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Re: What! » linkadge

Posted by Larry Hoover on December 14, 2005, at 22:55:52

In reply to Re: What!, posted by linkadge on December 14, 2005, at 20:33:23

> I don't think that a net reduction has been *clearly* demonstrated at all.

Like I said before, I like to let the facts speak for themselves. I'm an empiricist. This is one of the most convincing studies I've come across, in years. The source data are completely independent (collected for other legitimate but reliable purposes) and show highly significant statistical relationships.

Arch Gen Psychiatry. 2003 Oct;60(10):978-82.

Relationship between antidepressant medication treatment and suicide in adolescents.

Olfson M, Shaffer D, Marcus SC, Greenberg T.

Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York 10032, USA. olfsonm@child.cpmc.columbia.edu

CONTEXT: A decade of increasing antidepressant medication treatment for adolescents and corresponding declines in suicide rates raise the possibility that antidepressants have helped prevent youth suicide. OBJECTIVE: To evaluate the relationship between regional changes in antidepressant medication treatment and suicide in adolescents from 1990 to 2000. DESIGN: Analysis of prescription data from the nation's largest pharmacy benefit management organization, national suicide mortality files, regional sociodemographic data from the 1990 and 2000 US Census, and regional data on physicians per capita. PARTICIPANTS: Youth aged 10 to 19 years who filled a prescription for antidepressant medication and same-aged completed suicides from 588 three-digit ZIP code regions in the United States. MAIN OUTCOME MEASURES: The relationship between regional change in antidepressant medication treatment and suicide rate stratified by sex, age group, regional median income, and regional racial composition. RESULTS: There was a significant adjusted negative relationship between regional change in antidepressant medication treatment and suicide during the study period. A 1% increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicide per 100 000 adolescents per year (beta = -.023, t = -5.14, P<.001). In stratified adjusted analyses, significant inverse relationships were present among males (beta = -.032, t = -3.81, P<.001), youth aged 15 to 19 years (beta = -.029, t = -3.43, P<.001), and regions with lower family median incomes (beta = -.023, t = -3.73, P<.001). CONCLUSIONS: An inverse relationship between regional change in use of antidepressants and suicide raises the possibility of a role for using antidepressant treatment in youth suicide prevention efforts, especially for males, older adolescents, and adolescents who reside in lower-income regions.


> That is what has been argued for the past however many years.

It's been argued, but from smaller samples. Type 1 error is the biggest issue for scientists to manage.

> Many authors have come to the conclusion that no such reduction has been demonstrated.
>
> http://biopsychiatry.com/suicide.html

Or, there's this study, demonstrating a significant change in slope of the suicide rate coinciding with the introduction of SSRI meds. The only way to get a change in slope as described in this study is to have a change in the independent variable(s). It would be a big coincidence if it wasn't related to the introduction of SSRIs.

Pharmacoepidemiol Drug Saf. 2001 Oct-Nov;10(6):525-30.

Antidepressant medication and suicide in Sweden.

Carlsten A, Waern M, Ekedahl A, Ranstam J.

Department of Social Medicine, University of Goteborg, Sweden. anders.carlsten@telia.com

OBJECTIVE: To explore a possible temporal association between changes in antidepressant sales and suicide rates in different age groups. METHODS: A time series analysis using a two-slope model to compare suicide rates in Sweden before and after introduction of the selective serotonin reuptake inhibitors, SSRIs. RESULTS: Antidepressant sales increased between 1977-1979 and 1995-1997 in men from 4.2 defined daily doses per 1000 inhabitants and day (DDD/t.i.d) to 21.8 and in women from 8.8 to 42.4. Antidepressant sales were twice as high in the elderly as in the 25-44-year-olds and eight times that in the 15-24-year-olds. During the same time period suicide rates decreased in men from 48.2 to 33.3 per 10(5) inhabitants/year and in women from 20.3 to 13.4. There was significant change in the slope in suicide rates after the introduction of the SSRI, for both men and women, which corresponds to approximately 348 fewer suicides during 1990-1997. Half of these 'saved lives' occurred among young adults. CONCLUSION: We demonstrate a statistically significant change in slope in suicide rates in men and women that coincided with the introduction of the SSRI antidepressants in Sweden. This change preceded the exponential increase in antidepressant sales.


> There also exist studies that show the course of depression to be worsened by antidepressant use.

True. But when large studies were done, as were just recently published, there is no such signal. You have to consider Type 1 error.

> Current antidepressants reduce depression, and anxiety by creating emotional indifference.

That's one possible outcome.

> The frontal lobe syndrome caused by SSRi's serves to disinhibit the user, making them more prone to impulsive behavior.

What is this frontal lobe syndrome?

> I don't doubt for a minaute that antidepressants can increase the likeyhood of suicide.

There is a brief increase in suicidal risk from SSRIs. When compared to that induction caused by tricyclics, it is a smaller risk. What has happened is that the SSRIs are getting bad press, that tricyclics, for example, never faced.

> Dr. Tracy made a good point. The drug companies pay.
>
>
> Linkadge

That's where I disagree absolutely. Antidepressants are tools. When those tools are not properly managed, I would focus on the mismanagement. The idea that a potentially suicidal depressed patient is written a prescription for one of these drugs, and told to come back in three months (or whatever), is where the problem lies. Proper medical management requires much more than that. E.g. explicit warnings to the patient, to immediately report certain specific adverse effects; frequent reassessments by trained medical personnel; involvement of the family or close friends of the patient, for monitoring purposes; brief prescriptions initially, until the patient's response can be assessed.....so much more can be done, to make the use of these drugs safe.

The medications in question are powerful, complicated, and somewhat unpredictable. The treated patients are not inherently stable at the time of treatment. Complacency in management of these medications is the primary flaw, IMHO.

Lar

 

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poster:Larry Hoover thread:587690
URL: http://www.dr-bob.org/babble/20051211/msgs/589210.html