Tuesday, November 29, 2011

Violence and Anti-Depressants

We are coming up on the 10th anniversary of the Columbine Shooting tragedy. On April 20, 1999, two teenagers, Eric Harris and his Dylan Klebold stormed the Columbine High School, in Littleton Colorado, tossing pipe bombs and shooting helpless classmates, killing thirteen and injuring 23 before taking their own lives. Harris and Klebold's deadly plan went undetected by friends, teachers, administrators -- and, apparently, their own parents -- until the killings began. Both Eric and Dylan were bright and generally did well academically in school. Both enjoyed their computer class in school. Jefferson County School District and Columbine High School officials did not address the environment of classroom and play yard bullying that existed at the school and students reported later that the bullying and harassment went on uncontrolled throughout the school. Following the investigation of the shooting it was revealed that Eric had been forced by court order to take psychiatric medication, the drug Luvox – an SSRI antidepressant that can cause violent behavior, suicide and homicidal thoughts. There was a group of twenty kids picking on other kids, including the shooters Eric Harris and Dylan Klebold. They got spit on and called 'faggots' and pushed around. These two troubled boys, Klebold and Harris, plunged into a computer world where they could re-invent themselves and become more powerful and intimidating than the bullies at school they despised. Nobody did anything about the school bullying situation. Many teenagers at the school were reluctant to take their complaints to adults out of fear of retaliation or of being branded a snitch. Then the two outcasts decided to retaliate against those who bullied them – and the worst school mass murder occurred in Littleton, Colorado.

Eric Harris had experienced the life altering trauma of sexual assault. He was further re-traumatized by taunting by school classmates and was suffering from Post Traumatic Stress Disorder or PTSD. Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. Any human being has the potential to develop PTSD. But the use of Luvox - an antidepressant that affects serotonin levels in the brain was a disaster waiting to happen. Psycho-active antidepressants are capable of turning a depressed student into a smiling active killer.

What really happens inside the minds of "depressed" patients when these drugs are given? Let's consider first what is naturally happening to a victim of trauma and who has shown signs of depression or anxiety.

The truth is that sexual assault is a mind altering traumatic event that leaves its victims suffering Post Traumatic Stress. When a person has been forced into a situation that is life endangering, they respond by either fighting or fleeing. This is a very stressful situation and one that the victim cannot escape from and therefore the memory of the events brings great fear, anxiety and distress. The events that led to PTSD cause great fear, these emotional memories are etched deeply in the cognitive centers of the brain and linked by neural pathways to the deeper emotional centers of brain. These deeper emotional centers in the brain cause hormones to be released that act on the adrenal glands and cause these adrenal glands to release the hormones of cortisol and adrenaline into the blood stream. This hormonal release causes the heart to beat faster, blood pressure to rise and produces an euphoric state. This natural body response to the stress hormones allows a victim to flee, run, fight, and do the necessary things to survive. But after the real danger is gone, the memory of the horrible fear and the sense of eminent death that these events usually bring is forever permanently laid down in fast-track brain neural pathways. This is because in the evolution of human beings it was necessary to be able to remember your enemies and to rapidly flee or get ready to fight them. Thus the brain has developed a very fast neural pathway for the emotional memory center to get alerts from the cognitive front lobe of the brain and send information very fast through chemical hormones to the adrenal glands. These neural hormones then selectively stimulate the adrenal glands to produce cortisol. Cortisol is very powerful blood born chemical and in a few heart beats this powerful chemical message has readied the body to fight or flight. The heart rate has increased, the blood pressure increased, the lungs are breathing at a faster rate, and the parts of the body not needed for fighting or fleeing are given less blood. This all allows the body to pump blood containing oxygen to our muscles – the better to fight with and to run with. But the neural pathways that turn on this powerful message system do not have a corresponding turn off neural pathway. So once activated the body remains in alert status for a significant period of time until the affects of the hormones have worn off and the alert status for danger is over. But the next time those traumatic memories are triggered; the fast-track neural pathway is already there and immediately jumps into to action getting cortisol release from the adrenal glands. But sights and sounds that remind one of the trauma, make it happen even if there is no danger present – it is like being in a constant state of alert. Thus it is very important that a PTSD suffer learn how to turn off that response or at least moderate it, by using conscious awareness of how his own mind works to relax and to forget. Any medication that interferes with the ability of the patient to do this will not have good long term affects on a PTSD sufferer, and anti-depressants have been shown to actually increase cortisol and thus prolong the period of anxiety and fear.

