Dr. Steve’s Perspectives on “The Antidepressant Scare” — Part 1

A few years ago I had the opportunity to travel throughout the great state of Tennessee, doing some consulting. While there, I visited the office of a pediatrician who practiced in a rural community where he was the only children’s doctor for many counties.  That pediatrician told me about a 15-year-old boy who was a patient of his.  His patient had recently made three or four serious – and almost successful – suicide attempts within a relatively short period of time.

After spending several minutes telling me about this youngster’s severe, suicidal depression, the doctor said to me, “…but I’m scared to treat him with an antidepressant, because I don’t want to cause him to commit suicide!” Hearing this, my immediate instincts were to jump up out of my seat, grab this doctor by the lapels, get right in his face, and scream at him, Dude!  Are you kidding me?! Don’t you understand?  If you don’t treat this kid with an antidepressant, it’s all but certain that he will commit suicide!  And you will have contributed to his suicide by withholding treatment he desperately needs, based on fear that is fueled by ignorant public hysteria!  Your patient deserves better than this!!” 

Somehow, through the exercise of monumental levels of self-control, I didn’t grab him and yell at him.  In fact, I didn’t let on at all how appalled and frightened I was by his patient’s situation and his potentially dangerous hesitation to treat his patient appropriately.  Of course, I did respectfully suggest that he should go ahead and treat this youngster with an antidepressant medication (and do whatever he could to get him psychiatrically hospitalized, or at least some good psychotherapeutic treatment) since he desperately needed it, and might well die if his suicidal depression – the real threat to his life – continued to rage untreated.

It’s been at least 7 or 8 years since then.  I don’t know what happened to that doctor or, more importantly, to his patient.  But I do know that several years after the FDA’s widely publicized 2004 “black box” warning about antidepressants possibly increasing suicidal ideation in children and adolescents – and the absolutely ridiculous panic that it caused – the results were in.  And they were exactly what I and other child and adolescent psychiatrists had feared, and had warned people, would happen: rates of suicide among adolescents, which had been declining for over a decade before that warning, increased significantly.

You see, in the decade of the 1990s – some ten years before the warning and the “Antidepressant Scare” that resulted from it – the Centers for Disease Control and Prevention (CDC) in Atlanta had documented that suicide rates among adolescents had decreased nationwide.  And further analysis of that trend revealed that those parts of the country that had enjoyed the sharpest declines in adolescent suicides seemed to coincide with those areas with the highest rates of doctors prescribing antidepressant medications to children and adolescents.  We child and adolescent psychiatrists knew this, and were acutely aware of the danger posed to young people by the public hysteria that distorted the FDA’s warning, and implied that antidepressants are inherently dangerous and will almost definitely make kids commit suicide.

I remember watching nervously as famous TV talk show personalities like Larry King and Nancy Grace (who had huge audiences) hosted shows that fueled the hysteria about antidepressant medications being dangerous for kids and even causing them to commit suicide.  I remember being afraid that this would have a chilling effect on primary care doctors who practice in areas with what I call the “dual curse”: a desperate shortage of child psychiatrists and significant numbers of kids who have potentially life-threatening mental illnesses.

I learned in years of consulting work that the poor pediatrician I had met was one of many across America who are in the unenviable position of having to provide some semblance of mental health care to children and teens who simply wouldn’t get any care if their pediatricians didn’t provide it.  When I thought of those doctors and their patients, it seemed irresponsible, at best (and cruel and sadistic, at worst) for the mass media and others to whip up mindless hysteria that would scare any reasonable, well-meaning doctor into a paralysis that could be dangerous – even life-threatening – for their patients.  And then I had the chance to see it first hand, during my visit to rural Tennessee.

Before that consulting trip – but more stridently and angrily after it — I predicted that an increase in the adolescent suicide rate would result from all of this.  And it did.

Since that time, well-designed scientific studies have documented that there was, in fact, a sharp decrease in primary care doctors treating kids with antidepressant medications, and that decline coincided with increased suicide rates among children and adolescents. Obviously, there are many factors that contribute to suicide, and it’s exceedingly difficult to establish with certainty the direct cause for the rate increase that occurred.

But it still seemed that the hysteria had done its damage.

And of course, that damage was never publicized like the initial warning was.  No TV talk show hosts highlighting the dangers of whipping up fear about exceedingly rare side effects.  No one in the mass media decried the negative public health impact of frightening patients, families and doctors alike from treatments that already seemed to have a track record of saving people’s lives.  And certainly no apologies for misleading and possibly endangering at-risk kids and their families in a misguided and overzealous attempt to inform and protect them (or, if you’re more cynical: in a self-serving, opportunistic effort to sensationalize a frightening FDA warning and capitalize on the increased ratings that might result).

But that’s all old news.  Or is it?  I recently had a former patient of mine from almost 20 years ago contact me and ask if the antidepressant she was prescribed when she was a teenager has caused her some permanent damage to her brain and her emotional life.  There’s no evidence that any of the antidepressants will do that to people.  But I couldn’t help wondering if her question – which felt more like a conclusion she has already reached that the medicine had, in fact, damaged her – was related to “The Antidepressant Scare” of a decade ago.  Perhaps the damage caused by distorted warnings and public hysteria may be longer lasting than even I had thought.

Dr. Steve



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