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Depression raises the risk of suicide

There are so many problems with commentator Patrick Hahn's discussion of the role antidepressants may have played in the crash of Germanwings 9525 that I'm not sure where to begin ("Antidepressants: A Deadly Treatment?" April 11).

Let's start with the fact that the risk of suicide is higher among people with major depression, which it appears that Germanwings pilot Andreas Lubitz suffered from. Mr. Hahn doesn't mention this overriding fact once. He also neglects to mention that Mr. Lubitz's physicians had told him not to fly, something he reportedly hid from his employer.

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Mr. Hahn lists side effects of anxiety, agitation, paranoia, hallucinations and violence which he believes are shared among users of cocaine, methamphetamine and Prozac. He left out another drug that has the same side effect profile: alcohol. He neglected to mention that, as in the case of alcohol, the side effects of Prozac, in contrast to those other drugs, are largely avoidable when used properly.

While Mr. Hahn flogs various organizations that promote treatment of mental health for receiving support from drug companies, he fails to report that the authors of the 2010 PloS One article he touts as proving a link between antidepressants and violence all have received income from litigators or have been expert witnesses in legal proceedings involving antidepressants and mood stabilizers. Biases on all sides of this discussion should be disclosed.

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The Food and Drug Administration warned in 2007 that patients aged 18 to 24 may become suicidal during treatment with antidepressants during the first weeks of use. (Mr. Lubitz was 27.) The FDA advised clinicians to closely monitor these patients. Older age groups do not appear to have this problem.

Contrary to Mr. Hahn's assertion, there is a consensus among medical professionals, backed by data from randomized controlled trials and other types of studies, that antidepressants are useful treatments for patients with depression.

Mr. Hahn's article, rather than shedding light on the tragedy of the crash of Germanwings Flight 9525, called into question accepted and safe practices for patients afflicted with what William Styron, in his memoir "Darkness Visible," described as "hopelessness even more than pain that crushes the soul."

Dr. James P. Richardson

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