The Other War on Drugs

Is the cure for depression worse than the illness? The Food and Drug Administration’s (FDA) advisory committee recently answered in the affirmative in their recommendation to brand antidepressants with a “black box” warning label. Apparently, antidepressants and youth depression don’t mix; studies have documented a minimal increase in suicidal thoughts among children and adolescents taking prescribed antidepressants compared with those taking a placebo. This is worrisome indeed—not for the two or three percent on antidepressants who would experience heightened thoughts and ideas of suicide, but for the tens of thousands who may be deprived of vital treatment in the future. Avoidance or hesitancy among both physicians and family members to prescribe or even consider this form of medication is the real risk here.

The antidepressants in question are Selective Serotonin Reuptake Inhibitors (SSRIs) and are commonly known by their brand names—Prozac, Paxil, Zoloft and others. On the whole, they have reliably shown to be successful in treating depression, obsessive compulsive disorder and anxiety. Unfortunately, the very real disturbances of the depressed child or adolescent deprived of these medications have been all but pushed aside amid the discussions of the thickness and placement of the label warnings. A child or adolescent who has been identified as having depression accompanied with a high risk of suicidality will be much more likely to entertain such tendencies without rather than with antidepressants. Without the use of antidepressants they will be more likely to fall victim to the self-destructive patterns of depression, which are limitless: disturbed sleep and eating, inability to derive pleasure from activities one previously enjoyed, disinterest in families and friends. In short, a paralysis of normal functioning that is depression’s hallmark.

The studies documenting the increased risk of suicidality should not be dismissed, but instead be given serious consideration as has been the case thus far. In fact, further studies should be conducted to confirm the exact risks of these antidepressants, as well as their efficacy, which has come under fire as of late. What is missing, though, is perspective, and with it calm and specific deliberation. It is only disruptive to harp on the dangers of antidepressants when they have mended—saved—innumerable lives in the past. Nor is it constructive in any way to sloppily cover all SSRIs under one homogeneous red flag. Factors vary from one SSRI to the next, and have direct bearing on the risk of suicidal tendencies. Paxil has a much shorter life than Prozac, for instance, and therefore leaves the body much sooner, leading to a “rebound” period during which suicidality is more likely to occur.

While medical progress can only be attained by questioning present therapies and the conventions upon which they are based, ultimately dissuading practitioners and parents alike from considering antidepressants can only do harm—especially when the present uproar is not even based on actual suicides. This is exactly what the chosen labels, which are the most cautionary and daunting of any issued by the FDA, have already begun to accomplish.

Medication is an option, not a necessity, in treating depression. In the cases where antidepressants are considered alongside the requisite therapy sessions, however, one must weigh the risks and benefits of antidepressants carefully; if chosen, vigilant patient monitoring during the first few weeks (when the likelihood of suicide is greater) should be implemented. Until more is known, this is all that can be done, save hope that SSRIs’ negative press is only transitory. For we cannot afford to lose sight of all that antidepressants have done to assist the countless young victims of this debilitating illness, and all the benefits that they will continue to yield—if we let them.

Rebecca J.R. Steinberg ’07, a Crimson editorial editor, is a psychology concentrator in Quincy House.