The ongoing controversy over the links between antidepressant use and suicide among teenagers remains one of the great debates in health care these days.
Ever since the FDA acknowledged the problem by holding highly publicized hearings in 2004, which were then followed by Black Box warnings in 2005, a fresh debate erupted among doctors and others who feared the moves would cause the proverbial pendulum to swing too far - fewer scrips would be written and, consequently, more suicides would result.
For instance, two years after Health Canada warned about prescribing antidepressants to children, a study reported the number of kids who died by suicide increased 25 per cent after years of steady decline. And here's background on a similar study last year in the American Journal of Psychiatry. However, recent data from the Agency for Healthcare Research and Quality found antidepressant scrips in the US actually rose in 2005.
Now, a new report in the Journal of the American Medical Association finds that the overall observed rate of suicide among youth aged 10 to 19 years fell by 5.3 percent between 2004 and 2005 - from 4.74 to 4.49 per 100,000 kids. But the rates for both 2004 and 2005 were still significantly greater than the expected rates based on the 1996-2003 trend.
"The significant excess mortality due to youth suicide in 2004 and 2005 suggests that the marked increase in suicide rates from 2003 to 2004 was not a single-year anomaly," the authors conclude. "Attention must now be directed toward understanding whether this increase in the youth suicide rate after a decade-long decline reflects an emerging public health crisis."
Unfortunately, the authors - two of whom have past ties to drugmakers that sell antidepressants - leave us with little into the reasons for their findings. That's because there is no information at all in the study, which was supported by the National Institutes of Health, about whether anyone was treated with antidepressants And so, the conundrum remains, at least for the time being.
38 Comments
To suggest that SSRIs prevent suicide is rather absurd, if I am reading the post correctly. Being off of anti-depressants as a whole may increase suicidality, but no one should draw such conclusions regarding a particular class of medications.
The autopsy of suiciders reveals almost none were on anti-depressants. The sole proven method of preventing suicide is treatment of the conditions that cause it. The warning deterred family doctors from treating depression. Hundreds committed suicide needlessly.
The FDA Psychopharmacology Committee should resign. They allowed themselves to get bullied by strident, scapegoating, hate filled families, and pseudo-experts, some underwritten by the Church of Scientology. I am sure that after a face saving interval, all will be gone.
Atypical antipsychotics and other drugs for pediatric pediatrics psychiatric indictions.
Salmon
The above comments are naive. Medical Examiners aren't looking for SSRIs because they aren't voted in as a prescribed medication to look for by the states or counties Medical Examining Board. They are mostly screened for narcotics. So how would we know? In Florida alone, from 2000-2005 it was found that 50% of the teenage suicides were on or had been on SSRIs. How do you explain that away? Dan is correct, SSRIs do not prevent suicide. Talk to the grieving parents of those children who committed suicide after being placed on this crap. And please, by all means, show me real evidence-based medicine that there is a Serotonin or Dopamine link to depression that is being paid by the pharmaceutical industry.
The data from the CDC is useless since they don’t show who among the suicides was taking antidepressants and who wasn’t taking antidepressants.
We know from placebo controlled blind studies that youth were two to three times more likely to have suicidal behaviors on antidepressants during the clinical trials. Now, this is REAL science, not some pseudoscience published by the WSJ to try to fit suicides and antidepressants use together from incomplete date from the CDC.
On www.SSRIstories.com there are over 2,500 cases of suicides, murders, murder-suicides where the perpetrator was on an antidepressants. So we can’t say that these 2,500 people found antidepressants calming, soothing and pleasant.
Since the Physicians Desk Reference lists mania, psychosis, paranoid reaction, abnormal thinking, hotstility, etc. as adverse reactions from SSRI antidepressants, we should take a closer look at the 47 school shootings/incidents listed in www.SSRIstories.com/index.php since the full media article is avaialbe for every case and tells which SSRI the perpetrator was taking.
While the CDC authors and others drew no conclusions as to the meaning or possible cause of the increase, the pharmaceutical industry and its apologists have seized upon the data as an oppertunity to blame the FDA's Black Box Warnings concerning the increased risk of suicidality in children and adolescents taking antidepressants. Long-time champions of the use in antidepressants and other drugs to treat children and adolescents have come out of the woodwork to blame the black box. In evaluating these claims, the following should be kept in mind.
