When a suicide occurs, says Clayton, families and friends look for answers, and because prescription medications are so prevalent, they may well find that their friend or loved one was taking one or more medications and often make the connection. "But that doesn’t mean that the drug was a factor in the death,’’ Clayton says. 

Clayton and other psychiatric experts worry about listing suicidal thinking as a possible side effect on medications because, understandably, patients or their families are likely to see that and decide not to take a drug that could be beneficial for a medical condition.

Insufficient information
While investigators try to sort out the data and reports, family members of people who have committed suicide have said they didn’t have enough information when choosing a drug to determine whether it was a safe choice.

Although Cody Miller had no history of depression or suicidal thinking, his mother says that if she had known that Singulair was linked to feelings of sadness, she might not have let him take the drug.

In fact, Merck voluntarily added depression to the drug’s label in April 2007, three months before Cody’s doctor prescribed the drug, because a number of doctors and patients reported the side effect to the company or the FDA. But Miller says her doctor did not tell them the drug could cause depression, nor was depression listed as a side effect of the drug on the company Web site, which she checked when the drug was first prescribed, and wasn’t in the information that came stapled to the prescription from the pharmacy.

Getting drug information on your own While pharmacies and doctors may have a lag in finding out and telling patients about new drug warnings, patients can get that information quickly on their own. Ray Bullman of the National Council on Patient Information and Education in Bethesda, Md., suggests consumers check a new site called DailyMed, a project of the National Library of Medicine, which lists the updated labels produced by drug companies. And the Food and Drug Administration recently began an e-mail service that alerts consumers whenever a significant change is made to a medication or device. Consumers can choose from different categories for e-mail alerts (such as drugs or medical devices).

Insufficient patient and doctor information on side effects of prescription drugs is hardly a new issue. At a 2002 Congressional hearing, Congressman Bart Stupak (D-Mich.) reported a similar lack of information on the acne drug Accutane that his teenage son B.J. was taking. B.J. killed himself in 1999, after several months on Accutane, and his parents have linked his death with the drug.

At the hearing, Stupak said that in 1998 the FDA publicly noted reports of depression, psychosis and suicidal thoughts and actions with the drug, but a year later when B.J. got the drug their doctor had not informed them of the risk, and the patient information that came with the medication did not include it. A spokesman for Stupak says the congressman is looking into current drugs that have been linked to suicidal thoughts and actions.

Consumer advocacy groups such as Public Citizen in Washington, D.C., say there can be lags in getting information to consumers about new warnings on drugs. Refill prescriptions don’t necessarily highlight new information, and patient information that pharmacies staple to the prescription bag don’t always include all necessary information, says Ray Bullman, head of the National Council on Patient Information and Education in Bethesda, Md., which educates consumers and health professionals on safe medication use.

The FDA is looking into the quality and timeliness of the information consumers receive with their prescription drugs, and Congresswoman Gillibrand would like to see a mechanism put in place by the FDA to alert physicians directly whenever a serious drug side effect is announced.

Ask questions, follow up
Medication experts including Cohen, of the Institute for Safe Medication Practices, says that asking whether any medication might cause suicidal thinking or action is a reasonable question when a drug is prescribed, and if the answer is yes, that should be weighed, with your doctors, against the benefits of the drug.

Posner and other experts say a drug should not be dismissed out of hand because it has suicidal thinking and/or behavior as a side effect, without thoroughly discussing the risk-benefit profile of the drug.

Cohen urges family members to monitor children and young adults for behavior changes when any new drug is started and to contact the doctor immediately if they are concerned. He suggests that adults who are taking a drug that has been linked to behavior changes let a friend or family know about the prescription and ask them to stay attuned to any changes.

"Suicide ideation is incredibly common, and is addressable, if needed,’’ says Posner. "In almost all cases when you measure the risk against the benefit, it almost always favors treatment with the drug in question for conditions ranging from asthma to depression."

Fran Kritz is a freelance healthcare reporter in Silver Spring, Md., who also writes for the Washington Post and Los Angeles Times.

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