Side effects
Randomised clinical studies of antidepressants have been governed by the pharmaceutical companies and designed to demonstrate short-term effects rather than long-term safety of use (13). Little attention has been devoted to revealing side effects and harmful effects of these drugs (7). There is an imbalance between the emphasis placed on positive and negative effects (14). A number of serious side effects in clinical studies have not been reported or have been reported incorrectly (15). This notwithstanding, we now have data that call for an increased degree of caution in prescription practices.
Since 2004, the American Food and Drug Administration (FDA) has published numerous safety warnings concerning potentially increased suicidal intent following from the use of antidepressants among children, adolescents and young adults (13). Since 2007, all these drugs must carry a so-called «black box warning» that provides information on an increased risk of suicidal symptoms. This issue was raised as early as in 1958 (15). SSRI-induced suicidal intent as a class effect of antidepressants has been known since the early 1990s (16). A recently published Norwegian study among patients with bipolar disorder showed that attempted suicide in the case history is associated with previous use of antidepressants (17).
Whether such drugs overall serve to increase the number of suicides among adolescents and adults must be deemed unclear (18). In their review article, Healy and Aldred found that the risk of suicide during treatment with antidepressants is 2 – 3 times higher compared to placebo (15). The cause of this increase in suicidal intent during the use of antidepressants has not been conclusively determined, but several authors indicate a relationship to specific sub-groups and an association between drug-induced psychomotor agitation, «racing thoughts» and suicidal behaviour (1, 19).
Like antipsychotics, antidepressants may cause akathisia, i.e. inability to sit still, severe restlessness and an urge to wander around (16, 20). Several studies show that intense affective states characterised by desperation, anxiety, agitation and anger, even those of a passing nature, result in crises with a high risk of suicidal behaviour (21). Many highly suicidal patients tend to deny any suicidal intentions in their sessions with the therapist. Presence of severe anxiety and agitation are currently the only secure predictors of suicide during hospitalisation and immediately after discharge (22).
Antidepressants have a number of psychoactive effects and side effects, especially during the first days following the start of the treatment or after a change of dosage (6). Some patients develop paradoxical effects, including an exacerbation of their depressive symptoms (23). An American study showed that approximately 8 % of the admissions to psychiatric hospitals were due to mania or psychosis that had been induced by antidepressants (24).
The information folders for various drugs quite often contain warnings of behavioural change involving a potential for violence towards others. Most antidepressants are supplied with such information. In a recent study, Moore and collaborators analysed data from the American reporting system for side effects of drugs (25). They found that violence towards others is overall associated with few drugs. Antidepressants with serotonergic effects had the strongest association with such violent events.