1)The bias and vested interests of those proclaiming that the black box is the cause of the increase in suicide rates between 2003 and 2004. Almost all of the "scientists" speaking out about the black box and its relationship to rising suicide rates have a vested interest (including an interest in defending their own actions of promoting the use of the drugs for children and adolescents despite an abscence of efficacy data) and most have pharmaceutical industry ties.
2)The FDA's analysis, which found that antidepressants cause an increase of suicidality in children and adolescents Was Not announced until a September 2004 PDAC Meeting. The FDA did not ask the manufacturers of antidepressants to place black box warnings in their labels until October 2004
3)The black box warnings did not go into effect until January/February 2005 well beyond the analysis time period.
4)However, according to Psychiatric Services, News & Notes, Oct. 2004 Vol. 55,No.10:
In 2003, U.S. physicians wrote 15 Million antidepressant prescriptions for patients under 18, according to FDA Data. In the first six months of 2004, antidepressant prescriptions for children incresed by almost 8%, despite the new drug warning.
5)Failure to consider lack of efficacy. The drugs have not been schown to be an effective treatment for child/adolescent depression, so why would rising suicide rates be related to their declining use? Quite frankly, it's surprising the rate of antidepressant prescriptions for children hasn't declined even more dramatically given the drugs have repeatedly failed to demonstrate efficacy in this population.
As one of the the FDA advisory committe members who voted for the black box warnings (Dr. Thomas Newman, an epidemiologist and pediatrician from the University of San Francisco stated:
We have I think very strong evidence of harm and really not very good evidence of efficacy... You bring people in, you start a medication, and you see an improvement, you are very, very likely to believe that the drug is effective, and the reason why we do do randomized,double-blind trials is because personal experience, however compelling, is not a reliable way to tell whether drugs work.
Dr. Newman later articulated his point when he wrote:
It is easy to see why the personal experience of clinicians and patients would lead them to believe the drug to be effective, since they would have no way of knowing that more than 85% of the benefit they observed would also have occured with placebo.
In fact, the lack of proof of effectiveness was a consistent theme throughout both FDA advisory panel meetings, in Februaury and September 2004, as well as at the Congressional hearings that took place in September 2004 concerning the FDA's handling of the antidepressant issue.
There was even considerable discussion during the 2004 PDACs that langusge concerning the failure of the drugs to to demonstrate efficacy should be included in in the black box. For whatever reson, the issue later disappeared from the radar screen.
6)There is no scientific evidence that shows antidepressants prevent suicide. Pharmaceutical companies generally argue that only controlled clinical trials can answer questions concerning what is causing a particular outcome.
7)The current trend in suicides for children and adolescents could be the result in the meteoric rise in pediatric prescriptions of atypical antipsychotics, such as Abilify and Seroquel, drugs that also carry a black box for increased of suicide/violence
According to research cocluded by Medco Health Solutions, Inc., in which the company reviewed prescription drug claims of some 370,000 youngsters ages 10-19, the prevelance of adolescent girls taking antipsychotics has grown 117% in the past 5 years, while it has increased 71% for boys. The suicide rates are even higher in patients taking antipsychotics than those on antidepressants.
Something Carl Sagan said 20 years ago seems to apply here:
One of the saddest lessons of history is this: If we've been bamboozled long enough, we tend to reject any evidence of the bamboozle. We're no longer interested in finding out the truth. The bamboozle has captured us. It is simply too painful to acknowledge-- even to ourselves--that we've been so credulous
Carl Sagan, "The Fine Art of Baloney Detection,"Parade, February 1, 1987
Lisa, Very well-thought out post. Thank you for sharing your opinions. Rosie (from above) should carefully read the middle section of your post:
"It is easy to see why the personal experience of clinicians and patients would lead them to believe the drug to be effective, since they would have no way of knowing that more than 85% of the benefit they observed would also have occured with placebo."
