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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Larry Hoover on February 6, 2007, at 9:02:00
In reply to Disturbing results, posted by Squiggles on February 6, 2007, at 6:54:29
> The FDA has just announced a large increase
> in child and adolescent suicide rates within a year, following the Black Box Warning on Antidepressants, and consequent decrease in antidepressant treatment. I saw the article in a Yahoo group (psychiatry-research) but the copyright of American Press prohibits redistribution.
>
> SquigglesNo, the FDA did not announce any such increase. The statistic was buried in a raft of other stats released by the CDC (Centres for Disease Control, or something like that; http://pediatrics.aappublications.org/cgi/content/abstract/119/2/345). The article referenced on that Yahoo group was in the lay press (http://www.msnbc.msn.com/id/16996417/wid/11915773?GT1=9033), and includes speculative commentary about the coincidence between the FDA-mandated black box warnings and the statistical increase in adolescent suicides. Two events occurring at the same time may have no link whatsoever, although a correlation might be very tempting, or even reasonable. I agree, the correlation seems reasonable, but I can conclude only that this is further evidence that adolescent depression requires far more supportive intervention than is currently made available.
Lar
Posted by med_empowered on February 6, 2007, at 10:32:36
In reply to Re: Disturbing results » Squiggles, posted by Larry Hoover on February 6, 2007, at 9:02:00
No one has established a correllation. All we know is doc's reduced rx-ing of ADs, suicide rates went up. Also, although the percentages look huge, the absolute numbers (and absolute increases) were pretty small. And lots of things influence suicide, not just depression. Social class, ethnicity, family structure, religion/lack thereof--these and other social factors play a huge role in determining suicidality. Plus, suicide rates fluctuate anyway--remember the cluster suicides among teens in the 80s? Those boosted rates, then everything calmed down and the rates went down.
Also, given that some of these ADs haven't been shown effective for adolescents, I think we're overlooking the fact that the case for these meds being safe, effective treatment for depression (especially in young people) really hasn't been made...Paxil, for instance, turned out ineffective in several trials. In the UK, only Prozac is considered to have enough evidence to justify prescribing to adolescents.Speaking of teenage suicide...anyone seen Heathers? Awesome film.
Posted by Phillipa on February 6, 2007, at 11:05:50
In reply to Re: Disturbing results, posted by med_empowered on February 6, 2007, at 10:32:36
I'm starting to think that these SSRI's only work for a lucky few and then only the first time. Love Phillipa
Posted by med_empowered on February 6, 2007, at 11:10:33
In reply to Re: Disturbing results, posted by Phillipa on February 6, 2007, at 11:05:50
also..think about it this way: if increased use of psychiatric meds reduced the suicide rate, then our suicide rate now should be much, much lower then 50s, when Thorazine and Miltown and the MAOIs and first TCA (Tofranil) were introduced. Our rates are significantly higher across the boards.
I don't think psychotropics have a major impact on suicide rates overall.
Posted by bassman on February 6, 2007, at 12:58:22
In reply to Re: Disturbing results, posted by med_empowered on February 6, 2007, at 11:10:33
Am I oversimplifying or shouldn't everyone, not just teens, be closely monitored when they are depressed? You take a person that is at the end of their emotional rope and give them a drug that will probably make them feel worse, at least for awhile. That would seem to be a situation worth watching for anyone....your opinion?
Posted by med_empowered on February 6, 2007, at 16:35:29
In reply to Re: Disturbing results, posted by bassman on February 6, 2007, at 12:58:22
whats especially odd to me is that while some shrinks are fighting these warnings in the face of decent data, others have been saying: we've known this for a long time. Even "Listening to Prozac" talks about the first couple weeks, when the activation induced by medication can preceed anti-depressant effects and the patient is more at risk of suicide and other forms of self-harm. Other shrinks have talked about this, too--how they've known since the old days of TCAs and MAOIs that sometimes the meds will make things worse; sometimes this went away and other times it meant the patient had to switch meds or try something besides antidepressants.
Posted by bassman on February 6, 2007, at 17:10:49
In reply to Re: Disturbing results, posted by med_empowered on February 6, 2007, at 16:35:29
Really good point...not exactly late-breaking news about agitation and one would think people in the field would have read "Listening to Prozac" back before they had paved roads...