In situations of sexual abuse and assault, the victim is helpless to flee and may have, through no fault of his/her own, failed to defend him/herself. The psychiatric injury of PTSD is caused by an external cause and leaves lifelong psychological scars. A person suffering PTSD will experience hyper-arousal to things in the environment that remind them of their trauma – these are called triggering events. A victim will also be hypervigilant looking for danger – be ever watchful. The impact of the trauma will cause the victim to have difficulty trusting others and forming close relationships (may appear withdrawn, uncooperative, defensive or aggressive). He/she may have fears and concern for her/his safety but have difficulty expressing feelings, be irritable or depressed. Victims have nightmares and difficulty sleeping. Victims may respond rapidly to events and be prone to anger. They may act out; have traumatic memories that are intrusive in their daily thoughts. They will deny, and avoid the memory of their trauma and have difficulty with concentration. They will be distrustful and often alienated. Individuals suffering from PTSD live daily life as if the traumatic experience is recent, even though it may have happened years earlier. Events, words, visual images that evoke the memories are called triggers and will cause the event to be constantly re-experienced. PTSD interferes with the victim’s ability to verbalize the events and their meaning. People do not believe, and deny the severity of the trauma thus blaming and stigmatizing the victim. Society has a tendency to blame the victim for not being able to simply “get over it” and this cultural lack of support can be classified as secondary wounding and promotes a victim mentality, thus keeping the problem going.

This is what was happening to Eric Harris when he was prescribed the anti-depressant Luvox. Luvox affects the neurotransmitter Serotonin or 5-hydroxytryptamine (5-HT) in the brain. Serotonin is a neurotransmitter that affects the brain and plays a role in aggression, memory, learning, pain, sleep, appetite, anxiety, depression, migraine, and vomiting. Several different classes of psychiatric drugs like anti-depressants, anti-psychotics, anti-anxiety drugs, anti- migraine drugs and psychedelic drugs affect the level of this neurotransmitter inside the neuro-synapses of the brain. Some drugs such as tricyclic antidepressants (TCA’s) and selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin, making it stay in the synapse longer.

SSRI's and TCA antidepressants not only fail to modify cortisol, but actually stimulate/increase cortisol release. This is why these drugs can create a drug induced abnormally elated mental state, typically characterized by feelings of euphoria, racing thoughts and talkativeness. This can then progress further to a neurologically driven agitation. This agitation can range from mild leg tapping, to severe panic or even an extreme manic state. This does tragically lead directly to suicidal, aggressive and/or homicidal thoughts and behaviors.

Bill Forsyth of Maui, Hawaii, had taken fluxetine for only 12 days when he committed one of the first murder/suicides attributed to any SSRI. Joseph Wesbecker who had only been on the drug fluoxetine for 4 weeks killed eight others and himself in a Louisville, KY. at printing plant where he worked.

But the lesson from the Columbine School shootings was not learned, because in the U.S.A today these dangerous drugs are still being prescribed for depression – with fatal consequences. In 2005, Jeff Weise, aged 17, was taking Prozac and when his dosage was increased after his Prozac induced nightmares; he then went out and did a mass murder at the Minnesota Red Lake School.

News reports stated that Stephen Kazmierczak, who shot and killed five Northern Illinois University students at the Dekalb campus on February 14, 2008 had recently stopped taking medication and "had become somewhat erratic in the last couple of weeks." There was no apparent motive or any relationship with any of his victims who were mowed down as he fired more than 50 shots in a matter of seconds from a lecture hall stage. This was not unusual as often there is no motive with these drug-related killings. The profound influence of drugs on the person’s brain levels of neurotransmitters are affected so much that any sudden increase or decrease in the dosage can result in insane homicidal behavior.

Steven Kazmierczak was 27 when he purchased the shotgun and two of the hand guns prior to the attack. Kazmierczak had no criminal record but had been a patient for a year at Thresholds-Mary Hill House, a psychiatric treatment center for teens. Under Illinois state law he would not have been able to purchase a weapon legally if there had been a record of arrests or mental problems.

