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Re: Going through Effexor Withdrawl now SLS

Posted by Larry Hoover on July 13, 2004, at 20:29:11

In reply to Re: Going through Effexor Withdrawl now, posted by SLS on July 11, 2004, at 7:35:21

Hey Scott. How ya doin', buddy?

> These are powerful drugs eliciting unpredictable effects on a brain that we have very little understanding of. Many drugs produce depression as a frequent side effect. Drug manufacturers are required to include this fact in the packaging of their products. It makes for a long list of very diverse drugs. Antidepressants are not teleologically exempt from producing undesirable mood alterations because they have some sort of biological "safety" that permits only antidepressant effects and precludes depressogenic effects.

Anybody who can work "teleologically" into a sentence, with skill, has my support.

> For any given individual, there may be certain antidepressants (or any other type of drug) that will exacerbate the clinical depression and induce suicidal states. Prozac has, and will continue to cause suicides as long as prescribing physicians continue to think like you do.

There are particular windows of vulnerability to suicide, which require more effective medical management. Suicidal induction is not novel with respect to SSRI antidepressants. It is a well-known phenomenon since the introduction of the tricyclics. One of the driving forces in the development of the SSRIs was to provide an antidepressant which itself was not generally fatal in overdose, as the tricyclics are.

I've been studying the literature, and plan to write a review article on the subject of antidepressants and suicide. Overall, suicide rates are declining, while SSRI prescription rates are increasing. There are two distinct effects, but the summary statistic is that suicides are reduced by SSRIs, notwithstanding temporary increases in susceptibility.

> > The most logical explanation for the fact that sometimes people who take antidepressants commit suicide is
> > 1. Coincidence
> > 2. the antidepressants give them enough energy to commit suicide.
> Both of these explanations are absolutely valid. However, I would appeal to you that you leave open your mind to the possibilities of a third, especially if you are in a position to influence the medical treatment of anyone suffering from depression.
> By the way, statistics do demonstrate that antidepressants cause suicide.

I'm not convinced. Most of the data were collected for purposes other than that to which they have been put. Clinical trial data are not generalizable to the population at large, in my opinion. When you look at the epidemiological data, the government records of suicide, compared to prescription rates, and examination of post mortem toxicology, there is no obvious SSRI-suicide signal. Short-term clinical studies may happen to coincide with one risk window.

> It is statistics that are fueling the whole uproar regarding the use of SSRIs in pediatrics. I am sure that the statistics are there for adults too. We just need an expert like you to look for them once the trial data becomes public.

I'm not an expert statistician, but I am trained in methodology. I reviewed the pediatric paroxetine study, the full clinical dataset (over 500 pages).....the one where paroxetine was said to have a six-fold greater suicide risk than placebo....that conclusion is misleading, and is unsupported by the data.

It is a statistical fluke, combined with stringent adherence to protocols, which produced that disturbing statistic. For example, "emotional lability" is the category these events were collected under. Only four of the six incidents of emotional lability in the paroxetine group were "severe", and fully documented. One "severe" paroxetine case is due to one subject taking one or two extra tablets per week (b.i.d. dosing), over two consecutive weeks. Instead of taking fourteen tablets, she lost count and took fifteen or sixteen (out of 20 provided at a time), three weeks in a row. By protocol definition, and only because it was two (or more) consecutive weeks, that was a priori a case of severe emotional lability. The only true suicidal act occurred in the placebo group. They're comparing apples to oranges. Here's a link to a summary of my analysis:

I copied the actual case reports of the severe emotional lability incidents from the study appendices. Here's a link:

Paxil is being framed, in my opinion.

> On a more anecdotal note: The following drugs made my depression moderately - severely worse. Reboxetine and moclobemide in particular induced a suicidal state.
> amoxapine
> bupropion
> donepezil
> idazoxan
> mirtazapine
> moclobemide
> protriptyline
> reboxetine
> triiodothyronine
> valproate
> Best wishes,
> - Scott

I'm sorry you've had such a struggle with meds. Lithium made me suicidal, as did Serzone.





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