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Antidepressant-suicide link debated

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WASHINGTON, Aug 29, 2005 (United Press International via COMTEX) -- By her father's account, Ashlee Finlinson once was a healthy 16-year-old whose only significant difficulty was suffering from test anxiety, which led her to freeze up and fail while taking high school tests. A school psychiatrist referred Ashlee to a psychiatrist, who prescribed a 25-milligram daily dose of the anti-depressant Zoloft, manufactured by Pfizer.

"Within six weeks, she had turned into a completely different person," Tom Finlinson told United Press International.

As Ashlee became increasingly depressed while taking the drug, the psychiatrist increased her dosage. When she was taking 300 milligrams of Zoloft per day, she succeeded at committing suicide on her third try.

"We should be looking at colleges," Finlinson said. "Instead, we get to visit her grave site."

Finlinson, who lives in Bozeman, Mont., was one of about 35 people gathered at Lafayette Park in front of the White House last week to protest anti-depressant medications they think have harmed or killed their loved ones. The protest was initiated by Allen Routhier of Southbridge, Mass., who told UPI his wife Diane was given an unmarked sample of the anti-depressant Wellbutrin for stomach pain and shot herself fatally after experiencing a toxic reaction to the drug two years ago.

Many of the protesters came from the group Citizens for Pharmaceutical Safety Reform.

"I just want people to know of the dangers," Finlinson said.

Last February the Food and Drug Administration added stricter warnings to the labels of anti-depressant medications, as the debate grows about their safety. The warning now states major depressive disorders may worsen and lead to suicide, whether or not a patient is taking anti-depressants, but "there has been a long-standing concern that anti-depressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients."

A separate warning about suicide risk among children and adolescents states that -- according to placebo-controlled clinical trials of nine anti-depressant drugs in children and adolescents -- 4 percent of patients receiving anti-depressants experienced suicidal tendencies, in contrast with 2 percent of patients receiving placebos.

On June 30 the FDA released a public health advisory that began, "Several recent scientific publications suggest the possibility of an increased risk for suicidal behavior in adults who are being treated with anti-depressant medications."

According to the advisory, the FDA currently is conducting a review of all available data on the topic.

"Adults being treated with anti-depressant medications, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior," the agency's advisory continued. "Close watching may be especially important early in treatment, or when the dose is changed, either increased or decreased."

The warnings may have come too late for Patrick Leamy, according to his wife.

Susan Leamy, of Saratoga, N.Y., told UPI she is filing a lawsuit against the manufacturers of Lexapro for the drug's role in the suicide of her husband. After the Leamys' son died, Patrick experienced depression. A grief counselor described his reaction as part of the normal recovery process, but a psychiatrist gave him a sample of Lexapro, without any packaging or warning about the drug's possible side effects.

"For seven days he never slept," Susan Leamy said.

She said after taking the drug for eight days Patrick shot himself. She added she since has learned anti-depressants are particularly hazardous for people who have energetic "Type A" personalities, such as Patrick, a former New York state trooper.

The list of possible anti-depressant side effects on FDA warning labels now includes anxiety, agitation, panic attacks, insomnia, hostility, impulsivity, irritability, aggression, akathisia (a condition of painful inner agitation that can manifest as an inability to stop moving and/or irritability), hypomania and mania.

"All of these things, especially in a depressed person, contribute to suicidality and violence," said Dr. Peter Breggin.

"It's a prescription for disaster," he continued. "It's a cocaine-like effect."

Breggin, a psychiatrist in Ithaca, N.Y., who has served as an expert witness in trials regarding the negative effects of anti-depressants, pointed to the FDA action as a sign that anti-depressants are known to be ineffective.

"We now know that these drugs probably don't work at all," Breggin told UPI.

He cited a 1998 study in the American Psychological Association's journal Prevention and Treatment, by Irving Kirsch of the University of Connecticut and Guy Sapirstein of Westwood Lodge Hospital in Massachusetts. The study analyzed the results of drug-effectiveness studies with depressed patients and found, for a typical patient, 75 percent of the benefit obtained from taking an anti-depressant also could have been obtained from an inactive placebo.

Breggin cautioned against abrupt cessation of anti-depressant use because of withdrawal symptoms and recommended psychotherapy as a safer alternative for people with depression.

"Psychotherapy is very effective in depression because depression is usually a problem of hopelessness," he said. "It's usually one of the easiest things to help with psychotherapy, and it often goes away by itself."

American Psychiatric Association spokesman Jason Young told UPI that a combination of anti-depressants and therapy can be used to treat depression.

"In general, our stance is that the greatest threat to a depressed person is to receive no treatment at all," Young said.

He said the increase in suicidal ideation that can occur with use of anti-depressants simply is an increase in reporting, not a change in the underlying condition.

"The medication actually helps the person to talk," Young said. "It's not necessarily that the person's situation is worse or better."

According to data from the Centers for Disease Control and Prevention in Atlanta, the national suicide rate fell from 12.5 suicides per 100,000 people in 1990 to 10.4 suicides per 100,000 people in 2000 -- the same decade in which use of selective serotonin-reuptake-inhibitor anti-depressants increased dramatically.

Young said prescription rates increased when SSRIs became available because the previous generation of anti-depressants was toxic, with the potential for fatal overdoses.

"Depression is a painful and sometimes life-threatening disease that can rob individuals of their ability to enjoy life, and that, all too often, leads to suicidal thoughts and behavior," a Pfizer spokesperson told UPI in an e-mail message. "While no medication works equally well for all people in all cases, the most reliable medical information available, based on extensive patient experience, shows that Zoloft is an important treatment for depression that has been used safely and beneficially by millions of people with depression."


Eva Sylwester is an intern for UPI. E-mail:

Copyright 2005 by United Press International.

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