Public Health Advisory for medical professionals with patients on anti-depression medication

On Monday, March 22, 2004 the Food and Drug Administration issued a Public Health Advisory for medical professionals to monitor for signs of suicidal ideation in individuals who have recently started taking anti-depression medication or have had a recent change in dosage, especially for children who are taking these medications. Antidepressant medications involved in this warning include: Prozac (Fluoxetine), Zoloft, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor,, Serzone, and Remeron.

While concerns on behalf of the FDA, patients, families, physicians and others about medications for anti-depressants are understandable, it is important to consider that none of the conducted studies have shown that taking anti-depressants causes suicide.

Although the FDA's Advisory raises significant concerns, there is no need for patients or families to panic, nor should these medications be abruptly discontinued. Evidence of increased irritability and agitation may reflect an adverse response to antidepressants and an increased risk of suicidal thoughts. Therefore, these symptoms should quickly be reported to the prescribing physician.

Suicide attempts and ideation are common among people with serious depression. Considerable research has proven that people suffering from depression can be significantly helped with anti-depressant medication and/or psychotherapy. Monitoring of patients at risk for suicide due to depression is always appropriate during initial administration of medications. Anyone who has been prescribed medications for depression or other behavioral health problems should continue to take their medications as recommended by their physician and should consult with their physician if the person shows signs of worsening or significant side effects of medication. Failing to appropriately treat depression and other related behavioral health problems also poses a significant risk of suicide. It is important that parents of children with depression and other behavioral health problems make every effort to seek professional help for their child.

The Arizona Department of Health Services recommends that all persons receiving treatment for depression or other behavioral health problems be routinely monitored for suicidal ideation. Since 75% of persons who complete suicide have visited a doctor within one month of committing suicide, it is particularly important for medical professionals be vigilant in screening patients for suicide and other behavioral health problems during routine visits. Medical professionals should help patients and their families know the warning signs for suicide, medication side effects, and numbers to call in the event of an emergency.

Regardless of whether an individual is on antidepressants or not, the following suggests an increased risk of suicide and should be carefully assessed in all depressed individuals:

Individuals who are at the highest risk for suicide are those who have made prior suicide attempts and are currently abusing substances.

Warning signs and other factors related to potential suicide include:

- Previous suicide attempts
- Abuse of drugs and/or alcohol
- Suicidal or self-harming thoughts, plans, behaviors, and intentions
- Lethality of methods considered
- Feelings of hopelessness, guilt, shame, or worthlessness
- Impulsiveness, panic, or anxiety
- No reason for living or lack of future plans
- Serious and chronic medical illness, including chronic pain
- Other signs and symptoms of depression
- Changes in eating habits
- Sleeping problems
- Difficulty concentrating
- Lack of energy, fatigue, boredom, or not caring

- Family history of suicide
- Social problems: Loss of significant relationships, serious financial or legal difficulties, family problems, domestic violence, physical or sexual abuse or neglect, loss of employment, loss of housing, lack of personal supports
- School failure or other problems in school, being "bullied" by other children
- Poor control of emotions: anger, irritability, agitation, rebelliousness, or impulsiveness
- Getting rid of valued personal possessions
- Recent personality changes, poor coping under stress, or poor self-esteem
- Changes in personal hygiene
- Mental confusion or impaired thinking

Populations at higher risk of suicide:

- Individuals with a history of: Depression, Major Depression, Bipolar Disorder (Mania), Schizophrenia, Substance Use Disorders, Anxiety Disorders, or Borderline Personality Disorder
- Adolescents and young adults
- Males
- White/Caucasians
- Elderly persons who are isolated, living alone, or have serious medical problems
- Gay, lesbian, bisexual, or transgender orientation
- Native Americans

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