Posted by cache-monkey on September 16, 2004, at 0:13:56
In reply to That argument has been made before » uther, posted by Racer on September 15, 2004, at 20:02:05
<< Is there an increased risk of suicide while taking anti-depressants? Probably, and for a number of psychological reasons as well as any possible drug effects. For one thing, these drugs often take a while to kick in, so someone suffering severe depression who has had suicidal impulses may simply give up hope too quickly. Someone whose depression is not yet alleviated who experiences adjustment phase side effects may also give up, because of the discomfort.
On the other hand, the agititation caused by some of these agents has been targetted as the most likely cause of an increased risk of suicidal behavior. Someone who's experienced a vegetative depression may suddenly experience overwhelming agitation, without any relief from the depression, which may indeed increase that person's risk for suicidal behavior. Similarly, someone who experiences the agitation as distressing may also engage in such behavior, whether or not the medication addresses depression. >>To follow up on this: It is unfortunate, but not infrequent for people suffering from depression to have their thoughts drift toward suicide. There are usually social and moral checks that prevent this from becoming anything more than loose contemplation. But another thing that might serve as a check on acting on a suicidal impulse is the depression itself. It would have to take a lot of energy and drive to go through with something as drastic as that.
I think that when an antidepressant starts working (assuming it does), one of the first things that happens is that people start having more motivation and energy. But it takes a little while for the thought patterns to catch up. I.e. to realize at a higher level of cognition that you're *not* depressed, useless, and whatever other negative self-stereotypes that constitute and amplify our depressions.
As a result for some the may be this limbo period in which they might still have their suicidal ideation and actually have the energy to act on it. (I think this is -- to an extent -- what Elizabeth Wurtzel descibes in her memoir _Prozac Nation_.) And this is probably especially the case for the SSRIs, given how much faster they work as a class of drugs. For slower-acting drugs, there's more time for the thoughts to catch up with feelings.
What I'm saying is that for some a temporary increased drive toward suicide might be paradoxically a part of the recovery process. This is not to say that there isn't a drug-specific causal effect -- I think there are studies that show an increase in suicidual ideation and behaviour in otherwise "healthy" (whatever that means) people given SSRI treatment.
But, if anything, this speaks to needing to have a greater awareness of treatment-emergent suicidal tendencies, as well as support systems to help people _live_ through them.
That being said, I don't think that has been the goal of the stories in the media dealing with this phenomenon. Instead, I think the media is engaging in sensationalism-as-usual. Which is unfortunate, given the general lack of understanding (and often downright stigmatizing) of depression in a large segment of our society.
peace,
cache-monkey
poster:cache-monkey
thread:391220
URL: http://www.dr-bob.org/babble/20040915/msgs/391375.html