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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by gardenergirl on May 15, 2013, at 22:33:42
In reply to Antidepressants and suicide is not either-or., posted by SLS on May 15, 2013, at 20:32:55
I liked Scott's post so much, I thought those on the meds board might want to see it, too.
> > antidepressants cause suicide rather than preventing them
>
> It is unfortunate that some people should feel compelled to confine themselves to polar "either-or" thinking regarding this issue.
>
> Antidepressants, even in young people, prevent more suicides than they provoke. The suicide rates in young people have been increasing since 2003, the year that the black-box warning first appeared on antidepressant labeling. This was demonstrated by the CDC as early as 2007. I don't think cause-and-effect has yet been established, though. One can find conflicting interpretations of this data. Nevertheless, they exist.
>
> http://abcnews.go.com/Health/Healthday/story?id=4508580&page=1#.UZQ0zcoQtJI
>
> Antidepressants can make some people feel more depressed. This is a negative reaction, to be sure. Sometimes, whereas one antidepressant fails to produce an improvement, another might succeed. Paradoxically, some people actually experience an increase in suicidal ideation early in treatment precisely because the antidepressant begins to work. As anergic vegetative symptoms begin to recede without a commensurate improvement in outlook, one has more mental energy to act on their negative impulses.
>
> Each pediatric case must be evaluated individually. I am not a doctor, but I should think it preferable that psychotherapeutic modalities be explored first before pharmacotherapy in this population.
>
> A more balanced perspective, perhaps?
>
> http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
>
> I haven't come to any firm conclusions regarding the use of antidepressants in young people. If the illness is severe enough, I'm not sure there is any better choice but to use one. I don't doubt that antidepressants affect the immature and developing brain of young people in ways that differ from those of adults. The rate of iatrogenic suicidal ideation in younger people is probably higher. One statistic I saw was 0.2% for placebo versus 0.4% for active drug.
>
>
> - Scott
Posted by SLS on May 16, 2013, at 0:09:06
In reply to Re: Antidepressants and suicide is not either-or. » SLS, posted by gardenergirl on May 15, 2013, at 22:33:42
> The rate of iatrogenic suicidal ideation in younger people is probably higher. One statistic I saw was 0.2% for placebo versus 0.4% for active drug.
Sorry...
Correction:
The rates of suicide were 2.0% for placebo and 4.0% for active drug.
http://jama.jamanetwork.com/article.aspx?articleid=206656
- Scott
Posted by SLS on May 16, 2013, at 0:15:39
In reply to Re: Antidepressants and suicide - Correction, posted by SLS on May 16, 2013, at 0:09:06
> > The rate of iatrogenic suicidal ideation in younger people is probably higher. One statistic I saw was 0.2% for placebo versus 0.4% for active drug.
> Sorry...
>
> Correction:
>
> The rates of suicide were 2.0% for placebo and 4.0% for active drug.
That should be "suicidal ideation" - not "suicide"."The US Food and Drug Administration (FDA), in its review and meta-analysis of 24 placebo-controlled trials assessing use of antidepressant medications among more than 4400 children and adolescents, concluded that these medications pose a 2-fold (4% vs 2%) increased risk for suicidal behavior or suicidal ideation, although no suicides were reported."
> http://jama.jamanetwork.com/article.aspx?articleid=206656
- Scott
Posted by Willful on May 16, 2013, at 9:42:31
In reply to Re: Antidepressants and suicide - Corrections, posted by SLS on May 16, 2013, at 0:15:39
As SLS says, if you read the results they say the following
"these medications pose a 2-fold (4% vs 2%) increased risk for suicidal behavior or suicidal ideation, although no suicides were reported."
This is a bit confusing I think, but I would read an increased risk of a certain percentage as depending on the general rate of risk, which rises by a certain amount (percentage) when drugs are used. (Why use of a placebo increases the risk is something I don't understand-- if that is what the 2% is).
