- The Washington Times - Tuesday, February 3, 2004

Parents pleaded with the Food and Drug Administration yesterday to end the use of popular adult antidepressants on children, saying the drugs can increase youths’ risk of suicide and violence.

“To die in this violent, unusual fashion without making a sound … Paxil must have put her over the edge,” said Sara Bostock, describing how her daughter Cecily stabbed herself in the chest with a kitchen knife shortly after graduating from Stanford University and two weeks after starting the drug.

Another parent agreed.

“You have an obligation today … from preventing this tragic story from being repeated over and over again,” said Mark Miller of Kansas City, Mo., whose son Matt hanged himself in his bedroom closet after taking his seventh Zoloft tablet.

But countering those complaints were a handful of families who say the class of antidepressants known as SSRIs have changed their children’s lives by alleviating serious depression.

“My children have had tremendous improvement with their illnesses,” said Dr. Suzanne Vogel-Scieilia of the National Alliance for the Mentally Ill, who has two sons using the drugs. “I shudder to think of their plight if these medicines were not available.”

The FDA is examining whether the suicide risk is real, and if so, what to do. It’s a difficult decision because depression itself can lead to suicide.

Among 25 studies of the suspect medications involving 4,000 young people, there were no suicides. But 109 patients experienced one or more suicide-related behaviors or attempts, FDA medical reviewer Dr. Thomas Laughren said yesterday.

The problem, he said, is that studies varied dramatically as to what was considered suicidal behavior. Among 19 patients classified as cutting themselves, for instance, almost all wounds were superficial, with little bleeding.

Still, “there’s obviously something going on here,” Dr. Laughren said.

The FDA has hired Columbia University to help determine how much suicidal behavior occurred in studies of the drugs before it decides its next steps by late summer. Meanwhile, the FDA warns doctors to use great caution in prescribing any antidepressant other than Prozac to patients younger than 18.

But dozens of anguished parents pleaded with the FDA yesterday to put warnings of suicide risk on the drugs’ labels as soon as possible. Over and over, they described youths becoming agitated after starting the pills, and seemingly sudden impulses that turned deadly.

When Effexor user Justin Cheslek hanged himself at college, “beneath him was a laptop and a glass of Coke.”

“It was as if some sudden impulse made him do this,” said his father, Gary Cheslek, of Vicksburg, Miss.

Some families blamed the drugs for killings and school violence.

“These drugs are hell. Look what they’ve done to my son,” Jay Baadsgaard said after his son Corey described taking Effexor four years ago and then waking up in jail, claiming no memory of holding his Mattawa, Wash., class hostage at gunpoint.

But a few parents, despite boos from the crowd, credited the drugs with saving their children.

“I ask that you appreciate the enormous benefit these medicines have had,” said Sherri Walton of Arizona, whose 14-year-old daughter, Jordan, has used SSRIs to treat obsessive-compulsive disorder and depression. “Her medicines were sometimes the only things she could depend on to help her.”

FDA files show 110 reports of suicide among youths taking any of 10 antidepressants since they hit the market more than a decade ago. But the difficulty of knowing what led to a suicide has the agency depending on studies, not anecdotes, to decide the issue.

“To err in either direction has significant consequences,” said Dr. Laughren, who worries warnings that overstate the risk could dissuade patients from helpful treatment.

Depression occurs in up to 10 percent youths, and 1,883 10- to 19-year-olds killed themselves in 2001. Some 1.8 million teens attempted suicide that year, a quarter of them requiring medical attention, said Dr. David Schaffer of Columbia University.

In 2002, almost 11 million prescriptions were dispensed to patients younger than 18 for SSRIs and other newer antidepressants to treat depression and other conditions, the FDA said.

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