Tuesday, March 23, 2004

On the FDA antidepressant warning

Here's a bit more info on the FDA surprise suicide alert regarding antidepressant use. This is major, considering how lucrative this market is for the pharmaceuticals: 12 billion dollars worldwide.

My personal sense is that it's a couple of things. This warning is directed at familiy practitioners who prescribe with little followup, which has to do more with managed care, and also how easily psychotropics are being prescribed. Psychotropics are not like antibiotics; they affect brain chemistry and behavior. Family practitioners are now forewarned to monitor their patients: ask questions, see them more especially in the beginning, maybe even, god forbid, refer for psychotherapy. How about assessing for suicidality? In this managed care environment, this hasn't been happening. Something to do with how they might get penalized for spending too much time on them or by referring them for services.

Second is that family practitioners need more training in prescribing antidepressants: to be able to diagnose the more subtle bipolar illness variant in individuals in addition to the floridly bipolar disorder version that everyone thinks of. The reality is antidepressants can precipitate manic episodes in those individuals with bipolar disorder, diagnosed or underlying. This is biology speaking, a brain chemistry/health problem, not a moral/self-control problem.

Third: more studies needed, especially with kids and looking at the bipolar variant in individuals. This is a real ethical problem. I really feel mixed about this because to do this requires kids to be in studies. I don't want to see this especially if these aren't safe drugs. Studies haven't adequately addressed safety to be sure. England completely banned use of antidepressants in kids, with the exception of Prozac. Aside from drug safety studies, more studies are needed to look at the incidence and biology of the bipolar variant in people.

Of course, the drug industry says there is no evidence of connection between their drug and suicide yet. Studies are in progress; no results yet but this precaution by the generally pro-industry FDA is certainly very interesting.