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Paxil Can Drive Young People To Despair, Suicide

Aug 20, 2003 | Economic Times

Since June, Paxil, one of the world’s most prescribed anti-depressants, has been put out of bounds for people who are under 18, after a study conducted by GlaxoSmithKline, the British manufacturer of the drug, showed that it may spark off suicidal thoughts in young people.

A week later, the US Food and Drug Administration followed suit, saying it had information from three studies in paediatric patients that failed to show that the drug was more effective than a placebo. Reports from other studies showed that Paxil use in the younger population was associated with increased risk of suicidal thoughts.

The FDA also recommended that patients should not discontinue the drug suddenly. It added that it had never approved Paxil for use in people below 18.

This is why we must be cautious, experts emphasise, about findings from drug trials, especially to patients and conditions that are substantially different from those for which the drugs were originally evaluated.

In the Glaxo study, Paxil (sold as Seroxat in UK) more than doubled emotional side-effects, including mood swings, crying episodes, suicidal thoughts and self-harm in children, compared to those taking a placebo. A spokesperson for GSK in Mumbai clarified that the company did not market the best-selling anti-depressant, which belongs to a class of compounds called SSRIs or selective serotonin reuptake inhibitors. This includes well-known brands like Prozac and Zoloft. SSRIs work by boosting the concentrations of a neurotransmitter chemical called serotonin, which plays a key role in mood regulation and sleep cycles.

The concern that Paxil and similar drugs could cause suicide first surfaced many years ago. At that time an ad hoc committee of experts set up by the US FDA cleared the drugs of a link to suicide in ‘91. Since then, millions of people have taken the drugs and experts say the medicines have prevented many more suicides than the reading of the new findings suggests they could have caused.

“The increased risk of suicide in the early stages of anti-depressant treatment has long been recognised,†says Jaslok neuropsychiatrist Rajesh Parikh, who spent several years at the John’s Hopkins Hospital in Baltimore. “It’s part of standard training of resident so that the doctors are not lulled into a false sense of security when early improvement begins to set in. What prevents a patient from suicide is psychomotor retardation, which is one of the integral symptoms of depression that impairs an individual’s ability to act on his or her thoughts,â€

“When depression is treated, whether by SSRIs or other drugs, or even non-drug treatment such psychotherapy or electro-convulsive therapy, the psychomotor retardation often resolves before the depressive mood and thought. Paradoxically, therefore, an individual who might have been paralysed by his or her depression from acting on their suicidal impulses is actually at a higher risk of attempting to harm himself just when he or she is getting slightly better,†added Mr Parikh.

Doctors do not use Paxil as a first line drug due to withdrawal problems and weight gain, a side effect that is particularly objectionable to young adults, reports Psychology Today. Other experts on suicide describe the warning against Paxil as premature because the size of GSK’s data may not be large enough for establishing a direct connection between the drug and instances of its emotional side effects. As evidence they point to the statistics of suicide in the UK, which have declined and not grown in recent years even as the use of SSRIs has expanded.

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