The same could be said of those 2500 tragic events of which she speaks. The vast majority of those events would likely have happened anyway. It's easy to draw a conclusion from personal experience that these drugs caused the events. But unless there is "control group" (taking a placebo), we'll never know. Obviously that experiment will never be done so I suspect that my grandchildren will probably be debating this same issue with your grandchildren!
And if they were on antipsychotics, were they receiving the appropriate counseling that is supposed to accompany the prescription? That's what I want to know.
Harpy,
The answer to your question, is no.
Nathan,
I appreciate the kind words. Maybe, had the Individuals on ssristories.com had received antidepressant medication guides, these tragedies may never have occured.
AHHHHH,.. Speaking of Grandchildren. The birth of my first grandchild is due this Thanksgiving.
The antidepressant medguides may or may not say what you think. The atypical antipsychotic guides don't exist.
A major factor in these suicides and homicides remains lack of information. Doctors themselves often do not know that the most dangerous times for suicide/homicide are when the drug is first taken and when it is stopped. In the first case, families should be told to HOVER over the patient while in ending the drug, a very careful tapering schedule should be devised. I would guess that these warnings are seldom given...through lack of knowledge or because the doctor does not get paid to give this critical, life-saving advice.
Autopsy findings include clinical data. It is not anti-depressants or anti-psychotics that prevent suicide. It is the successful recovery from the psychiatric diagnosis that does. About half the suiciders, half the murderers, and about half the murder victims are intoxicated. None of the biased commenters is mentioning intoxication as the number one cause of violent death.
It is not anti-depressants or anti-psychotics that prevent suicide. It is the successful recovery from the psychiatric diagnosis that does. About half the suiciders, half the murderers, and about half the murder victims are intoxicated. None of the biased commenters is mentioning intoxication as the number one cause of violent death.
Could this be a combination of SSRI use and alcohol as a possible factor?
http://seroxatsecrets.wordpress.com/2008/01/01/more-on-paxil-withdrawal-addiction-and-alcohol-craving/
Suicide Malpractice,
"Hate filled families,..Scientologists." Is that the best defense you can provide for a severely flawed analasys? Its old, and its irrelevent!
and its called Involuntary Intoxication, which Courts across the United States accept as a viable defense.
Anne,
"The atypical antipsychotics guides dont exist" They do for Abilify and Seroquel for their use in the pediatriac population.
Sounds like evolution in action to me.
I am a man LIVING in the 3rd generation of a family history of suicide.
Drugs are not the answer, they are the problem. Positive social interaction is the answer. However the media, the doctors, big pharma and all those who stand to profit from illegally prescribed medications behind the closed doors of mental health facilities dont want you do know that!
Suicide and shooting sprees will skyrocket astronomically as long as the truth is ignored :) have a nice day! www.z-tron.com
Darrell Potts wrote: "I am a man LIVING in the 3rd generation of a family history of suicide..."
What causes people to commit suicide (and take others with them)?
Matt
Irresponsible ideologues, like the ones here, must live the resulting reduced access to care that killed thousands of young people needlessly. The quality of their writing implies some are untreated mental patients.
"...The quality of their writing implies some are untreated mental patients."
That's an interesting observation - what is it about a person's writing that suggests that they are mentally ill (and how does one recognize mental illness, outside of the grotesquely inadequate contents of the DSM series?)?
Matt
I will not be specifying names or passages. But if the statements are devoid of fact, logic, or sense, and the writer cannot be swayed, it is delusional.
But if the statements are devoid of fact, logic, or sense, and the writer cannot be swayed, it is delusional.
Are you referring to "chemical imbalances theories" ... They are certainly devoid of fact, logic and sense.. And as for opinions that cannot be swayed... Psychiatrists have a lot of opinions which cannot be swayed, are you calling them "delusional" .. I would have used to words "misguided" and "sociopath" , but then again, I am biased...
Truthman, tell us the truth.
Are you a mental patient, and have you gone psychiatric medication free?
