The impact of antidepressants, adverse events warnings, and survey results

455 A 16-year-old girl presents to her physician with a sixmonth history of fatigue, insomnia, lack of energy, a 10-pound weight loss, and disinterest in friends and school. Three months ago, after a fight with her boyfriend, she took several aspirins to “fall asleep and not wake up”. She wishes to be dead but has no plans to kill herself. In the past month, she has self-lacerated her wrist twice superficially while feeling angry or numb. Depression is diagnosed and fluoxetine is started. During follow-up, she reports feeling more “nervous and hyper”, having difficulty sleeping and having more thoughts about cutting. She asks if these are side effects of the medication. Her mother is worried because she recently heard a Food and Drug Administration (FDA) warning on the radio about selective serotonin reuptake inhibitors in young people. Because of the side effects and the mother’s concerns, the physician lowers the dose, feeling that the medication was still indicated, and refers her to an adolescent psychiatrist.