ANTIDEPRESSANTS: A WARNING TO POSSIBLE VIOLENT AND SUICIDAL BEHAVIOR

The LOS ANGELES TIMES  reports that Corey Baadsgaard felt depressed. It was the kind of depression that doesn’t go away with time. His general practioner prescribed Paxil. It didn’t seem to do the job so he was switched to Effexor and the dosage was escalated. Soon thereafter, Corey took a loaded high powered rifle to school, herded his 3^rd period English class and teacher into a corner and threatened to kill them. It took the principal 45 minutes to talk the young man to give up his gun.

Corey got 14 months in juvenile detention center.

Harvard Medical School psychiatrist wondered out loud if antidepressants are related to a rash of shootings and murder-suicides over the last decade. After the news release, the FDA has mandated that antidepressants carry a warning of potential adverse reactions.

The findings may be spurious, but the pharmaceuticals should quietly celebrate that the warning can be a buffer to their profits and the viability to their products. Unfortunately, the Physicians Desk Reference carries caveats and disclaimers that to the lay public are troubling, confusing, and obtuse (key into search engine, effexor side effects.) Further, pharmacists and physicians may downplay the side effects, adverse effects, and contraindications because of the fear of the self fulfilling prophecy. A patient reads the untoward effects that are generally in a computer print out that comes with the prescription and starts feeling worse when they are getting better. Further, the adverse effects may be occurring with only a few patients per thousand clients.

Additionally, there is less stigma going to the family physician than to a psychiatrist.

Again, misfortune may play a role here, because the G.P. must know a little about a lot and specialists like psychiatrists are knowledgeable (or should be) about the latest medications and their efficacy. However, as specialists, they may know a lot about a small part of the overall current medical literature. This all make sense in post industrial economies where there is a division of labor composed of generalists and specialists. Further, recent innovations have created pharmacologists who make the rounds with physicians and whose expertise is to know the potencies and properties of the latest meds in all fields. Even this has become more specialized with psychiatrist being assisted by psychopharmacologists who are in the know about all the ramifications of the latest

psycho-pharmaceuticals.

Thus, we suggest that a warning be placed on the medication. It might read something like this.

In a few instances, this medication may indirectly encourage you to want to harm yourself and or others. Seek immediate medical help!

This would be one of the many labels placed on the pill bottles. Others include “may cause drowsiness” “may cause dizziness” “take with food” and related. For the sticker on the pill bottle, “may cause harm to self or others” should suffice.

We believe that one more label in a bright special color will not ultimately sully the sales of antidepressants. It could save lives and improve the health of an area that though filled with debate may be under diagnosed and treated.

Mitchell Marsh, PharmD. Psycho pharmacologist, St. Elizabeth’s Medical Center, Lincoln, Nebraska.

Joel Snell, MA, MIBA Medical Sociologist, Kirkwood College, Cedar Rapids, Iowa.