A" 2-fold (4%vs2%) increased risk" means the BASE RISK of suicide for children and adolescents is increased by 2 or 4 percent--and depends on what the base risk among children and adolescents is-- to know for example-- what the actual number of risk is, by what number the risk actually increases.It leaves unclear to me, at least, what 'suicidal behavior' is-- is it actually trying to kill yourself, or does it include just making plans, buying or saving something to use, etc, without actually making an attempt? It also, presumably, includes failed attempts-- so deriving anything about an increase the increased risk of a successful suicide --or the increase in the number of successful suicides--from this is wouldn't be possible.
At least that's how I read it. I guess I'd have to read more of the study to understand exactly what it meant.Willful
Posted by Phillipa on May 16, 2013, at 9:48:57
In reply to Re: Antidepressants and suicide - Corrections, posted by Willful on May 16, 2013, at 9:42:31
Good question. Phillipa
Posted by Dinah on May 16, 2013, at 11:27:34
In reply to Re: Antidepressants and suicide is not either-or. » SLS, posted by gardenergirl on May 15, 2013, at 22:33:42
Yet completed suicides have increased since the black box warnings. Again, not necessarily connected, but...
Couldn't the incidents of suicidal ideation beginning during AD treatment have to do with undiagnosed, or even subclinical, bipolar spectrum tendencies? Something to be considered and watched for?
Posted by poser938 on May 16, 2013, at 18:53:40
In reply to Re: Antidepressants and suicide - Corrections » Willful, posted by Phillipa on May 16, 2013, at 9:48:57
One idea for the suicide rate going up since 2004 could be that there are fewer people seeing a psychologist. It is usually recommended to someone seeking mental health treatment that they see a psychologist as well as a psychiatrist. But, definitely giving much more thought on prescribing chemicals for mild depression, since in mild depression there has not been shown to be a benefit over a placebo.
When antidepressants first came out it was thought they would only be used for maybe 1 in ever 1000 people. Today, they say its more like what, 1 out of every 5? Maybe recommend therapy for 1 in 5.
If psychiatrists used these meds how they're supposed to be used there wouldn't be near as much a controversy over them.
There are too many conflicts of interest in the psychiatric Med system for people to get the most benefit out of mental health treatment.I went to my psychiatrist and told her in the past about how I responded to Wellbutrin. That it caused a decreased libido. She Said "Wellbutrin *can't* cause decreased libido.
Also, I'm on Lamictal and she thought I was describing its effect as making me more depressed. She said Lamictal *can't* cause depressed mood. But I was actually saying it hasn't had an effect on me yet.Anyway, where do you think she's getting her information? Its not the official side effect information. I'm thinking its all coming from drug company representatives.
If I were to take her information to heart about how Wellbutrin affected my libido, then I'd think there's something seriously wrong. I might go waste money on a blood test to measure my hormone levels. I might think its a good idea to waste money on supplements claiming to increase libido. And after getting nowhere with all this I would just continue feeling such distress from my genitalia staring at the floor all the time.
But like many times, I degrees.
But when they say "talk to your psychiatrist about this or that" in my experience you'd be better off talking to a wall.
Posted by poser938 on May 16, 2013, at 19:13:58
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 16, 2013, at 18:53:40
But like many times I digress***
I'm starting to get annoyed by the auto spell correction on my tablet.
Posted by SLS on May 16, 2013, at 22:07:40
In reply to Re: Antidepressants and suicide is not either-or. » gardenergirl, posted by Dinah on May 16, 2013, at 11:27:34
> Couldn't the incidents of suicidal ideation beginning during AD treatment have to do with undiagnosed, or even subclinical, bipolar spectrum tendencies?
That's a GREAT suggestion.
> Something to be considered and watched for?
Yes. There are many reasons why a doctor should monitor their patients very closely during treatment, especially during the first few weeks. Unfortunately, it doesn't seem that this is a standard practice. I think a patient should be seen every week and be explained to that there is a possibility that the treatment will make them feel worse. The patient should be encouraged to contact the doctor should they feel more depressed or otherwise uncomfortable. This is not rocket-science.