Psychiatrists have been misled, the numbers were wrong!
http://translate.google.com/translate?u=http%3A%2F%2Fwww.psychiater.nu%2Fpsychiaters-zijn-misleid-antidepressiva-zetten-aan-tot-zelfmoord-bij-kinderen.html&hl=en&ie=UTF8&sl=nl&tl=en
Suicide Malpractice wrote: "...But if the statements are devoid of fact, logic, or sense, and the writer cannot be swayed, it is delusional."
There is always a logic. Always. It may not be one that one recognizes, but it's there, if one chooses to look for it, because nothing happens in isolation (ie, there will be something underpinning their beliefs).
As to delusions: a person must hold a fixed, false belief, in the face of evidence to the contrary. Well, as Truthman suggests, there are a lot of experts who keep prescribing drugs, when the evidence is that they don't work. They are not delusional, however, because they are the ones making the rules, and won't permit themselves to be challenged, or scrutinized (sometimes explicitly so, like Joe "where you going with that gun in your hand" Biderman). This amounts to "my unsubstantiated BS is true, your unsubstantiated BS is false, and there's nothing you can do about it."
No belief is fixed. The only question being "can I make my argument compelling enough to counter something that I perceive to be dangerous to the individual holding that belief, and possibly others?"
Matt
Matt: Add to the definition of a delusional belief, "that is not taught." We are staying away from other people's religious beliefs.
You may be right about the delusional doctor, but not about clinical care. Clinical care requires delusions in the patient putting up with unrelieved distress, the family complaining, the referral source getting an earful about the doctor, the supervisors and colleagues of the doctor, the ancillary staff. The chance that a delusional belief could persist in clinical care is nil.
Truthman, tell us the truth. Are you a mental patient, and have you gone psychiatric medication free?
Am I a mental patient? No, I am not a mental patient... Have I suffered from depression?.. Yes,I have at one point in my life.. Was I prescribed An SSRI?.. Yes I was prescribed Paxil..
Is this relevant to my postings on here? In a broad context .. no.. Why do you call yourself Suicide malpractice? Are you a psychiatrist? Are you a "mental patient"? And what is your point?
Your opinions come from the experience of one. The rest is bias.
Suicide,... Make that, the experience of 2.
Suicidal Malpractice wrote: "...The chance that a delusional belief could persist in clinical care is nil."
OK. A guy believes that the phone company killed Kennedy, and is said to be delusional, because such a thing isn't possible. He's assessed to be a risk to himself, or others, and gets committed.
Now, in a clinical environment, it will be impossible for him to still believe that the phone company killed Kennedy? Is that what you're saying? I don't see that clinical care would make one iota of difference to such a belief, or have I missed something?
Matt
Suicidal Malpractice wrote: "...Add to the definition of a delusional belief, “that is not taught."
A belief, which may be contradicted with certain evidence, will nevertheless have something underpinning it.
It was delusional to believe that the Earth was flat, or that the Universe rotated around the Earth. Nevertheless, because they were orthodox beliefs, I understand, they WERE taught. And learnt.
And this issue of learning is key, because we don't need to be taught formally to learn, and acquire "knowledge," whether that knowledge be accepted as fact by the majority, or otherwise.
In summation, our conspiracy theorist, with his belief in a phone company capable of assasinating a president, may not have been taught this in school. He would have been taught that Oswald was responsible, because that is the orthodoxy.
However, there will be something that tells him that that version of events does not have the ring of truth about it, and rather than accept the idea of the lone gunman, he looks for more likely candidates, and settles on the phone company. He may be wrong - he may have overlooked something, but is a wrong belief, underpinned by logic, truly a delusion?
Matt
"Your opinions come from the experience of one. The rest is bias"
I have already admitted that I was biased, as an ex "SSRI Addict" , an unwilling one at that I might add, as in I was not aware at the the time of the ethos of psychiatry, nor was I aware of the deceit of pharmaceutical companies. My experience is the norm unfortunately...
After 6 years of being SSRI-free and 6 years of researching the pharmaceutical industry, I think my opinions hold a lot of weight.. I can't say the same for yours, as you failed to address any of the questions which I put to you...
Sometimes the experience of one is just as important as the experience of the many..
Would you discredit an individual experience of the holocaust as "bias"..
I think not...