Current gun control policy is geared to accept that patients “under the care of a physician” are approved to purchase a deadly weapon. These pills do not “cure” mental disease – they alter brain function – often with devastating effects. Remember that the supervising clinical doctor is perhaps only seeing the patient for 15 minutes every 3 months. Some supervising physicians are not even seeing their patients that frequently, as they are allowing nurses or PA’s with prescription authority to actually do the face to face with the patient, in these instances the MD may not see the patient hardly at all.

Many states permit mental patients on these medications to purchase guns – not considering at all the fact that the FDA warning inserted in every antidepressant prescription warns of possible violent behavior and suicide. Those empowered to make public policy decisions on gun control legislation should reevaluate the assumption of low risk of gun violence from patients taking psychotropic drugs. When will the public policy on gun control actually reflect the research findings that lead to the FDA warning label on these dangerous mind altering drugs - when will we finally realize that taking a pill doesn't make someone "normal" or safe to handle a gun. Right now the legislation is worded in such a way as to prevent someone who uses non-drug therapy (such as Cognitive Behavioral Therapy or psychotherapy) from purchasing a weapon but place a weapon in the hands of someone else taking a drug that is known to cause persons to do mass violence.

When will public officials wake up to the real danger - the psychotropic drugs that cause disruption of brain activity and thoughts of violence.


Check out the full transcript of Columbine Shooting progress report submitted to the court:

http://columbinefamilyrequest.org/evidence-repository/pages-00001-00100/

http://columbinefamilyrequest.org/evidence-repository/pages-101-200/

http://columbinefamilyrequest.org/evidence-repository/pages-00201-00300/

http://columbinefamilyrequest.org/evidence-repository/pages-00301-00400/

http://columbinefamilyrequest.org/evidence-repository/pages-00401-00500/



See the following list of traumatic incidents and deaths associated with antidepressant use.

Violence & Antidepressants

2004 08/18 Antidepr. Violence Yvonne Jenkins, 27; medication for anxiety attacks and depression
2004 08/17 Antidepr. Violence "Man", 41; anti-depressant medication
2004 08/06 Antidepr. Violence Dr Joseph Coladonato, 61; antidepressant
2004 07/00 Antidepr. Killing Mark Hobson, 35; anti-depressants
2004 07/27 Antidepr. Killing Gerry Christensen, 55; Prozac/Sarafem (fluoxetine)
2004 07/26 Antidepr. Killing Mary Ellen Moffitt, 37; Paxil/Seroxat (paroxetine)
2004 07/11 Antidepr. Violence Alex Yun, 26; antidepressants
2004 07/07 Antidepr. Killing Gina Davis, 36; antidepressant
2004 07/06 Antidepr. Fraud Rene Rivkin, 55; Prozac/Sarafem (fluoxetine)
2004 06/29 Antidepr. Killing Raymond F Noll, 58; Effexor/Efexor (venlafaxine)
2004 06/22 Antidepr. Killing Emiri Padron, 24; Zoloft/Lustral (sertraline)
2004 06/18 Antidepr. Killing Timothy Joe Irwin, 42; antidepressants
2004 06/16 Antidepr. Violence Gale Thomason, 36; Celexa/Cipramil (citalopram)
2004 03/06 Antidepr. Violence Ryan Dowling, 25; antidepressants
2004 02/00 Antidepr. Violence Morag McManus, 57; anti-depressants
2004 02/22 Antidepr. Violence William J Heck, 35; Paxil/Seroxat (paroxetine)
2004 01/14 NewYorkPost Wellbutrin/Zyban (bupropion) induced delusion