This should not be news.
http://www.dr-bob.org/babble/20000526/msgs/35096.html
- Scott
Posted by poser938 on May 16, 2013, at 22:19:21
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 16, 2013, at 18:53:40
But let's not pretend like suicide is the worst thing these meds can cause.
I get the feeling I'm starting to sound like Lou. But its because I'm feeling so hopeless. There is scarce advice for my situation.
Posted by SLS on May 16, 2013, at 22:39:49
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 16, 2013, at 18:53:40
> One idea for the suicide rate going up since 2004 could be that there are fewer people seeing a psychologist.
Are there any data indicating that this is the case?
> But, definitely giving much more thought on prescribing chemicals for mild depression, since in mild depression there has not been shown to be a benefit over a placebo.
I'm not so sure that this is true.
Not all "depressions" are impelled by biological pathologies. I think we will see that the type of depressions that are not biologically-driven are more likely to be mild rather than severe; biological depressions more likely to be severe rather than mild. This would skew the the results and their interpretations. This proposition would offer a scenario that explains the results of the studies reporting that mild depression is no more likely than placebo to respond to antidepressants. My guess is that a biological depression that is mild in presentation will be just as amenable to antidepressant treatment than more severe presentations. In other words, antidepressants may indeed be significantly more effective than placebo once diagnostic devices become more precise and selective for the various types of mental illnesses that produce a state we call "depression". Of course, dysthymia is considered a relatively mild biological depression. Hopefully, the biomarkers now being identified will produce diagnostic tools to differentiate between the different types of depression.
> When antidepressants first came out it was thought they would only be used for maybe 1 in ever 1000 people.
What? Are you sure about that? I never heard of any such thing. I should think that the initial excitement over the discovery of antidepressants would lead psychiatrists to be more aggressive in their use the new miracle pills. However, I have no evidence to present you with regarding this. Do you have evidence indicating that there was a protocol suggesting that antidepressants be used in only 1/1000 (0.1%) of people?
> If psychiatrists used these meds how they're supposed to be used there wouldn't be near as much a controversy over them.
How are they supposed to be used?
- Scott
Posted by SLS on May 16, 2013, at 22:41:52
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 16, 2013, at 22:19:21
> But let's not pretend like suicide is the worst thing these meds can cause.
>
> I get the feeling I'm starting to sound like Lou. But its because I'm feeling so hopeless. There is scarce advice for my situation.I'm sorry that you are in such a bad place right now.
:-(
- Scott
Posted by Dinah on May 17, 2013, at 2:32:42
In reply to Re: Antidepressants and suicide is not either-or. » Dinah, posted by SLS on May 16, 2013, at 22:07:40
To be fair, it's not my idea. It was suggested to me by a psychiatrist, in a discussion about my own mixed response to Luvox.
It isn't rocket science, and it's a shame that not all pdocs understand these things. I've had both kinds of psychiatrists - harmful and helpful. Perhaps we should suggest consulting a competent psychiatrist instead of just any old psychiatrist.
Posted by Dinah on May 17, 2013, at 2:38:09
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 16, 2013, at 18:53:40
You need a new psychiatrist. Yours sounds like my first psychiatrist as an adult, affectionately known as the pdoc from h*ll. Psychiatrists numbers 2 and 3 were far more helpful.
It's not just psychiatrists. I had an internist who thought my textbook case of kidney stones was diverticulitis. The specialist looked incredulous. She also tried to prescribe narcotics for migraines without even trying a prophylactic. And you should have seen the treatment my mother got in a major hospital ER.
An M.D. does not guarantee excellence, and I'd judge from experience that it doesn't even guarantee competence.
Look elsewhere. Better ones do exist.
Posted by poser938 on May 17, 2013, at 17:37:14
In reply to Re: Antidepressants and suicide - Corrections » poser938, posted by SLS on May 16, 2013, at 22:39:49
I've always thought antidepressants worked better for severe depression because severe depression is much less likely to respond to a placebo. Especially if its biological.
