Antidepressants- Friend or Foe?

Features & Analysis: Antidepressants- Friend or Foe?
Andrzej Sienko, April 2008

***This is the first in a serious of articles that I wrote during my studies at Hofstra University that have either never been published or only saw limited distribution. Some may require additional updates, but I have tried to select only the most timely pieces. Here is a short feature I wrote about antidepressants that I think is both informative and even-handed. Looking forward to hearing what you think about this issue!***



Almost a decade ago a high school senior in Colorado applied for the Marine Corps, but was rejected. The reason: recruiters learned he was taking the powerful antidepressant Luvox. Five days later Eric Harris opened fire on fellow students in Columbine High School, killing 13. Today the controversy continues over whether antidepressants are safe.

A 2005 study by the U.S. Center for Disease Control and Prevention said antidepressants are the most commonly prescribed drugs in the United States. Recently traces of antidepressants have even been found in the drinking water of major cities. Prescription medication to treat depression has been around since the 1950’s, but use in antidepressants surged in the 1990’s after SSRI’s, or selective serotonin reuptake inhibitors, became available. SSRI’s like Luvox, Paxil, and Zoloft increase levels of the neurotransmitter serotonin, which influences mood, and is thought to alleviate depression. The concern comes from the side effects, which include suicidal thoughts and mania.

The effectiveness of antidepressants is still in dispute, with many contradictory studies. A 2002 study in the psychology journal Prevention and Treatment said that antidepressants are 30% more effective than a placebo at improving mood. However a 2006 analysis by the Food and Drug Administration found that antidepressants double the risk of suicidal behavior for patients 18 to 25 years old. The FDA put a “black box” warning label on antidepressants in 2004 because of these concerns.

“They are effective,” said Charles Levinthal, chair of the Hofstra University psychology department and author of Drugs, Behavior, and Modern Society, “whenever you have studies that compare pharmaceutical therapy and talk therapy, the best treatment is a combination.” Levinthal said in his book that suicidal thoughts only increase in 3% of patients on SSRI’s compared to a placebo, and thoughts do not necessarily mean actions. “That concern should not be the main reason of withholding medication from a patient, absolutely not,” said Levinthal.

In fact the black box label may have increased the youth suicide rate after a sharp decline in antidepressant use in 2004. The suicide rate for ages 14 to 19 increased 11% that year, leading some to reexamine the warning. Levinthal said the label is appropriate: “the medical professional should know the full story. It may not scare off people necessarily.”

If the relationship between antidepressants and suicide is complex, what part they play in violent acts is even less clear, and much more controversial. Many of the perpetrators of recent school shootings, including Columbine and Virginia Tech, had been on antidepressants. However many had not taken their medication at the time.

There was no trace of the Prozac prescribed to Virginia Tech’s Seung-Hui Cho, who ignored a court order to continue treatment. Three weeks before Steven Kazmierczak killed five students in a shooting at Northern Illinois University he had abruptly quit taking Prozac and began behaving erratically. Groups like the International Coalition for Drug Awareness said the case highlights the dangers of antidepressants. Many psychiatric professionals argue that the drugs played little role in the shootings. “Those incidents are more about when a person doesn’t take their medication than does,” said Levinthal.

The debate over antidepressants is likely to continue, especially because of the difficulty in relating so many different variables. One factor is genetics: everyone reacts to the medication differently. There is risk involved, but many psychiatric professionals agree that proper treatment is always better than none when it comes to depression.