February 22, 2008
By Robert Goldberg and Peter J. Pitts
After serving for more than 12 years in the Army and the Army Reserves, 32-year-old Julianna Gehant enrolled at Northern Illinois University last fall. This week she was laid to rest along with four other victims of Steven Kazmierczak's killing spree. To add to the already tragic nature of the story, a former professor described Kazmierczak as a most gentle, quiet guy in the world. Harder still to assign blame or responsibility. Or is it?
Kazmierczak had a history of mental illness, including institutionalization. He did not take his medication regularly, and weeks before the killings he went off his antidepressants.
Much like the killer at Virginia Tech, the signs were all there. So, too, was the groundwork laid by the media, freelance pundits and by some in Congress to irresponsibly scare people away from taking the medicines that very well could have kept such anti-social homicidal behavior in check.
Less then four years ago, there was plenty of media airtime and political effort invested on Capitol Hill trying to scare teenagers and their parents from taking the most commonly prescribed anti-depressants â€” selective serotonin reuptake inhibitors (SSRI), such as Prozac, Paxil and Zoloft. It was alleged by Rep. Bart Stupak and Sen. Charles Grassley that there was conspiracy of silence between drug companies and the Food and Drug Administration to hide information about SSRIs turning otherwise happy kids into potential suicides.
Here's an inconvenient truth: Suicide is a leading cause of death among young people. The good news is that it's both treatable and preventable â€” particularly with the timely and appropriate use of antidepressants. But what parent or troubled kid would, in the wake of the concerted campaigns of Messrs. Stupak and Grassley, want to do so? In 2004, for instance, at a hearing where the FDA was accused of conspiring with drug companies to hide data about how SSRIs caused suicides, Mr. Stupak threatened to introduce legislation banning the prescribing of antidepressants to anyone under age 18 "if the FDA didn't act forcefully and swiftly to protect America's children."
Indeed, Mr. Grassley claimed there was a coordinated effort by the Food and Drug Administration to suppress the truth about the suicide risks of antidepressants. He gave top billing to internal FDA studies that looked at the relationship between SSRIs and suicidal thoughts but claimed it looked at suicide.
And so the New York Times dutifully reported the "risks of suicide" posed by SSRI and the Los Angeles Times claimed "Suicide Risk to Children Affirmed."
Not surprisingly, the hearings and the coverage lead to panic and, predictably, noncompliance. Ultimately, the FDA accepted an advisory committee recommendation to require that all antidepressants carrying a Black Box warning that they increase the "risk of suicidal thinking and behavior ... in children and adolescents" with depression and other psychiatric disorders. A decline in SSRI prescriptions followed.
Then, last year, Robert D. Gibbons, director of the Center for Health Statistics at the University of Illinois at Chicago, found that suicide rates among American youths dramatically increased from 2003 to 2004, coinciding with a steep drop in antidepressant use.
The 19 percent increase in suicides among those 19 and younger is the biggest year-to-year increase seen since the Centers for Disease Control and Prevention started tracking the data in 1979. A similar jump in suicide â€” and decline in antidepressant use â€” was found in Europe over the same period of time.
Curiously, neither Mr. Stupak nor Mr. Grassley commented on this connection and it was all but ignored by the media and other self-appointed guardians of medical truth.
The FDA's black box is not killing kids. But the collective actions and rhetoric that lead up to it are. Darryl Regier, the former director of the National Institute of Mental Health, notes, "Contrary to expectations, other treatments, such as alternative medicines or psychotherapy, which have limited effects on childhood depression, did not increase to fill the gap."
That gap was created by Congress and irresponsibly spread by sensationalist media coverage. When senior leaders within the FDA to tried to balance benefits and risks on antidepressants they were savaged by Messrs. Stupak and Grassley. And when the FDA tries to explain the complexities of Ketek or Avandia, Mr. Stupak demands resignations â€” in speeches that still include the claim that that antidepressants cause suicides. Drug-company lobbyists counsel cowardly silence. Science and common sense give way to tabloid medicine.
Peter J. Pitts, a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest. Robert Goldberg is vice president for research programs at the Center for Medicine in the Public Interest.