Letters Antidepressant use and FDA warnings

Authors’ reply to Mosholder and colleagues

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6516 (Published 29 October 2014) Cite this as: BMJ 2014;349:g6516
  1. Christine Y Lu, instructor1,
  2. Gregory Simon, senior investigator2,
  3. Stephen B Soumerai, professor1
  1. 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
  2. 2Group Health Research Institute, Seattle, WA, USA
  1. christine_lu{at}harvardpilgrim.org

We are glad that Mosholder and colleagues agree that psychotropic poisonings increased, not decreased, after the warnings and news reports.1 2 We believe that debate in this area is instructive for all those looking at nationwide health policies that cannot be studied using randomised controlled trials.3

As discussed in the online comments, Mosholder and colleagues mis-state our conclusion. We did not conclude that “antidepressant warnings discouraged appropriate pharmacotherapy for depression.” We stated repeatedly in the article and National Institute of Mental Health proposal that the most important intervention was the alarming worldwide publicity that exaggerated the FDA warnings. This was immediately accompanied by reductions in antidepressant use (as corroborated by Mosholder and colleagues’ older data), small increases in suicide attempts by psychotropic drug poisoning (possibly owing to undertreatment of mood …

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