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By Ami Albernaz
Antidepressants including Prozac, Paxil and Wellbutrin, might soon
come with new warning labels urging users and doctors to watch for
agitation, hostility and suicidal tendencies. The Food and Drug
Administration is recommending such warnings following the British
Government's decision last year not to prescribe antidepressants
for children and the subsequent suicides of American teenagers who
were using the medications.
While an FDA investigation into a possible link between the drugs
and suicidal behavior is expected to end this summer, a renewed
discussion of prescribing the drugs has already begun. Elena Eisman,
Ed.D., executive director of the Massachusetts Psychological Association
says that her organization is taking the opportunity provided by
the current scrutiny of antidepressants to spotlight alternatives
to medication.
"We're talking about [medications] in terms of current information
on risks and benefits, and in terms of alternatives, such as behavioral
intervention, where appropriate," she says. To counter what she
calls "a rush to prescribe," the association is trying to ensure
that other options are presented.
The warning labels, if approved, would be applied to antidepressants
in use by adults and children, regardless of whether they are taking
the drugs to treat depression or other unrelated problems. Patients
taking the drugs - which also include Zoloft, Celexa, Effexor, Lexapro,
Luvox, Remeron and Serzone - and experiencing side effects, are
advised to contact their physicians, who may prescribe lower dosages
or stop the medication altogether.
Although Prozac is the only antidepressant that has been approved
to treat depression in children, doctors have been prescribing the
others on the grounds that they have been safe and effective for
adults.
Some psychiatrists have argued that discouraging the drugs could
be detrimental to those who would benefit from them and that the
suicides that prompted the scrutiny should not be blamed on the
antidepressants, but on the underlying depression. Some psychologists,
meanwhile, are advocating that patients proceed with caution.
Nadine Kaslow, Ph.D., president of the American Psychological Association's
Society for Clinical Psychology, says that antidepressants often
are helpful and advocates "thoughtful choices and close monitoring
of the symptoms and the medication," if it is tried.
"Parents and children need to look at the whole picture," she continues.
"If depression is mild or moderate, they often do fine with psychosocial
therapy. If that's not enough - or if the depression is severe -
the data shows that medication can be helpful. The data doesn't
say never use medication."
Some practitioners say that the new concern over antidepressants
is not much discussed.
"We haven't noticed this research having any impact at all," says
Linda Guttman, Psy.D., assistant director of clinical services at
the University of New Hampshire's Counseling Center. "My guess is
that students are not aware of this particular research. There are
always students that have reservations about taking medications
in general, however."
Christine Gray, Psy.D., a psychologist in Lewiston, Maine who works
mainly with chronic pain patients, also says the issue has not yet
"hit the radar" in her state. She does, however, advise her clients
to take a realistic approach to psychotropic drugs.
"There's a misunderstanding among some people about what antidepressants
will do for them," she says. "There are unrealistic expectations.
They're not going to make someone happy, and they're not going to
make someone's problems go away."
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