Suicide Watch

The surprise warning issued by the Food and Drug Administration last week that people taking antidepressants can become suicidal and should be closely monitored probably came as a shock to the millions of Americans who take these pills. It's important to understand what the advisory means — and doesn't mean — and not to overreact.

The FDA didn't tell people taking the drugs to stop cold turkey — that can be dangerous. Nor did it tell doctors to stop writing prescriptions for depressed patients. What the agency did say was that in the first few weeks after a patient starts taking an antidepressant, or when the dose is increased or decreased, care-givers and family members should watch closely for signs of increased anxiety, irritability, hostility, impulsivity or restlessness. The combination of severe depression and restlessness is especially dangerous, according to Dr. Adelaide Robb of the Children's National Medical Center. In the first weeks under medication, she says, "someone can still be feeling overwhelmingly sad, but their energy level is high enough to plot and carry out a suicide."

The problem is that depression, left untreated, too often ends in tragedy. So if depressed patients go on the drugs and kill themselves, it's impossible to determine whether the suicide was the result of the pills or of the underlying condition.

The FDA has urged the manufacturers of 10 popular antidepressants to issue new, more stringent warning labels. The drugs named in the advisory are Prozac, Zoloft, Wellbutrin, Zyban, Paxil, Celexa, Effexor, Serzone, Luvox and Remeron. Together these pills racked up sales of about $12 billion worldwide in 2002. Some experts believe that it was their very popularity that concerned the FDA. Many doctors, the agency apparently fears, are giving out the pills too freely, without adequate monitoring.

The FDA action follows gut-wrenching hearings last month filled with stories of teen suicides. The agency took pains last week to say there are no studies showing that antidepressants actually cause people to take their lives, but decided to err on the side of caution. Given the risks involved, that's probably not a bad idea.

Sanjay Gupta is a neurosurgeon and CNN medical correspondent