So I ask you again are you a psychiatrist? , and have you ever been on psychiatric drugs?.. To paraphrase your question back at you.. Are you a "mental patient"?...
Ask people who have lived through one of the worst side effects from SSRIs -- akathesia. I'm one of them. I would never have believed either that these drugs were capable of messing you up so bad that you wanted to kill yourself or others.
There's lots of us in all age populations who have gone through this. We're the luck ones because we managed not to kill ourselves or others, even though the urge was very strong to do so. Do the research. It's out there. And, BTW, the vast majority of us had never, ever had a suicidal thought, or certainly not a serious one where we actually thought of going through with it, until we shook hands with an SSRI. If you keep adding up the experience of one person and then another and another and another, you get thousands. That's where we are now. Read "Medication Madness" by Dr. Peter A. Breggin and you'll get to read about more anecdotes.
It is certainly criminal what is being done to children. It guess BigPharma likes to adhere to the policy of "get 'em when they're young." The young people that are survivors of these drugs are suffering greatly. Hopefully their suffering won't be in vain and they'll be able to talk about what these drugs did for them as young children. Believe me, it ain't pretty. I'm sure glad this crap wasn't out there when I was growing up.
Ask people who have lived through one of the worst side effects from SSRIs — akathesia. I’m one of them. I would never have believed either that these drugs were capable of messing you up so bad that you wanted to kill yourself or others.
Thanks Cathy Yes, I had Akathisia too, from Paxil, its absolutely horrible..
My opinion, but I would not term this a debate. Debates dialogue over ideology, in large part. This is science. Analyze objective data and seek statistical significance.
I have my beliefs on this issue, but I refuse to conclude or validate my beliefs until this data presents itself.
I'll accept multiple correlations, though, as a catalyst for such an analysis.
hI. I have evidence to prove when you take a normal woman. no history of mental illness. no history of suicide thoughts. The age was 25 We came from a nice family. My parents were good to us. No complaints. I am one of 4 girls the youngest. well I have discovered after years of anguish, hurt, trauma, the list is endless of emotions suffered by myself and with my family who lost one of our own in 1981. As above I stated..My sister was 25. she was going through a divorce. so she moved home with us. the divorce was final before her death. There was a number of things that did not fit when my sister took her life. I remember the days that lead up to her death. I remember how she suddenly changed..How she started to act.. that was not her. I remember the flu she went through shortly before her death. I remember asking the professionals she was seeing for checkups..she is acting like this: putting a belt around her neck like a noose. and telling me to pull as hard as i could until she was dead, she asked me to suffocate her in her sleep, she would play dead then laugh when i got scared and shook her to wake up. she would say. oh im just kidding i just wanted to see what you would do if i were really dead! she would say if i stick my finger in the electric socket will I die? I remember how she got so angry one day out of no where..and pushed me with the strentth of 2 men. she was only 120lbs. I remember her being hyper. Walking and Talking so fast, rocking in a rocking chair that night in our living room and looking at me. I remember when she watched the deer hunter with my other sister she said do you think if i do that it would work? It was the prisinor scene of the Russian Roullette with the hand gun to the head. pull you die. or pull and your lucky no bullet in chamber ..try again! she would talk about death, and dying, but yet say to me you don't have to worry I won't really do anything Im too chicken! and she was. My memories are many but you get the idea. Well when my parents and older sister told the dr. they said to us. YOU DON'T HAVE TO WORRY ABOUT HER. SHE WILL NOT DO IT! SHE DOES NOT HAVE IT IN HER TO HARM HERSELF OR ANYONE ELSE. AND MY SISTER ASKED ALSO IF WE SHOULD WATCH HER TAKE HER MEDS..AND THE REPLY WAS.. YOU DO NOT HAVE TO WATCH HER TAKE HER MEDS. SHE IS A BIG GIRL. WELL.. GUESS WHAT.. AFTER ALL THESE YEARS. 6 WEEKS AGO THANK GOD FOR THE COMMERCIALS ON THESE DRUGS. THE BLACK BOX WARNING ADVERTISING ON THESE DRUGS NOW..AND THE COMPUTER WORLD OF INFORMATION. I SOLVED THE MYSTERY! I KNOW WHY AND HOW MY SISTER COMPLETED HER OWN SUICIDE!! ANYONE WANT TO TAKE A GAMBLE AT WHY? EMAIL ME ASAP. MY STORY IS GOING TO BRING OUT MANY FAMILIES WHO ALSO LOST DUE TO GREED. AND MONEY AND POWER. HINT. GO LISTEN TO DR. PETER BREGGIN ON YOU TUBE. HE TELLS ALL. ITS THE TRUTH. I AM A WITNESS TO IT. AND WILL PURSUE JUSTICE FOR VICTIMS SUCH AS MY SISTER AND OTHER VICTIMS WHO HAVE BEEN LOST IN THE SHUFFLE OF THE WORD SUICIDE! IT SHOULD OF BEEN CALLED. PSYCHIATRIC DRUG INDUCED BEHAVIOR.. CAUSED NORMAL HEALTHY WOMAN TO TAKE HER LIFE! 1981 AGE 25.
