Posted by Larry Hoover on December 16, 2005, at 11:16:06
In reply to Re: Dr. Tracy on SSRIs.., posted by linkadge on December 16, 2005, at 10:12:42
> But I am wondering what you mean by autopsy indicating SSRI potentiation of suicide?
I'll rephrase. We can compare population exposure to a substance, and autopsy evidence for exposure to a substance, and see if the incidences differ.
The idea that SSRI exposure somehow leads to suicide is testable.
Tracy suggested that was the case. If SSRIs potentiate suicidal thinking and acts, we'd observe disproportionation at autopsy.
> Is it routeen for a person who has killed themseves with a gun to be tested for levels of antidepressants in their system ?
Absolutely not. (Except in parts of Scandinavia. They document everything.) But the question was asked. And some medical examiners have looked. They recorded the data, and gave summary statistics. The pattern in those statistics is inconsistent with an SSRI-triggering theory.
> I am just questioning what kind of data may be collected, and I don't see how an autopsy would disclude a link between SSRI's and suicide since the death may not be an overdose of SSRI's.
>
> LinkadgeOverdose of SSRIs seldom leads to death. So seldom, that it is reported in case report form in medical journals. But the very presence or absence of SSRI drugs in known suicide may reveal important relationship-type data.
We look to toxicological data, such as exposure to e.g. cocaine, alcohol, amphetamines, neuroleptics, antidepressants, marijuana, and so on, in a series of confirmed suicides. Method of suicide is not considered. The blood evidence for exposure to drugs, etc. is simply listed. Then, we can compare this suicide population, to the general population, based on known exposure patterns. And, what we find is an under-representation of proven SSRI exposure in known suicides. Alcohol exposure runs at about 40%, give or take, in known suicides. Just as a contextual element, I raise alcohol exposure.
Here's a sample of the SSRI data.
Acta Psychiatr Scand. 2005 Apr;111(4):286-90.
Comment in:
Evid Based Ment Health. 2005 Nov;8(4):113.
Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides.Isacsson G, Holmgren P, Ahlner J.
Neurotec, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden. goran.isacsson@neurotec.ki.se
OBJECTIVE: To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents. METHOD: Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26,422 cases of deaths by accident or natural causes in Sweden 1992-2000. RESULTS: There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs. CONCLUSION: The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.
Br J Psychiatry. 1999 Mar;174:259-65.Comment in:
Br J Psychiatry. 1999 Jul;175:90-1.Psychotropics and suicide prevention. Implications from toxicological screening of 5281 suicides in Sweden 1992-1994.
Isacsson G, Holmgren P, Druid H, Bergman U.
Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Sweden. Goran.Isacsson@cnsf.ki.se
BACKGROUND: Systematic clinical investigations of consecutive suicides have found psychiatric disorders in 90-95% of subjects (depressive disorder 30-87%). AIMS: To investigate use of psychotropics in men and women of different ages who commit suicide. METHOD: Results of toxicological screening in 5281 suicides in Sweden 1992-94 were studied. RESULTS: Psychotropics were detected in 45.3% of the suicides. Antidepressants were detected in 12.4% of the men and 26.2% of the women (7.2% and 14.2%, respectively, of those under 30 years of age). Neuroleptics or antiepileptics (in the absence of antidepressants) were detected in 8.3%, and anxiolytics/hypnotics alone in 20.5% of the subjects. Overdose by an antidepressant was the probable cause of death in 2.1% of the men and 7.9% of the women. CONCLUSIONS: The pattern of psychotropics detected in toxicology was incongruent with the pattern of diagnoses found in the clinical investigations of suicides mentioned above. Depression appears to be under treated in individuals committing suicide, especially in men and in subjects under 30 years of age.
Just for its thought-provoking capacity, I present the following. There is a powerful correlation between homicidal violence and vegetable oil consumption (dominant source of omega-6 fatty acids). Just look at that correlation coefficient (r = 0.94) and the significance (P < 0.00001). That's less than 1/1000th of 1% chance the observation is a fluke, with 88% of the variation (r squared) attibutable to this variable.Makes me wonder much more about diet than drugs.
Lar
Lipids. 2004 Dec;39(12):1207-13.Increasing homicide rates and linoleic acid consumption among five Western countries, 1961-2000.
Hibbeln JR, Nieminen LR, Lands WE.
Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20892, USA. jhibbeln@mail.nih.gov
Clinical intervention trials and animal studies indicate that increasing dietary intakes of long chain n-3 FA or reducing linoleic acid intake may reduce aggressive and violent behaviors. Here we examine if economic measures of greater n-6 consumption across time and countries correlate with greater risk of homicide. Linoleic acid available for human consumption was calculated from World Health Organization disappearance data for 12 major seed oils in the food supply for the years 1961 to 2000 in Argentina, Australia, Canada, the United Kingdom, and the United States (US). Homicide mortality rates, adjusted for age, were obtained from the central judicial authority of each country. Apparent linoleic acid intake from seed oil sources ranged from 0.29 en% (percentage of daily food energy) (Australia 1962) to 8.3 en% (US 1990s). Greater apparent consumption of linoleic acid correlated with higher rates of homicide mortality over a 20-fold range (0.51-10.2/100,000) across countries and time in an exponential growth regression model (r = 0.94, F = 567, P < 0.00001). Within each country, correlations between greater linoleic acid disappearance and homicide mortality over time were significant in linear regression models. Randomized controlled trials are needed to determine if reducing high intakes of linoleic acid by seed oils with alternative compositions can reduce the risk of violent behaviors. These dietary interventions merit exploration as relatively cost-effective measures for reducing the pandemic of violence in Western societies, just as dietary interventions are reducing cardiovascular mortality. Low linoleate diets may prevent behavioral maladies that correctional institutions, social service programs, and mental health providers intend to treat.
poster:Larry Hoover
thread:587690
URL: http://www.dr-bob.org/babble/20051211/msgs/589564.html