The possibility that a group of widely prescribed antidepressants, including Prozac and Paxil, might trigger suicide and other violence in a small percentage of users has been the subject of isolated reports in the major media since they first arrived on the market. Recently, however, the concern has been recognized by the federal government. In June, following actions taken by British drug authorities, the FDA released a statement recommending that physicians refrain from prescribing Paxil to new patients under 18.

Paxil is one of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Studies funded by the drug's maker, GlaxoSmithKline (GSK), showed it was no more effective than placebos for treating pediatric depression. The same studies also showed an increased occurrence of emotional disturbance in those taking it. The likelihood of a suicide attempt, for example, was about three times greater for Paxil users than for those taking placebos. In August, Wyeth pharmaceuticals drew essentially the same conclusions about its antidepressant Effexor, sending out a two-page letter to healthcare workers stating it may not be safe for pediatric use. This led to the FDA's reanalyzing data for Effexor and several other SSRIs, and in October the FDA issued an advisory citing similar findings for Celexa, Effexor, Prozac and Zoloft. In December drug authorities in Britain banned all but one SSRI from use by children because of evidence that they can cause children to become suicidal. The consistency of these findings suggests that perhaps the FDA should be taking actions that should have been taken long ago to curb adult use of SSRIs.

Reports of a possible link between adult SSRI use and violence, including suicide, first appeared in 1990. In 1991, however, the FDA made a finding, based on a highly selective set of data put together by Eli Lilly scientists, which concluded that Prozac did not cause suicide and was safe. Since that time, SSRI makers have dismissed all allegations that the drugs cause violence and suicide by citing the FDA's report--a report that now looks especially dubious in light of concerns over giving these drugs to children.

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