patricia Casey, of UCD and the Mater Hospital, Dublin, says: "There is no evidence that selective serotonin reuptake inhibitors [SSRIs are the newer group of antidepressant drugs which include Prozac and Seroxat] cause suicidal thoughts. All research shows that people with depression who are treated with antidepressants are more likely to have suicidal thoughts in the early stages of taking medication because as the person's drive improves, these thoughts emerge and he/she is are more at risk of suicidal actions.

"Many patients were taken off the older antidepressant medication [tricyclic antidepressants] because they were toxic if patients overdosed on them."

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Casey believes the controversy is linked to the wider problem of patients with mild forms of depression - often linked to stressful life events - being given antidepressant medication (see main piece) . In the United States, the Food and Drug Administration has asked that several antidepressants include information recommending that adults and children taking these drugs be closely observed for worsening depression and the emergence of suicidal thoughts.

In Britain, the Medicines and Healthcare Products Regulatory Agency has advised that SSRIs other than fluoxetine (Prozac) should not be used in children and that the dose of paroxetine (Seroxat) should be limited to 20 mg in adults. In Ireland, paroxetine (Seroxat) was never licensed for use with children and the Irish Medicines Board has advised all medical practitioners not to prescribe it for children and teenagers.

"The increase in prescribing of SSRIs has coincided with a fall in the suicide rate in many countries, implying that SSRIs are not a major cause of suicide," Geddes argues.

"Short-term randomised trials of SSRIs in children and adolescents show a modest increase in some suicidal thoughts and behaviours, but it is unwarranted to assume that this translates into an increase in the risk of suicide itself, rather than reflecting the transient increase in agitation that is a recognised adverse effects of SSRIs."

The forthcoming British Institute for Clinical Evidence guidelines on managing depression suggests the role of SSRIs is strongest in major depression of at least moderate severity but their use for mild depression - which presents frequently in primary care - is unproved.