FDA Warning Label Letter to the Editor

That antidepressant medications are recommended for warning labels by the FDA because of their potential for increasing suicide risk misses the point; the warning label needs to be put on the practitioner, not the pill.

With few exceptions, the American healthcare industry is under-trained and generally incompetent to detect and assess suicide risk in the patients for whom they prescribe these otherwise helpful agents. Writing a prescription for an antidepressant for an already suicidal patient is a national problem, and especially among our older citizens. Among the findings published in the 2002 Institute of Medicine (IOM) report, Reducing Suicide, a National Imperative, are the following:

• Most People who complete suicide had contact with a health professional within a year of death, and 40 percent of these contacts were within one month of their death. Many people die by overdose on the prescription medications provided them at these visits.
• Screening for depression, substance abuse and suicide potential is not routine in primary care, even though primary care providers are often the 'first and only medical contact" suicidal patients have with the healthcare system. As a result, suicide risk is not detected.
• Primary care physicians lack training and evidence-based screening, assessment, and referral practices for suicidality.

Before we frighten the people who need these potentially life-saving medications away from their proper use under competent medical supervision, perhaps we should require non-psychiatric healthcare providers to learn something about how to detect, assess and manage those at risk for suicide before reading for their prescription pads. In the matter of suicidal, depressed people the current "Don't ask, Don't tell," don't work.

Paul Quinnett, Ph.D. is the President and CEO of the QPR Institute, a training organization devoted to preventing suicide, and the Editor-in Chief of Preventing Suicide: the National Journal.