But it was odd when about 2 months ago I called a hospital in my state where a DBS clinical trial was being done. The guy I talked to told me the trial was not accepting more patients. Then he asked me if I had any questions about it. I asked if DBS seems to be more affective than AD's. He just said AD's are very effective for depression except for biological depression, that it doesn't work well in those cases. This confused me.I can't remember where I read that antidepressants were once thought to only be needed by about 1 in 1000. I tried to find the article but I couldn't. I think it was on the Huffington. But it was talking about the very early days. Like, back in the early 1950's.
And for how these meds should be used, at least in my opinion, they would only be used by about half the people that are currently taking them. I believe the rest would either have their depression clear up on its own or with seeing a good psychologist. The system is backwards. When entering the mental health system, someone should start out seeing a psychologist for mood problems. And if the psychologist comes to the conclusion that medication is needed, then send him to the psychiatrist. But many see a psychiatrist and more often than not, they leave with a prescription.
But like I said, there is a near complete conflict of interest in the mental health treatment system. The drug companies are training the psychiatrists. The drug companies decide on what information the FDA needs to see. And if I can't get a halfway decent evaluation on how I respond to a certain med by my psychiatrist, why would a drug company be doing the most ethical evaluation of how someone responds in a clinical trial?
Where there are billions of dollars to be made, there is likely to be cheating, lies, and information withheld. The rule that clinical trials are to be listed on clinivaltrials.gov is being bypassed. I know this because the clinical trial I called about DBS wasn't listed on there.And the biggest problem, the psychiatrist just doesn't listen to the patient. For the majority of psychiatrists, if they hear something that is contrary to their "knowledge" they either let it go in one ear and out the other OR tell the patient that he's mistaken or delusional.
Posted by poser938 on May 17, 2013, at 17:52:28
In reply to Re: Antidepressants and suicide - Corrections » poser938, posted by Dinah on May 17, 2013, at 2:38:09
> You need a new psychiatrist. Yours sounds like my first psychiatrist as an adult, affectionately known as the pdoc from h*ll. Psychiatrists numbers 2 and 3 were far more helpful.
>
> It's not just psychiatrists. I had an internist who thought my textbook case of kidney stones was diverticulitis. The specialist looked incredulous. She also tried to prescribe narcotics for migraines without even trying a prophylactic. And you should have seen the treatment my mother got in a major hospital ER.I know better psychiatrists exist. I've found only one that actually took my situation in consideration. Psychiatrists don't like hearing you when you tell them their meds are having seemingly permanent effects on you.
But the one that believed me and would honestly prescribe me ANYTHING as long as we could make a case for it. But we kept running into dead ends, probably partly because I don't have insurance and couldn't afford the tests she wanted me to get done. But she ended up having her secretary send me an email letting me know that she thought my case was above her expertise, and I got passed on to another dim psychiatrist.
>
> An M.D. does not guarantee excellence, and I'd judge from experience that it doesn't even guarantee competence.
>
> Look elsewhere. Better ones do exist.
Posted by SLS on May 18, 2013, at 0:12:22
In reply to Re: Antidepressants and suicide - Corrections, posted by poser938 on May 17, 2013, at 17:37:14
> But it was odd when about 2 months ago I called a hospital in my state where a DBS clinical trial was being done. The guy I talked to told me the trial was not accepting more patients. Then he asked me if I had any questions about it. I asked if DBS seems to be more affective than AD's. He just said AD's are very effective for depression except for biological depression, that it doesn't work well in those cases. This confused me.
It confuses me, too. I really can't address his statement, as I am not a doctor with clinical experience.
> And for how these meds should be used, at least in my opinion, they would only be used by about half the people that are currently taking them.
I share your sentiments. I won't venture a guess on percentages, though.
> When entering the mental health system, someone should start out seeing a psychologist for mood problems.
I'm not sure I would agree with this. Some presentations of depression clearly indicate somatic therapy based upon symptomatology.
I agree with you that there is much about the practice of psychiatry that needs to change.
- Scott
This is the end of the thread.
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