Antidepressant warnings should elicit caution

What you don't know might hurt you after all - at least when it comes to taking antidepressants.

A Food and Drug Administration report released earlier this fall calls for stronger warnings on drug labels about the increased suicidal thoughts antidepressants can cause in pediatric patients.

All antidepressants will now carry a black box safety alert, the government's strongest warning.

And experts say college students should be paying attention as well.

FDA spokesman Jason Brodsky said the new warning was aimed mostly at health care providers, who now might use more caution in prescribing antidepressants to children and adolescents under 18. But students, including those in college, still could benefit from the message.

Although most students at the University are older than 18, it's reasonable not to be too rigid about the cutoff age when the difference is only a few years, said Robert Golden, chairman of UNC's Department of Psychiatry.

"Any teenager or young adult should be aware (of the side effects)," he said.

Still, antidepressants have proven helpful for many - without any negative side effects.

Last year, Patrick Lyons, a sophomore from the Outer Banks, was facing the sort of problems that often end up in a prescription: He was feeling depressed and having difficulty adjusting to his first year of college.

So he made an appointment with UNC's Counseling and Psychiatric Services, where he said he "had a prescription for Zoloft within half an hour."

Lyons' was a success story; he was able to stop taking the medication after about a year and a half and didn't suffer from an emergence in suicidal thinking.

But CAPS sees a lot of students, many of whom turn to it for help with depression, and no one is sure how the FDA's reports will affect its services.

"Thirty-six percent of people who are seen at CAPS will have a diagnosis of some sort of depression during the semester they're seen," said Dr. Allen Hamrick, psychiatrist and associate director of CAPS.

Much of the concern surrounding antidepressants in young patients originated last summer in Britain, where health regulators warned doctors not to prescribe the drug Paxil to those under 18.

Back in the United States, New York state Attorney General Eliot Spitzer filed a lawsuit against the British-based drug company GlaxoSmithKline, accusing it of concealing negative information about the medication.

Despite this public awareness, doctors still are not sure why taking antidepressants can lead to increased suicidal thought.

Golden said younger patients who suffer from this malady might actually have undiagnosed bipolar disorder, which antidepressants can unmask - consequently exposing manic, and possibly suicidal, tendencies.

Still, Golden and Hamrick both said the greatest loss that could come about from this new information would be a decrease in the number of patients taking their medication.

The most common side effects from antidepressants are still diarrhea, vomiting and changes in energy levels.

"Even in the context of this finding, it is much safer to treat children than not," Golden said.

He also said it is important to make a distinction between suicidal thoughts and suicide.

It has only been established that antidepressants can cause increased suicidal thinking in pediatric patients, not necessarily suicide attempts.

Hamrick stressed that CAPS is on call 24 hours per day, so if patients on antidepressants have any problems, they have someone to talk to.

And more research is under way at the University, especially on serotonin activity in the brain.

"We have a long-standing series of programs that are looking at this," Golden said.

"It would be a tragedy for people to misinterpret this finding and stop taking their medications."

Contact the Features Editor at features@unc.edu.