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Antidepressants and Teenage Suicide.
Do antidepressants cause teen suicide? - It seems counter-intuitive. The thought that the newer antidepressants collectively known as selective serotonin reuptake inhibitors (SSRIs) like Paxil or Prozac would increase the risk of suicide in teenagers or worsen depression in children but there is a growing movement out there that believes that this is entirely true.
The FDA opened hearings on this issue this week and are they ever in a tight spot. On one hand they have parents who claim that their children committed or attempted suicide after being placed on a SSRI medication and on the other hand depression and suicide among teenagers and young adults is a massive problem that needs solutions. Should they go so far as the Department of Health in the UK which recommended against the use of all SSRIs except Prozac in patients under the age of 18? But the UK took this step primarily because of what they saw as a lack of effectiveness in the use of SSRIs in children and teenagers.
Professor Ian Weller, chairman of the working group, told the BBC: “The evidence is that the drugs either don’t work, or work only very little, and there are large number of side effects that children get, such as headache, shaky hands, agitation, loss of appetite, loss of weight.”
The evidence of a lack of effectiveness comes from unreleased studies from the drug makers themselves. The perceived increased risk of suicide in teenagers comes from data from a GlaxoSmithKline (makers of Paxil) study that found increased rates of suicidal thoughts and attempts rather than any actual deaths.
The FDA had asked all makers of adult antidepressants to submit research showing how their drugs affect children. Three studies of Paxil found it didn’t seem to help pediatric depression — but FDA scientists spotted some safety concerns and ordered manufacturer GlaxoSmithKline to reanalyze the data. That reanalysis — submitted last month, first to the British government and then to FDA — found the risk of suicidal thoughts and suicide attempts was three times greater among Paxil users, mostly teens, than among children given dummy pills, the FDA said.
There were no deaths during the studies, but FDA officials wouldn’t release the actual number of suicide attempts, citing manufacturer confidentiality. GlaxoSmithKline would detail only the rate of all “emotional side effects,” ranging from mood swings to suicide attempts: 3.2 percent of pediatric Paxil patients compared with 1.5 percent of those given dummy pills in studies that included about 1,000 children and teens.
However, the independent American College of Neuropsychopharmacology has released it’s own report from a panel that evaluated the data on SSRI use and suicide risk and came up with some very different conclusions. To summarize;
- The idea that antidepressants can increase suicidal thinking in patients is not new. There are several case reports from 1991 (mostly in adults) but a separate analysis from 1992 showed no correlation between the cases with any type of antidepressant, dosage or changes in dosages, or the length of treatment. The only commonality found among these cases was the presence of a psychiatric disorder (such as depression) that increases the risk of suicide itself (page 5-6).
- None of the studies cited by UK or FDA regulators were specifically designed to look at suicidal ideation or attempts so the evaluation of each was left up to the individual investigators without any standardization. There were no attempts to evaluate the potential lethality of each “suicide” attempt. For example, many impulsive attempts such as taking a non-lethal dose of medication or minor self-inflicted injuries are more “cries for help” or “for attention” than serious suicide attempts while some very dangerous or self-destructive behaviors (like reckless driving) may have suicide as a motivation.
- The data provided to the FDA by GlaxoSmithKline reportedly showing a higher suicidal ideation and attempt rate of patients taking Paxil over those on placebo were actually not statistically significant meaning that a larger study group is needed to show a statistical difference (many studies exclude patients with high suicide potential). Pages 7-8.
- A study from the UK data base of adverse drug reactions that influenced the UK ban had no control group and the data came from subjective patient reports of side effects or other reactions which may have been influenced by a TV program that aired in the UK about the side effects of medications. Page 6.
- According to the World Health Organization (WHO) there has been an average decline in the suicide rates of people ages 15-24 of 33% over 14 years in 15 countries that cannot be explained by any changes in alcohol or drug use or firearms control. In all but 3 countries the decline began after SSRIs first entered the market. Page 9.
- No single study of SSRI use in adults has shown an increase rate of suicide ideation or attempts. Page 10.
- Toxicology studies have shown that the majority of people who committed suicide were not on medication at the time. Page 8.
Every year in the U.S. more than 4,000 people ages 10-24 commit suicide and it is the third leading cause of death in this age group (source). For each suicide there are 10-20 attempts and beyond that a whole hell of a lot of teens and young adults with severe depression. Ideally the treatment of depression should include both medication as well as therapy but the medication option is in real danger of being taken away in the same manner that the FDA allowed unsubstantiated hysteria to nix silicone breast implants. Silicone breast implants don’t cause death but neither does their absence. With a restriction of SSRI use in children we may see a reverse in that 33% reduction in suicide among young people.
But whether or not you believe that SSRIs are effective, to blame suicidal ideation and attempts in teens and young adults with depression on the use of the medications themselves without definitive evidence is like blaming termite damage on the use of insecticides. Since the emergence of SSRIs their use in children and teens in the treatment of major depressive disorders has sky rocketed. This is no surprise since suicide and depression in young patients was and still is a massive problem that didn’t have any safe and effective treatment prior to SSRIs (which are safer than older antidepressants).
Even though the rates of suicide in young patients has fallen, thousands still attempt it and now these patients are more likely to be taking an SSRI. I find it very curious that more and more parents are now able to find something to blame for their child’s suicide or attempt where as in the days before SSRIs this was just a tragic and often blameless event. Ironically, through their actions and concerns they may make this type of tragedy a more common reality for thousands more parents.
