The Underlying Cause of Suicides and Homicides with SSRI Antidepressants:
Is It the Drugs, the Doctors, or the Drug Companies?
How a dysfunctional medical-pharmaceutical complex causes and perpetuates unnecessary harm.
Jay S. Cohen M.D.Reports of unusual, severe reactions with selective serotonin reuptake inhibitor antidepressant drugs (SSRIs) emerged soon after the first SSRI, Prozac, was introduced in 1988. One of my own patients, a woman with a mild depressive disorder and no history of major psychiatric symptoms, became psychotic after just three days on Prozac. Another woman, a highly successful attorney, developed such severe panic attacks that she couldn't work. Such cases were reported so frequently that Congress held hearings on the issue in the early 1990s. But because the hearings got no further than arguing whether SSRIs cause suicidal and homicidal behavior or not, and never looked at the underlying causes, nothing was accomplished.
I have never doubted that SSRIs (Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox, Effexor, Sarafem) can provoke impulsive, violent behavior. Now, sixteen years after the first reports, British regulatory authorities have acted against the use of SSRIs in children because of an increased incidence of suicide. This forced the U.S. Food and Drug Administration to take a second look. In early February 2004, a FDA advisory committee heard powerful testimony from bereaved parents and medical experts and issued a call for stronger warnings on the labels of these drugs. The FDA is considering it.
Even if the FDA acts, will such warnings make any difference? Not likely. As the FDA has learned, adding warnings to package inserts does little to improve how doctors prescribe drugs.1-3 Doctors kept prescribing Rezulin and Seldane inappropriately despite added warnings, and patients continued dying until the drugs were withdrawn. About 20% of all medications ultimately require additional "black-box" warnings about dangerous side effects discovered after the drugs' approvals,1 yet despite these additional warnings, doctors' prescribing methods remain poor and the incidence of medication-caused hospitalizations and deaths remains high.
Merely adding warnings to package inserts is inadequate because once doctors begin prescribing a drug, they don't read every updated package insert of every drug they use. Doing so would take hours, and package inserts are long and written in tiny, barely readable script, so new warnings are easily overlooked. Moreover, it usually takes years for such warnings to be added to package inserts, during which time doctors continue prescribing the drugs to millions of people. The fact is, most doctors rely on information provided by the drug companies' legions of sales representatives who accentuate the positive and downplay the negative.
What should be done? The answer is obvious: look at why these reactions are occurring and impose appropriate solutions.
My book, Over Dose: The Case Against The Drug Companies (Tarcher/Putnam 2001)4 laid it out and, for doing so, received excellent reviews including the recommendation of the Journal of the American Medical Association. Here is a more succinct explanation of why good drugs cause so much unnecessary harm, and why the medical-pharmaceutical complex allows it to happen again and again
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http://medicationsense.com/articles/april_june_04/underlying_cause.html