Adults: Shootings, Violence & Delusions

2003 12/00 Antidepr. Dreams Denise Martin, 53; Paxil/Seroxat -dreams of killing
2003 11/01 Antidepr. Violence Frank Kendall, 37; Effexor (venlafaxine) -"flipped out"
2003 09/10 Antidepr. Killing Mijailo Mijailovic, 25; anti-depressants
2003 08/16 Antidepr. Killing "Mother", 38; anti-depressants
2003 07/08 AntiDepr. Killing Doug Williams, 48; Celexa & Zoloft
2003 06/17 Antidepr. Violence Merrilee Bentley, 36; -Effexor (venlafaxine)
2003 06/17 Antidepr. Violence "Mum", 32; Paxil/Seroxat & Effexor -attempted murder/suicide
2003 06/14 Antidepr. Killing George Harold Davis, 46; Paxil/Seroxat withdrawal rage
2003 04/00 Antidepr. Fraud Robert Treadway, 36; antidepressants
2003 04/08 Antidepr. Killing Colleen Mitchell, 51; Zoloft/Lustral & Wellbutrin/Zyban
2002 12/27 Antidepr. Killing Christopher Bernaiche, 27; Prozac/Sarafem (fluoxetine)
2002 09/26 Antidepr. Violence Wayne L Horowitz, 52; Prozac/Sarafem (fluoxetine)
2002 07/24 Antidepr. Killing Carol Ackels, 40; Paxil/Seroxat (paroxetine) -killing daughter
2002 07/12 Antidepr. Killing Lee Sims, 68; antidepressants, Paxil/Seroxat (paroxetine)
2002 06/20 Antidepr. Violence Andrew Meyers, 28; Zoloft/Lustral (Sertraline)attempted murder
2002 05/03 Antidepr. Killing Cindy Gail Countess, 49; Paxil/Seroxat (paroxetine)
2002 05/02 Antidepr. Killing Jason Davidson, 33; Zoloft/Lustral (sertraline)
2002 01/04 Antidepr. Killing Albert Pacheco, 47; Zoloft/Lustral (sertraline)
2001 10/25 Antidepr. Killing Scott Ellison, 41; "medication for anxiety & depression"
2001 09/02 AntiDepr. Killing Leslie Wallace, 39; Wellbutrin/Zyban (bupropion)
2001 06/30 AntiDepr. Violence Diana Reese, 40; Prozac/Sarafem (fluoxetine)stabbing with knife
2001 06/23 AntiDepr. Violence Paula Townsend, 31; Prozac/Sarafem (fluoxetine)tire slashing spree
2001 06/20 AntiDepr. Killing Andrea Pia Yates, 36; Effexor, Wellbutrin & Remeron
2001 06/08 AntiDepr. Killing Mamoru Takuma, 37; 10 times his daily dose of an anti-depressant
2000 12/26 AntiDepr. Killing Michael McDermott, 42; Prozac, Paxil & Desyrel (trazodone)
2000 03/25 AntiDepr. Violence Nadine Trewin, 31; Prozac/Sarafem -cooking cat in microwave
1999 10/00 Antidepr. Killing Donna Yost, 29; anti-depressant
1999 08/22 Antidepr. Rape Matthew Giannascoli, 21; Strattera (atomoxetine), an SNRI
1999 08/01 AntiDepr. Killing David Hawkins, 76; 5 Zoloft/Lustral tablets
1999 06/10 Antidepr. Killing Kelly Silk, 32; Prozac/Sarafem (fluoxetine)
1998 02/13 AntiDepr. Killing Donald Schell, 60; 2 Paxil/Seroxat (paroxetine) tablets
1997 12/00 AntiDepr. Robbery Christopher DeAngelo, 28; Prozac/Sarafem (fluoxetine) -robbery spree
1997 08/05 Antidepr. Killing Richard Shuman, 55; Zoloft/Lustral (sertraline)
1995 12/15 Antidepr. Killing Gerald Clemons, 36; Prozac/Sarafem
(fluoxetine)


Teens, Murder and Antidepressants

2004 08/23 Killing at Home 10 year old boy, 10; Prozac/Sarafem -killing father
2003 01/03 Killing at Home Ryan Furlough , 18; Effexor/Efexor (venlafaxine)
2002 11/02 Killing at Home Dustin Lynch, 16; Paxil/Seroxat
2002 05/29 Killing at Party Katrina Sarkissian, 17; antidepressants
2002 04/10 School Violence Sean McEvoy, 15; Paxil/Seroxat
2002 01/25 Killing at Home Tavares Eugene Williams, 18; Prozac/Sarafem
2001 11/28 Killing at Home Christopher Pittman, 12; Paxil & Zoloft
2001 04/15 Imprisonment Cory Baadsgaard, 16; Paxil/Seroxat & Effexor
2001 03/22 School Shooting Jason Hoffman, 18; Celexa (citalopram) & Effexor (venlafaxine)
2001 03/07 School Shooting Elizabeth Bush, 14; antidepressants
1999 04/20 School Shooting Eric Harris, 17; Luvox Related
1998 05/21 School Shooting Kip Kinkel, 15; Prozac/Sarafem