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Current Depression Medications: Are SSRIs Beneficial or Deadly?
Presently, for the treatment of depression and other what some claim are mental disorders, as some claim some mental disorders are somewhat questionable, selective serotonin reuptake inhibitors are the drugs of choice by most prescribers today, clearly. Such meds, meds that affect the mind, are called psychotropic medications. SSRIs also include a few meds in this class with the addition of a norepinephrine uptake inhibitor added to the SSRI, and these are referred to SNRI medications, which are the number 1 top therapeutic class of prescriptions presently. Examples of SNRIs are Cymbalta and Effexor. Some consider these classes of meds a next generation after benzodiazepines, as there are similarities regarding their intake by others, yet the mechanisms of action are clearly different, but not their continued use and popularity by others. Furthermore, adding an additional agent is presumed to increase the effect by some.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is the DSM, states that the definite etiology of depression remains a mystery and is unknown. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected with limited scientific evidence. In fact, diagnosing diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinephrine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med.
And depression is only one of those mood disorders that may exist in certain patients, yet possibly the most devastating one. An accurate diagnosis of these mood conditions lack complete accuracy, as they can only be defined conceptually, so the diagnosis or impression concluded by the patient’s doctor is dependent on subjective criteria, such as questionnaires. A social patient history is uncertain and tricky. There is no objective diagnostic testing for depression. Yet the diagnosis of depression in patients has increased quite a bit over the decades. Also, few would argue that depression does not exist in other people. Yet, one may contemplate, actually how many other people are really depressed? What is believed is that if one is disabled or impaired from a mental paradigm, treatment is necessary and appropriate. Psychology is such a soft and manipulative science, perhaps like religious denominations. Further disturbing is an article in Time magazine that stated that the military in the war are pounding down SSRIs. Everytime there is a new war, there is a new drug, it seems.
Several decades ago, less than 1 percent of the U.S. populations were thought to have depression, it has been said. Today, it is believed that about 10 percent of the total population in the United States have depression at some time in their lives that may vary in severity and longevity. Why this great increase in the growth of this condition remains unknown and is subject to speculation.
What is known is that the psychiatry specialty is the one specialty most paid to by certain pharmaceutical companies for ultimately and eventual support of their psychotropic meds, as this industry clearly desires market growth of these products.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders are suspected by a health care provider. Yet these meds discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related disease states.
Over 30 million scripts of these types of meds are written annually, and the franchise is around 20 billion dollars a year now, along with some of the meds costing over 3 dollars per tablet. There are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be marketed for the treatment for menopause. The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received and desired by their manufacturers for additional indications besides depression for some really questionable conditions, such as social phobia and premenstrual syndrome. With the latter, I find it hard to believe that a natural female experience can be considered a treatable disease. Social phobia is a personality trait, in my opinion, which has been called shyness or perhaps a term coined by Dr. Carl Jung, which is introversion, so this probably should not be labeled a treatable disease as well. There are other indications for certain behavioral manifestations as well with the different SSRIs or SRNIs. So the market continues to grow with these meds. Yet, it is believed that these meds are effective in only about half of those who take them, so they are not going to be beneficial for those suspected of having certain medical illnesses treated by such meds. The makers of such meds seemed to have created such conditions besides depression for additional utilization of these types of medications, and are active and have been active in forming symbiotic relationships with related disease- specific support groups, such as providing financial support for screenings for the indicated conditions of their meds- screening of children and adolescents in particular, I understand, which is disease mongering, by definition. As a layperson, I consider such activities dangerous and inappropriate for several reasons.
Danger and concerns by others primarily involves the adverse effects associated with these types of meds, which include suicidal thoughts and actions, violence, including acts of homicide, and aggression, among others, and the makers of such drugs are suspected to have known about these effects and did not share them with the public in a timely and critical manner. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others, such as those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, including the decreased efficacy of SSRIs in general, which is believed to be less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding such important information- Elliot Spitzer specifically, as I recall.
Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them. For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect could cause harm rather than benefit? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring in their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist. It is observed in some who take such meds, but not all who take these meds. Yet health care providers possibly should be much more aware of these possibilities, along with the black box warning now on SSRI prescribing information for the youth since 1994.
Finally, if SSRIs are discontinued, immediately in particular method of avoid tapering the prescribed dose, or the gradual discontinuation, withdrawals are believed to be quite brutal, and may be a catalyst for suicide in itself, as not only are these meds habit forming, but discontinuing these meds, I understand, leaves the brain in a state of neurochemical instability, as the neurons are recalibrating upon discontinuation of the SSRI that altered the brain of the consumer of this type of med. This occurs to some degree with any psychotropic med, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs, it is believed.
SSRIs and SRNIs have been claimed by doctors and patients to be extremely beneficial for the patient’s well -being regarding the patient’s mental issues where these types of meds are used, yet the risk factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug. And doctors praised trycyclics, another class of anti-depressants, in a similar manner some time ago. Considering the lack of efficacy that has been demonstrated objectively, along with the deadly adverse events with these meds only recently brought to the attention of others, other treatment options should probably be considered, but that is up to the discretion of the prescriber. It is my hope that such a prescriber rules out possible deficiencies of a patient they diagnose as being mentally impaired, such as other diseases or meds that could cause a mental illness, imbalances with the patient’s hormones, deprivation of light and/or sleep, or life stressors. Rarely do prescribers consider such possibilities, it seems.
“I use to care, but now I take a pill for that.” — Author unknown
Dan Abshear
Author’s note: What has been written is based upon information and belief