Research done in Wales by Dr. David Healy, director of the University of Wales’ North Wales Department of Psychological Medicine, appears to show a cause-and-effect relationship between Zoloft (sertraline) and the emergence of suicidal thinking in a group of physically and mentally healthy adult volunteers. Zoloft, like Prozac (fluoxetine), is a selective serotonin uptake inhibitor (SSRI). Healy has completed a similar study with Prozac, but its results have not yet been published.

A spokesman for Lilly said today, “There is no scientific evidence to establish a link between Prozac and suicide.” He cited a l991 study by a Food and Drug Administration advisory panel, which unanimously agreed that there was “no credible evidence of a causal link between the use of antidepressants, including Prozac, and violent behavior.”

Even the drug’s critics agree that the effect, which the company says does not exist, occurs in only a small number of cases — fewer than 1 percent. Maris said that although the incidence is very low, when it happens it is such a serious matter that doctors should be very careful in prescribing Prozac, and extremely watchful when they do.

Maris said the danger is greatest during the first week or two of Prozac use, when some patients who were already at risk for suicide have a rare reaction that makes them feel energized and more ready to act on their self-destructive impulses. There is another dangerous time later, when a patient, who had been virtually immobilized by deep depression, still entertains suicidal thoughts. At this time, the drug has moderated their depression enough to make them able to carry out these thoughts.

Healy’s study showed a similar pattern, and left him convinced that a direct link exists between SSRIs and the emergence of suicidal thinking in people who had never had such thoughts. He is not the first medical researcher to suspect such a reaction. Dr. Martin Teicher of Harvard Medical School reported in 1990 that he and his colleagues had observed suicidal thoughts emerging in six patients who were taking Prozac. Other researchers and clinicians began reporting that they saw it too.

Serotonin is a relatively simple chemical that is vital to the brain’s regulation of a great many body functions — sleep, appetite, and even more basic activities such as muscular activity, breathing and blood circulation. Abnormal serotonin levels have been blamed for a large number of mental and physical problems, including depression, obsessive-compulsive disorder and panic disorder.

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