Anti-Depressant related Suicide (attempt) & Death


2004 08/27 Omaha Channel Vickie McCarthy & Paxil withdrawal: electrical zaps, suicide attempt
2004 08/20 Yahoo/Forbes Nancy Hugo, 57; -Zoloft: "urge to slam the phone into the side of my head"
2004 06/12 Antidepr. Suicide Perry Custance, 22; Lexapro/Cipralex (escitalopram)
2004 04/12 Antidepr. DeathCassie Jo Geisenhof, 19; Serzone/Dutonin -liver damage/transplant
2004 03/15 Antidepr. Suicide Stephen Leggett, 53; Celexa/Cipramil (citalopram)
2004 02/27 Antidepr. Suicide Deon Whitfield, 17 & Durrell Feaster, 18; Prozac/Sarafem -hanging
2004 02/21 Antidepr. Suicide Kaitlyn Kennedy, 16; Zoloft/Lustral (sertraline)
2004 02/07 Antidepr. Suicide Traci R. Johnson, 19; Cymbalta (duloxetine)
2004 01/01 TheLedger Report links Paxil/Seroxat (paroxetine) to crash
2003 00/00 Antidepr. Suicide Joey Casseday, 16; Celexa/Cipramil (citalopram)
2003 12/01 Antidepr. Suicide Michael Halton, 41; an anti-depressant drug
2003 11/00 Antidepr. Suicide Stephanie Fritz, 15 Zoloft/Lustral (sertraline)
2003 11/00 Antidepr. Suicide Joanne Marsh, 26; antidepressants
2003 10/00 Antidepr. Suicide Rhett Kunkel, 21; antidepressants
2003 10/29 Antidepr. Suicide Larry Boyd Smith, 61; Celexa/Cipramil (citalopram)
2003 09/04 Antidepr. Suicide Peter Hearn, 51; Prozac/Sarafem (fluoxetine)
2003 08/00 Antidepr. Suicide Candace Downing, 17; -Zoloft/Lustral (sertraline)
2003 08/00 Antidepr.SelfHarm Alicia Quartermain, 18; Paxil/Seroxat/Aropax (paroxetine)
2003 08/05 BostonGlobe Michelle van Syckel was suicidal on Seroxat/Paxil
2003 07/22 Antidepr. Suicide Julie Woodward, 17; Zoloft/Lustral (sertraline)
2003 07/08 Psychology Today Jamé Tierney, 14; Effexor withdrawal reactions, suicidal impulses
2003 06/12 TheGuardian Novelist Helen Walsh was suicidal during her time on Seroxat/Paxil
2003 06/01 Antidepr. Suicide Colin Whitfield, 56; Seroxat/Paxil
2002 09/17 Antidepr. Suicide Wendy Hay, 52; Prozac/Sarafem
2002 04/10 Antidepr. Suicide Jessica Viscount, 28; Prozac/Sarafem (fluoxetine)
2002 03/24 Antidepr. Suicide Joseph Scholes, 15; Prozac/Sarafem
2002 01/00 Antidepr. Suicide Gareth Christian, 18; An SSRI-antidepressant
2001 12/00 Antidepr. Suicide Douglas Bruce Hopey; Paxil/Seroxat (paroxetine)
2001 06/07 SSRI Suicide Kara Jaye-Anne Otter was 12... Paxil/Seroxat -child suicide
2001 05/23 Antidepr. Suicide Daren Alli; Prozac/Sarafem (fluoxetine)
2001 05/15 Antidepr. Suicide Jay Douglas Goodwin, 16; "medication"
2000 00/00 Antidepr. Death Child, 9; liver cytochrome P-450 2D6 deficiency; Prozac-related death
2000 11/00 Antidepr. Suicide LaVerne M. Shell, 63; Prozac/Sarafem (fluoxetine)
2000 08/00 Antidepr. Death Alan Ridley, 46; Wellbutrin/Zyban (bupropion)
2000 06/03 Antidepr. Suicide Kevin Rider, 14; Prozac/Sarafem (fluoxetine)
2000 12/05 AntiDepr. Suicide Jacob Williams, 14; Prozac/Sarafem (fluoxetine) -suicide 2000 04/11 AntiDepr. Suicide Sarah Lawson, 22; Prozac/Sarafem (fluoxetine) -voluntary suicide
1999 06/03 Antidepr. Suicide Hugh Blowers, 17; Prozac/Sarafem (fluoxetine)
1998 10/23 Antidepr. Suicide Jean Hurley's Husband; Prozac & Effexor
1997 07/28 Antidepr. Suicide Matt Miller, 13; Zoloft/Lustral (sertraline)
1994 06/01 Antidepr. Suicide Evan, 18; Prozac/Sarafem (fluoxetine)
1990 03/11 Antidepr. Suicide Chris Reid, 18; Prozac/Sarafem
1990 02/08 Antidepr. Suicide Del Shannon, 56; Prozac/Sarafem (fluoxetine)

