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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Ame Sans Vie on June 20, 2003, at 11:15:13
If you ask me, this applies to a much larger segment of the population than children (i.e. EVERYONE), but here's the article.
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NEW YORK (Reuters) - The U.S. Food and Drug Administration (news - web sites) (FDA) on Thursday warned that patients younger than 18 should not take GlaxoSmithKline's antidepressant Paxil because of a possible increased risk of suicidal impulses associated with the drug.The statement from the FDA comes nine days after British regulators issued similar precautions for children and adolescents. The drug, one of Glaxo's top sellers, is known as Seroxat in the UK.
The drug generated global sales of about $3.4 billion last year, but it is facing the prospect of generic competition in the United States within the next 18 months.
The medicine has been the subject of increased public concern because of reports of adverse reactions, prompting Britain to set up an expert panel to investigate.
Although only officially approved for adults, doctors have had discretion to prescribe Paxil/Seroxat to young people on a so-called "off-label" basis.
Although companies are allowed to promote and market drugs only for approved uses, doctors are free to prescribe drugs to patients at their discretion.
Children account for a small portion of patients taking the antidepressant. For instance, a total of 4 million prescriptions were written for Seroxat in Britain last year, with around 8,000 patients under 18 receiving treatment.
New data from various clinical trials showed episodes of self-harm and potentially suicidal behavior were between 1.5 and 3.2 times higher in patients younger than 18 taking the drug than in those receiving a placebo.
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Posted by linkadge on June 20, 2003, at 17:28:22
In reply to FDA: Children shouldn't use Paxil, posted by Ame Sans Vie on June 20, 2003, at 11:15:13
In my experience I found that SSRI's could increase the feelings of wanting out.
I suspect the reason for this is what happened to me. I was very suicidal before taking the drug. I wanted out, but felt so guilty about wanting to commit suicide. I would have never done it for fear of judgement from God and leaving family alone.
However after taking celexa, that changed. While the depression itself did not really lift for a long while, the guilt left almost immediately. I had an apathy that made me not at all *afraid* of killing myself. Infact suicide all of a sudden became *no big deal* It was just shortening your life a little early.
In my oppinion, the drug did nothing to promote suicidal behavior, but instead made it seem all the more justified, normal, and acceptable.
So depressed children not taking the drugs aren't going to feel better, infact worse because they are too afraid to do anything.
You know you're really out of controll of your life when you don't even feel its your right to take. For me, feeling like I *could* die if I wanted to was a step towards improvement. It seemed to let me at least feel in control.
I know it sounds very strange but thats the way it happened with me.
Linkadge
Posted by noa on June 20, 2003, at 19:53:53
In reply to Why SSRI's can cause suicitiality, posted by linkadge on June 20, 2003, at 17:28:22
SSRIs are DISinhibiting, so if you have suicidal feelings and thoughts but are inhibited from acting upon them (from guilt or whatever), the disinhibition of the SSRI could put you at risk if you are still having the suicidal thoughts. I think that the disinhibition happens more quickly than the full antidepressant effects.
Did the events occur in Britain I think? WHen I saw the Ap article about the FDA warning, I thought it said the warning originated first in England. All I could think of was the NHS and what I've heard about it here. Here is my fantasy: depressed kids are given Paxil and sent on their 'merry' way with no mental health follow up, no monitoring, etc. and I wonder if kids who are followed closely by both a mental health therapist and a good pdoc would end up with the same awful results. Just my thoughts.
Posted by noa on June 20, 2003, at 19:54:43
In reply to Why SSRI's can cause suicitiality, posted by linkadge on June 20, 2003, at 17:28:22
I also wonder if some people experience such severe agitation on SSRIs that could lead to suicide?
Posted by Viridis on June 21, 2003, at 15:04:19
In reply to Re: Why SSRI's can cause suicitiality-PS, posted by noa on June 20, 2003, at 19:54:43
I think it could also be general "activation" -- if someone has been paralyzed by depression and thinking suicidally, but has been unable to put together a coherent plan, then a sudden "jolt" from a new drug might give them the energy to follow through. Sad, especially if the AD would have worked out over time.
I suspect that a lot of doctors don't realize just how powerful some of these meds can be, or how strongly some people can react. That's one of the reasons it makes me uneasy to see GPs handing them out left and right. It's not that psychiatrists are perfect, but on average I'd guess that they'd be more alert to possible suicidal ideation, and more likely to provide a second med (e.g., benzo) to smooth the transition to ADs and calm the patient.
Overall, though, I'll bet that ADs have prevented many more suicides than they've caused (or enabled).
Posted by Questionmark on June 22, 2003, at 0:21:44
In reply to Why SSRI's can cause suicitiality, posted by linkadge on June 20, 2003, at 17:28:22
> In my experience I found that SSRI's could increase the feelings of wanting out.
>
> I suspect the reason for this is what happened to me. I was very suicidal before taking the drug. I wanted out, but felt so guilty about wanting to commit suicide. I would have never done it for fear of judgement from God and leaving family alone.
>
> However after taking celexa, that changed. While the depression itself did not really lift for a long while, the guilt left almost immediately. I had an apathy that made me not at all *afraid* of killing myself. Infact suicide all of a sudden became *no big deal* It was just shortening your life a little early.
>
> In my oppinion, the drug did nothing to promote suicidal behavior, but instead made it seem all the more justified, normal, and acceptable.
>
> So depressed children not taking the drugs aren't going to feel better, infact worse because they are too afraid to do anything.
>
> You know you're really out of controll of your life when you don't even feel its your right to take. For me, feeling like I *could* die if I wanted to was a step towards improvement. It seemed to let me at least feel in control.
>
>
> I know it sounds very strange but thats the way it happened with me.Great post; great points. It was the exact same for me with Paxil. The guilt and fear of leaving, so to speak, were substantially lessened. And i completely agree-- feeling that "leaving" is a legitimate and decent option is SO much easier and nicer than feeling like even thAt is a terrible option. The difference is amazing. Strange. So yeah i agree that that's probably one of if not the biggest reason(s) for SSRIs causing increased suicidality or whatever.
***Another possiblly major reason, though, is the sevERE, dark, dark depression that they give you near the beginning of treatment (for like 3 to 10 days usually, it seems like). i experienced this and everyone i talked to about it who has tried an SSRI has also experienced this. i think this is an extremely significant aspect of SSRI therapy, and crucial for people to know-- and highly overlooked in psychiatry. i wonder how many people experienced this horrible despair when starting an SSRI and then killed themselves because they didn't realize it was just the med and would not last very long. Probably more than a handful. So sad. ... And absolutely sickening that so many patients are not warned about this (if ANy). Surely the pharm. companies would have information on this right? Ah, i duno.
This is the end of the thread.
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