I FOUND HER DEAD IN HER CAR I WAS ON MY WAY TO SCHOOL AND I SAW RED. JUST RED IN HER CAR ON THE SEATS. AND ALL I SAID WAS. NO...SHE IS JUST FAKING AGAIN THAT IS JUST KETSUP! WELL AS I GOT CLOSER..I LOOKED IN THE PASSENGER SIDE WINDOW. AND THERE SHE LAY. SLUMMPED OVER. BLOOD DRIPPING OFF HER BOTTOM LIP ONTO THE SEAT AND A SMEAR MARK FROM WHERE SHE MUST OF FELL FROM SITTING UP. TO HER HER DEATH. ALL I COULD SAY AT THAT MOMENT WAS... SHES NOT DEAD. SHES FAKING. SHE WILL WAKE UP..AND I WAITED..STUNNED..JUST STARING ..WATITNG..NOTHING. SHE DID NOT MOVE THIS TIME OR LAUGH AT ME AND SAY. JUST KIDDING..IT REALLY HAPPENED. SHE DID IT. SOMEONE MUST OF HELPED HER..DENIAL IS EVIDENT ANYWAY WHEN SOMEONE COMMITS SUICIDE. WHY HOW.. WELL IN THIS CASE..I WAS RIGHT.. MY DENIAL WAS TRUE. I WITNESSED IN 1981 THE BEGINNING OF MANY MORE SUICIDE VICTIMS TO FALL NOT BY THIER OWN HANDS AS IT LOOKED BUT BY THE ANTIDEPRESSANT SIDE EFFECT/ADVERSE EFFECT. THE PUZZLE IS TOGETHER NOW. THE REASON WHY SHE DID WHAT SHE WOULD NOT OF DONE OTHERWISE IS CALLED AKATHISIA. SHE STOPPED THE DRUG ON HER OWN. NOT KNOWING WHAT WOULD HAPPEN. NO WARNINGS. NO PAPERS TELLING DANGERS NOTHING! SHE TOLD A FRIEND I DON'T LIKE HOW THIS MEDICINE IS MAKING ME FEEL IM NOT GOING TO TAKE IT ANYMORE. SO SHE STOPPED. WELL THIS THROUGH HER INTO THE WITHDRAWL..LIKE I SAID I REMEMBER HER GOING THROUGH THE FLU. WELL IT WAS NOT THE FLU. IT WAS THE WITHDRAWL FROM THE DRUG. AND SHE NOR WE HAD ANY IDEA! SOON AFTER SHE TOOK HER OWN LIFE. SHE WAS SKINNY..PALE.. ETC. HER DRESS WAS IN THE BOX WHAT SHE WANTED TO WEAR FOR HER OWN FUNERAL. AND HER NOTE SAID. ITS NOBODYS FAULT. I JUST FLIPPED. :o)
Lisa, so sorry to hear about your sister. Not sure if you have seen this but I stumbled upon it and it might be relevant to the discussion. From a former drug rep. Gwen Olsen http://www.youtube.com/watch?v=KFbs8s3VI6M
A new study out today
http://ajp.psychiatryonline.org/cgi/content/abstract/166/1/42