Posted by Larry Hoover on December 15, 2005, at 1:51:46
In reply to Re: What!, posted by linkadge on December 14, 2005, at 23:48:14
> I see no significant relationship.
>
> I quote from a study in the Archives of General Psychiatry of all U.S. suicides between 96-98.Earlier work, before the issue was more fully examined. We're a decade past this report.
> http://archpsyc.ama-assn.org/cgi/content/abstract/62/2/165
>
> "The overall relationship between antidepressant medication prescription and suicide rate was not significant."Ahhh, but you fail to quote the following: "By contrast, increases in prescriptions for SSRIs and other new-generation non-SSRIs are associated with lower suicide rates both between and within counties over time and may reflect antidepressant efficacy, compliance, a better quality of mental health care, and low toxicity in the event of a suicide attempt by overdose."
It's the lumping together of TCA and newer antidepressants that gives a non-significant outcome. TCAs are themselves quite toxic, and are associated with a significantly higher rate of completion.
> Most psychiatrists agree that the only agents that have demonstrated a clear effect on suicidiality are lithium and clozapine.
That's not the case.
> >It's been argued, but from smaller samples. Type >1 error is the biggest issue for scientists to >manage.
>
> I don't see anything conclusive here.
>
> Many of the Brittish records show an increased rate of suicide for during start up, but then little to no effect aftarwards.By six months of treatment, there is no longer a signal. What that means is that suicide reduction has already cancelled any start up effect. From there on, it is straight reduction in suicidal frequency. The "start up" effect, or whatever you want to call it, is present with every antidepressant class, and always was. Actually, a little worse with TCAs. It's just that nobody talked about it.
> >True. But when large studies were done, as were >just recently published, there is no such >signal. You have to consider Type 1 error.
>
> No, I am referring to the whole course of the illness. Ie, how without antidepressants, most people recover from depression 8mos to a year. Some studies show that with treatement, it actually becomes a more chronic disorder.You've snipped so much of what I said, I have no idea what you're replying to.
In reply to your closing sentence, chronic recurrent depression is associated with more frequent treatment. Correlation is identical, when you invert the variables. Same magnitude, same direction.
Moreover, your thesis ignores the kindling effect. Aggressive medication protocols were developed precisely because of kindling.
> >What is this frontal lobe syndrome?
>
> http://www.antidepressantsfacts.com/frontal-lobe-syndrome.htmOnce again, a rare outcome, easily addressed by proper and thorough medical management of the treated patient. All five subjects had their adverse effects corrected with medical management. Not a drug problem. A management problem.
>
> >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.
> Even when the tools are used properly, bad things can happen. I am an example. I used the drugs properly.By properly, do you merely mean as prescribed? Were your adverse symptoms immediately reported, and addressed by changes in protocol, monitoring, and management?
>
> >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.
>
> No arguments.My thesis, in simple form. SSRI meds are not inherently injurious to patients. Poor outcomes and extreme adverse effects arise from the absence of: medical oversight and monitoring; true informed patient consent; lack of social supports during treatment; and, failure of the medical community to communicate with respect to the management challenges arising during treatment, to develop protocols for adverse events.
Tracy remains a quack, and a fraud for calling herself doctor.
Lar
poster:Larry Hoover
thread:587690
URL: http://www.dr-bob.org/babble/20051211/msgs/589243.html