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Critics Question Use of Antidepressants

Sep 5, 2003 | The Salt Lake Tribune Six weeks after her father purposely idled his car in his workshop and died from carbon monoxide poisoning, Amy Coburn of Perry guzzled drain cleaner in a failed suicide attempt.

After vomiting violently, the 13-year-old ran next door to her sister's house and was Life-flighted to Primary Children's Medical Center in Salt Lake City.

She blames her and her father's suicidal tendencies on the widely prescribed antidepressant Paxil, which they were taking for depression.

"I wasn't suicidal until I started taking Paxil," said Coburn, who is now 20, Paxil-free and vying to win Box Elder County's Peach Queen pageant. "My friends and family noticed a lot of changes in me. I began to think everyone else would be better off if I was dead. I thought I would be better off if I was dead."

Amy's mother, Judy Coburn, sued the drug's manufacturer, GlaxoSmithKline, in 1998, and the suit has since been settled. She is barred from discussing terms of the settlement but said she is happy to see officials are finally investigating allegations that the drug causes some people to become suicidal.

Doctors prescribe Paxil for people who suffer from depression, panic disorder, social anxiety disorder and obsessive-compulsive disorder.
In June, the British government banned Paxil for use in children, saying it was potentially dangerous for adolescents. Now the U.S. Food and Drug Administration is reviewing reports of an alleged increase in suicide attempts in people under 18. Although the FDA has not completed its evaluation, it is recommending that doctors stop prescribing Paxil for children and adolescents. The FDA has warned parents that their children should consult a physician before discontinuing use of Paxil and they should avoid abruptly stopping use of the drug because going cold turkey can lead to seizures, depression and other problems in some people. Doctors recommend tapering the dosage. On Aug. 22, Wyeth, another drug company, sent a letter to doctors saying they should not prescribe Effexor, an antidepressant, for children because it may carry a higher risk of prompting them to have suicidal thoughts. Effexor is not FDA-approved or recommended for use in children. Paxil has been, however.

David Fassler, a child and adolescent psychiatrist in Vermont and a trustee of the American Psychiatric Association, said he believes Paxil is safe for adults but he questions its efficacy in adolescents.

"Paxil is a medication that has a long history of use with adults and has been quite successful," Fassler said. "Based on data from the United Kingdom about increased agitation and suicidal thinking in children, I think the FDA acted appropriately. If parents have children who are taking Paxil, they should call their physician and make plans to transition to a new medication."

Fassler recommended switching to Prozac or Zoloft and he stressed the importance of counseling.

One Utah woman is especially thrilled about the recent inquiries into Paxil.

Ann Blake Tracy, the executive director of the International Coalition for Drug Awareness and author of Prozac: Panacea or Pandora? Our Serotonin Nightmare, said it is about time the government takes action against what she calls dangerous drugs. She has been fighting for years to get Paxil and similar antidepressants, called selective serotonin re-uptake inhibitors (SSRIs), recalled for adults and youth alike -- and removed from America's ever-growing medicine cabinet. She became involved after seeing family and friends have adverse reactions to SSRIs.

Her battle won't be easy considering she is up against some of the largest drug companies in the world and that SSRIs have gained immense popularity among patients and doctors alike. SSRIs affect the levels of serotonin, a brain chemical that is linked to mood, emotions and mental state.

In Utah, antidepressant use is higher than any other state, with 16 percent of the population taking them, according to Express Scripts, a company that puts together a yearly drug trend report. The second highest use is 14.4 percent, in Maine.

"They're doing the exact opposite of what they should be doing," Tracy asserts. "When you impair someone's ability to metabolize serotonin, it increases impulsive suicide, murder, cravings for alcohol and psychosis."

Mary Anne Rhyne, a spokeswoman for GlaxoSmithKline in the company's Raleigh, N.C., headquarters, said Paxil has been proven to be safe for adults but there are some questions as to whether it is safe for all children.

"Paxil has been available for more than 10 years and many people have taken the medication and realized improved health," she said. "Many medicines are different for children. Their immature bodies are different and they're developing."

She is aware of Tracy's crusade against the drug and other SSRIs.

"She has a viewpoint that I think if you look at the evidence from patients, physicians and psychiatrists it points in a different direction," Rhyne said.

Tracy has been hired as an expert witness by plaintiffs who sued drug companies in cases where those taking SSRIs committed violent crimes or suicide.

She worked as a consultant in lawsuits brought by victims in cases including the family of Phil and Brynn Hartman.

Brynn shot Phil, a comedian who appeared on "Saturday Night Live" and was the voice of some of the characters on "The Simpsons," and then turned the gun on herself. She was taking Zoloft and her family filed a wrongful death lawsuit against the drug's maker, Pfizer Inc., which was eventually settled out of court.

Andy Vickery, a trial lawyer in Houston who specializes in representing people who sue pharmaceutical companies, said Tracy's relentless warnings about SSRIs are finally coming to bear. "Ann Tracy is a very dedicated person who believes strongly these drugs have harmed a lot of people," Vickery said.

"I do too. Ann should be justifiably proud of the developments that have happened because she contributed to the efforts."

Vickery won the first case challenging a drug maker over SSRIs. The case involved a Gillette, Wyo., man whom a jury ruled killed himself and three family members because he was taking Paxil.

"I've never said they should be banned," Vickery said. "For the right people they work. But for other people they don't."

Crystal Barbieri, 20, formerly of Salt Lake City, has her own personal horror stories that she blames on use of Paxil as a teenager.

During the two years she was on the drug for a mood disorder, starting when she was 13, Barbieri beat up her mother, wrote about stabbing her mother to death, swore at her teachers, ripped apart her classroom, suffered from seizures, tried to kill herself and was committed to three psychiatric facilities. Today, Barbieri works for a fragrance company in San Jose, Calif., and she has stopped taking antidepressants.

"I think they're [the drug companies] just after the money, and I think it [Paxil] absolutely should be banned," Barbieri said. "As soon as I got off of it I turned a 180. Every year in high school my grades went up. My life has been so much better."

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