Author: Julio Licinio
Position: Chairman of Psychiatry
Institution: University of Miami
E-mail: licinio@miami.edu
Submitted Date: September 26, 2006
Published Date: October 3, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Vera Hassner Sharav and the Alliance for Human Research Protection (AHRP) are misguided in their comments. First, all drugs cause adverse reactions, and citing a list of such reactions as proof that a drug is dangerous is not convincing. Since their introduction over 50 years ago, antidepressants have been used by millions of individuals. If the drugs are as dangerous as Ms. Sharav asserts, the rates of adverse reactions would be going up, not down. It is a factual truth that as antidepressant prescriptions have gone up, the rates of suicides have gone down. While causality cannot be established, if antidepressants were as noxious as Ms. Sharav states there should have been an increase, not a decrease, in the rates of suicide.

This is further supported by the article recently published by Henriksson & Isacsson entitled "Increased antidepressant use and fewer suicides in Jamtland county, Sweden, after a primary care educational programme on the treatment of depression" [Acta Psychiatr Scand. 2006 Sep;114(3):159-67]. In that article the authors documented that suicide rates in Jamtland decreased to the same level as the national average in Sweden in the context of a concerted public health effort to increase antidepressant use. In this program, the use of antidepressants increased from 25% below the Swedish average to the same level. The selective serotonin re-uptake inhibitors (SSRIs) were preferred because of their tolerability. Suicide issues were considered to be most important in the management of depressed patients. The authors show a trend towards a greater prescription of antidepressants and fewer suicides after an educational program on depression for GPs. As background, Isacsson et al had published in Br J Psychiatry (1999 Mar;174:259-65) an article entitled "Psychotropics and suicide prevention. Implications from toxicological screening of 5281 suicides in Sweden 1992-1994". The conclusion of the analysis of that extensive dataset was that "depression appears to be under treated in individuals committing suicide, especially in men and in subjects under 30 years of age".

The title of Ms. Sharav's letter is "Misapplying Population Trends - No Competing Interests". I ask: what are her interests?

I publicly disclose all of my conflicts, sources of, and strategies for funding. The funding strategy for a meeting of the International Society of Pharmacogenomics that I organized and which is cited by Ms. Sharav was publicly disclosed and did not result in any personal gain or honorary. I find it ironic that in contrast, in her disclosure Vera Hassner Sharav and the Alliance for Human Research Protection (AHRP) state that this group does not get funding from government or industry. But she does not state where she gets her funding from.