Celebrity Suicides Highlight Antidepressant Questions

March 2, 2010— -- February was a month plagued by celebrity suicide. Former "Growing Pains" actor 41-year-old Andrew Koenig, 40-year-old fashion designer Alexander McQueen and Michael Blosil the teenage son of singer Marie Osmond all took their lives within weeks of each other.

Yet in between the vigils and TV coverage of the deaths, were the standard (and almost incongruous) commercials for antidepressants, promising relief.

In a country where antidepressant use is booming and suicide rates have barely budged, experts say science is still just trying to find the basic answer to how antidepressants work.

Celebrities, meanwhile, often become the face of what is usually a personal struggle. Everyone from actor Jim Carrey to singer Alicia Keys feed the public their own views on how to deal with depression.

In a 2004 interview with CBS's "60 Minutes" Carrey said he had to stop taking drugs to feel better from depression. "I had to get off at a certain point because I realized that . . . everything is just okay," he said. "It feels like a low level of despair you live in where you're not getting any answers but you're living okay and you can smile at the office," he said.

Alicia Keys confessed to a two-year bout of depression. But the singer-songwriter said she can work through her depression.

"Pain ... it's just an immediate feeling that drives me to write. But now I can say that even in joy I can express myself," Keys told the Toronto Sun in 2009.

Not everyone in America finds creativity in depression.

By 2005, 10 percent of Americans over the age of 6 were taking antidepressants, according to the Agency for Healthcare and Research Quality. Meanwhile the suicide rates in the past 10 years have modestly declined for men from 24 to 20 suicides per 100,000 people. The suicide rate was unchanged for women.

"We still don't know why these medications work, when they work or why they fail when they fail," said Dr. J. Raymond DePaulo, chair of the psychiatry department at Johns Hopkins University in Baltimore.

DePaulo said it is impossible to tell whether Koenig's decision to stop taking antidepressants might have contributed to his death. Most antidepressants fall into a class of drugs called SSRIs, or selective serotonin reuptake inhibitors.

SSRI's help increase levels of serotonin in the brain. Serotonin is a neurotransmitter that is widely believed to play a key role in regulating mood. Although the first SSRI's hit the market in 1987, researchers still don't know how they work.

And since suicidal people are generally not allowed to participate in clinical trials of the drugs, it is quite difficult to judge exactly how or when antidepressants might affect a suicidal person.

"These studies don't take people with severe depression or those who are acutely suicidal. Since FDA trials involve half the group taking placebo it is unlikely we will ever conduct a definitive trial of an antidepressant in acutely suicidal people," said Dr. P. Murali Doraiswamy, professor of psychiatry at the Duke University Medical Center in Durham, N.C.

In other words, it would be unethical to give a placebo to someone who is in danger of killing themselves. So doctors have a hard time proving antidepressants hurt or help.