Posted by notfred on February 6, 2007, at 17:22:40
In reply to Re: Disturbing results, posted by med_empowered on February 6, 2007, at 16:35:29
"whats especially odd to me is that while some shrinks are fighting these warnings in the face of decent data, others have been saying: we've known this for a long time."
Perhaps because GP's started handing out SSRI's like candy ?
Posted by linkadge on February 6, 2007, at 17:31:47
In reply to Re: Disturbing results, posted by notfred on February 6, 2007, at 17:22:40
Of course they'll fight it. The livelihood of psychiatrists is dicectly proportional to the demand for and public opinion of such drugs.
Linkadge
Posted by FredPotter on February 6, 2007, at 18:34:14
In reply to Re: Disturbing results, posted by linkadge on February 6, 2007, at 17:31:47
If there's a true and direct correlation between the black box icon and rates of youth suicide then it may be because it thereby advertises itself as a drug that can be used for suicide. In the first 2 weeks this might be especially tempting. Probably there are multiple causes, most not direct, such as reluctance to prescribe SSRIs which is a cause one stage removed
Fred
Posted by notfred on February 6, 2007, at 18:41:33
In reply to Re: Disturbing results, posted by FredPotter on February 6, 2007, at 18:34:14
>"If there's a true and direct correlation between the black box icon and rates of youth suicide then it may be because it thereby advertises itself as a drug that can be used for suicide."
SSRI's cannot be used for suicide, that was the major advantage of them over older AD's, the TCA's.
LD50 is no way near a 30 day supply of a SSRI.
Posted by nolegirl23 on February 6, 2007, at 19:02:51
In reply to Disturbing results, posted by Squiggles on February 6, 2007, at 6:54:29
> The FDA has just announced a large increase
> in child and adolescent suicide rates within a year, following the Black Box Warning on Antidepressants, and consequent decrease in antidepressant treatment. I saw the article in a Yahoo group (psychiatry-research) but the copyright of American Press prohibits redistribution.
>
> SquigglesI have always wondered why they limit the suicide increase rate to adolescents. I have been on SSRI's as an adult, (granted a young adult) which caused me to have non-stop urges to end my life. When I was on Paxil, I had this unbelievable and compelling urge to drive my car head on into a semi, and do other harmful things that would result in my death.
I was over 18, but still experienced this side effect.
What is it about turning 18 that makes this risk factor null and void?
Posted by bassman on February 6, 2007, at 19:16:37
In reply to Re: Disturbing results, posted by nolegirl23 on February 6, 2007, at 19:02:51
I so agree. See above:
http://www.dr-bob.org/babble/20070201/msgs/730429.html
Posted by notfred on February 6, 2007, at 19:20:53
In reply to Re: Disturbing results, posted by nolegirl23 on February 6, 2007, at 19:02:51
"I have always wondered why they limit the suicide increase rate to adolescents. What is it about turning 18 that makes this risk factor null and void?"
In this case this study was published in a Pediatrics journal, hince the limitation to kids.
Otherwise, teen suicide is the 3rd leading cause of death among young adults and adolescents following unintentional injuries and homicide. The rates are even worse for some high risk teens. Suicide as a cause of death is not even in the top 10 for most adults.The reasons for high rates amoung teens are complex and mostly hard to fix so an easy answer is very welcome.
Posted by Squiggles on February 6, 2007, at 19:26:02
In reply to Re: Disturbing results, posted by nolegirl23 on February 6, 2007, at 19:02:51
>
I think the Black Box Warnings always apply to
the children and adolescents first, maybe on
the assumption that kids are more impulsive--
there may be some truth to that. Though, personally, I agree that adults can be just as childish emotionally.Squiggles
Posted by linkadge on February 6, 2007, at 19:48:38
In reply to Re: Disturbing results, posted by Squiggles on February 6, 2007, at 19:26:02
I found that zoloft made me suicidal I was 21 at the time.
>I think the Black Box Warnings always apply to
>the children and adolescents first, maybe on
>the assumption that kids are more impulsive--I think the phenomina could occur with adults as well, perhaps somebody thought the moral responsability of communicating the childs risk was more important.
>there may be some truth to that. Though, >personally, I agree that adults can be just as >childish emotionally.But, I don't think that when a drug makes sombody suicidal, that childish has anything to do with it. I mean suicidal is almost by definition, the worst somebody can feel. I think in general, adults probably kill themselves more often than children (I am not sure though).
