The frequency of these reported cases prompted Congress to hold hearings on the issue in the early 1990s, however the underlying causes were never determined and nothing was accomplished.

In his essay, Jay Cohen said he never doubted that taking certain antidepressants could provoke impulsive and violent behaviors. Because of an increase in suicides, British authorities have acted against children taking anti-depressants. Also, medical experts and parents have made pleas to the U.S. Food and Drug Administration (FDA) for stronger warnings on the labels of these antidepressants.

Cohen said he feels the obvious answer can be found by looking at why the reactions are happening and then impose the appropriate solutions.

Here are some of the explanations on why good drugs are causing so much unnecessary harm as detailed in Cohen’s essay:

The Drug Companies

• It’s all about making profits, increasing sales and overlooking any ethics of pharmaceutical companies. Drug companies make a point of trying to impress doctors with superior effectiveness claims and easy-to-use drugs.

• The marketing strategies of the pharmaceutical companies today have kept their focus on keeping it strong and simple.

Doctors and SSRI Antidepressants

• Most doctors don’t understand SSRI drugs or the difference between major and minor depression, which are used to determine the dosage of medication to be prescribed.

• Often, even psychiatrists have been found to be ignorant of how SSRI drugs work.

• Since doctors aren’t informed of SSRI reactions, they can’t warn patients of them and resort to denying side effects when patients report them.

• Medical educators have sought better education about medications for doctors, but were told the students’ schedules were already booked with more important classes.

Cohen’s Six-Point Solution to the SSRI Problem:

1. Patients must be started off on the lowest, safest and most effective dosage of SSRI antidepressants with the exception of acute cases.

2. Drug companies must provide information on the package inserts including all their data on any drug to be used in humans.

3. Doctors must go through training and certification on the safe use of SSRI drugs and have some basic knowledge of the drug metabolism process.

4. Doctors must monitor their patients closely and warn them about possible side effects. They should start out with low doses and gradually increase the dosage making adjustments accordingly.

5. Patients, including parents of patients, must be warned of the possible risks of SSRI drugs and the patients should inform the doctor if they experience any side effects.

6. The FDA needs to initiate policies requiring companies to make the lowest and safest doses on all drugs, not just SSRI drugs. Also, the FDA should add warning labels listing side effects on all package inserts.

Cohen claimed this six-point solution would benefit all three parties involved; the drug companies would still be able to market SSRI drugs, the doctors would continue to prescribe them and the patients would receive the benefits of them at minimal risk. This solution would also strengthen the doctor-patient relationship.

MedicationSense.com April-June 2004