2 comments:

Anonymous said...

I knew Joe Scholes....

while I belive in theory than anti-deps can cause suicidal thoughts, people are often more complex than that, hence why they are on medication at the time.

Its of most peoples belife that had Joe not been sent to a prison without specialist help, he could well still be with us today.(not me, I don't know enough about his situations and problems to make such claims)

I myself have attempted suicide, and been on many Anit-Deppresants and Anti-Pychotics, buy at no point did I feel they made me more vunrable to a suicide attempt.

Your blog makes easy assumptions with no real evidence.

MedicalWhistleblower said...

The FDA held numerous hearings on the increase in suicidal thoughts and violent behavior on antidepressants. There was clearly a lack of willingness on the part of the pharmaceutical companies to accurately report clinical research results and many studies pointing to the increased risk were deliberately withheld from the public and from regulators. Drug companies routinely suppress negative trials, manipulate data, and only report positive results. It has been known for a long time that antidepressants have the potential to induce mania, agitation, and similar behavior. Reports surfaced that a small percentage of kids in Paxil trials exhibited signs of suicidal behavior, the FDA in July requested the manufacturers of eight other antidepressants to look at data from their pediatric drug trials for evidence of suicidality. In August 2002, Wyeth made a labeling change to Effexor and sent a letter to doctors recommending against its pediatric use. In October, the FDA sent a public health advisory, urging caution for all antidepressants for pediatric use. A drug trial researcher, Andrew Mosholder MD reported that there was evidence of an increased suicide risk in kids based on a review of 25 pediatric trials, 16 related to depression. The report also found that only three in 15 pediatric depression trials had succeeded, which made the FDA look at the issue of benefits vs risk. In February 2004, the FDA's combined Psychopharmalogic Drugs Committee and Pediatric Advisory Committee convened a public hearing, and as a result of that meeting, the FDA announced its intention to strengthen the warning labels on antidepressants. The FDA's UK counterpart, the MHRA released research data on the suicide risk showing that in three large trials, Paxil showed, a "possibly suicide-related" risk of 6.5 percent and 5.4 percent suicide attempts in one trial (vs 1.1 percent and zero, respectively for the placebo), no risk for the other two trials. (MHRA) Data from three trials found suicidality in 3.7 percent of patients (vs 2.5 percent placebo). Emotional lability occurred at rates of four and seven percent in two trials (vs three and one percent placebo) and hostility at eight percent in one trial (vs zero percent placebo). Another antidepressant Prozac in an MHRA study showed hyperactivity 6.1 percent (vs 0.7 percent placebo), agitation (3.1 percent vs zero percent). "The incidence of manic or hypomanic reactions ... (2.6 percent) was significantly higher than in placebo-treated children and adolescents (zero percent)." The drug Zoloft according to the MHRA showed a combined suicidality/self-harm rate of 2.7 percent (vs 1.1 percent placebo) from two depression trials, agitation (6.3 percent vs 1.1 percent). No suicidality/self-harm in OCD trial. On the strength of existing evidence in 2004 an FDA panel voted 18 to 5 to require manufacturers of all antidepressants to add black box warnings to their product labeling. A month later, the FDA adopted the panel's recommendations. The warning reads in part:

"Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior."