The pediatrician Lawrence Diller, writing in The Washington Post, says the Food and Drug Administration has issued "an official warning . . . on the increased risks of suicidal tendencies when taking antidepressants such as Prozac." This is probably how most Americans interpreted the FDA's recent public health advisory covering 10 antidepressants.
Yet the FDA emphasizes it "has not concluded that these drugs cause worsening depression or suicide." Despite more than a decade of publicity about the alleged suicide-triggering properties of Prozac and its cousins, the FDA says, "a causal role for antidepressants in inducing such behaviors has not been established."
It is therefore hard to understand why the FDA is requiring that manufacturers of these drugs add a conspicuous suicide warning to their labels. The warning advises health care providers to "carefully monitor patients receiving antidepressants for possible worsening of depression or suicidality, especially at the beginning of therapy or when the dose either increases or decreases." It says "health providers should be aware that worsening of symptoms could be due to the underlying disease or might be the result of drug therapy."
The FDA defends the warning by arguing that it makes sense to keep an eye on depressed patients even if there's no truth to the claim that antidepressants make people kill themselves.
"We think this is good advice whether the drugs did it or not," an FDA official told The New York Times. "If someone commits suicide, it doesn't really matter whether it's the drug or the underlying disease. In either case, you need to pay attention."
Putting aside the issue of whether people who feel happier after taking antidepressants are suffering from an "underlying disease," this rationale is rather strange. By the same logic, the FDA could require a warning that a heart drug might raise the risk of myocardial infarction not because there was good evidence that it did but because people with heart disease should be closely monitored.
Inevitably, the FDA's warning will lend credence to the lawsuit-inspiring claim the agency itself says has not been proven. Since people who take antidepressants tend to be depressed, it's hardly surprising that some of them think about, attempt or commit suicide, thereby providing anecdotes for activists and trial lawyers. But we can never know how these people would have behaved without the antidepressants.