Linkadge
Posted by SLS on February 7, 2007, at 5:40:45
In reply to Disturbing results, posted by Squiggles on February 6, 2007, at 6:54:29
> The FDA has just announced a large increase
> in child and adolescent suicide rates within a year, following the Black Box Warning on Antidepressants, and consequent decrease in antidepressant treatment. I saw the article in a Yahoo group (psychiatry-research) but the copyright of American Press prohibits redistribution.I have seen, repeatedly, statistics demonstrating a decline in the number of pediatric and adolescent suicides with the advent of SSRIs and the increased use of antidepressants. I just never elect to post them, and I elect not to search them out here. I find the generalized attack on these drugs to be ridiculous. If used properly, meaning under close supervision of a trained psychiatrist, antidepressants offer more safety than they produce suicidality.
- Scott
Posted by Squiggles on February 7, 2007, at 6:24:02
In reply to Re: Disturbing results, posted by SLS on February 7, 2007, at 5:40:45
I'm inclined to that (layman's) opinion as time
goes by.Squiggles
Posted by linkadge on February 7, 2007, at 8:08:43
In reply to Re: Disturbing results, posted by Squiggles on February 7, 2007, at 6:24:02
I've seen some statistics suggesting a lowered indicence of suicide since the introduction of antidepressants, but the correlation seemed very small, and was certainly on universal.
I don't think there is a consecensious about it.
From my knowledge the only conscensious is that lithium and clozapine consistantly shown a anti-suicide effect, but that other agents havn't.
Linkadge
Posted by Squiggles on February 7, 2007, at 11:56:41
In reply to Re: Disturbing results, posted by linkadge on February 7, 2007, at 8:08:43
I just don't know. It's hard to
believe statistics when there's a
controversy going on. It's like a
war-- the first casualty is truth.Squiggles
Posted by Maximus on February 7, 2007, at 12:36:25
In reply to Re: Disturbing results, posted by SLS on February 7, 2007, at 5:40:45
>I find the generalized attack on these drugs to >be ridiculous.
Hi Scott,
You're right indeed. But to come to this conclusion and seek out positive results, you have to be undepressed and stabilized...
Bye.
Posted by Larry Hoover on February 7, 2007, at 12:40:02
In reply to Re: Disturbing results, posted by Squiggles on February 7, 2007, at 11:56:41
> I just don't know. It's hard to
> believe statistics when there's a
> controversy going on. It's like a
> war-- the first casualty is truth.
>
> SquigglesThe statistics are certainly believable. The controversy is in their interpretation.
In 1990, the adolescent (ages 15-19) suicide rate was about 11 per 100,000, falling to 7.3 in 2003. In 2004 (the year these recent statistics summarize), the rate rose to 8.2/100,000.
Why is controversial.
Lar
Posted by Larry Hoover on February 7, 2007, at 12:41:15
In reply to Re: Disturbing results, posted by SLS on February 7, 2007, at 5:40:45
> If used properly, meaning under close supervision of a trained psychiatrist, antidepressants offer more safety than they produce suicidality.
>
>
> - ScottI couldn't agree more.
Lar
Posted by munificentexegete on February 9, 2007, at 1:47:12
In reply to Re: Disturbing results, posted by Squiggles on February 7, 2007, at 11:56:41
> I just don't know. It's hard to
> believe statistics when there's a
> controversy going on. It's like a
> war-- the first casualty is truth.
>
> Squigglesquick someone get a medic
Posted by munificentexegete on February 9, 2007, at 2:03:04
In reply to Re: Disturbing results » SLS, posted by Larry Hoover on February 7, 2007, at 12:41:15
> > If used properly, meaning under close supervision of a trained psychiatrist, antidepressants offer more safety than they produce suicidality.
> >
> >
> > - Scott
>
> I couldn't agree more.
>
> Lar
>
>question for you Lar,
with the ssris and the reuptake mechanism involved, is there a roughly linear response to increasing doses up to a maximum theraputic dose, beyond which any extra would actually only induce toxicity?
also what is the biology behind akathisia, which is often said to be induced by damage to the cholinergic system as in the case of pesticides and nerve toxin like vx or sarin, and why do ADs induce it?
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