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  1. #11
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    Re: SSRIs and Suicide Risk

    Hello Sam,

    You are probably tired of hearing this but I must say I am so very sorry for you loss.

    I am not a psychiatrist, psychologist or a pharmacists but I have taken SSRI's and with therapy they helped me through a very dark time in my life.

    I was warned about the fact that the medication would cause me to experience a "low" before the medication would begin to take effect which is a given due to the nature of an SSRI.

    As I understand it they work by inhibiting the body's production of serotonin which as I understand and according to my experience causes depression to temporarily get worse before it gets better when the endocrine system stabilises again all of which I am sure you know from your obviously extensive research.

    I am a bit fastidious in my desire to understanding things. So I did my research before agreeing to take an SSRI as recommended by my G.P. and my Psychiatrist as well as being provided with the general pamphlets and discussing the results of my research with both medical professionals before taking the prescribed medication.

    As I am sure you know because of the variable nature of body chemistry unique to the individual some people experience varied degrees of effectiveness and side effects of SSRI's and various other medications. So obviously they are not a perfect solution for all obviously further research is required and in fact necessary to ensure the effectiveness of it's use with therapy.

    So I say with great care and respect that I have no way of knowing how any of this effected your daughter or the diligence or lack there of by her doctors but I do understand why pharmaceutical companies and doctors are so quick to defend their use because I can vouch for the fact that the use of an SSRI with therapy have prevented many people from ending their lives.

    I do believe fear effects the public discussion of those it did not help or couldn't save because of the fear that it might prevent people from reaching for it when it could be of use despite the unknowns. This of course in no way makes those losses acceptable or any easier to bear but I thought hearing from some one who has been helped by them might help you to understand the way it's dealt with.

    I had a cousin of mine who chose to end his life despite the fact that he was in therapy on anti-depressants (I don't know what kind as I don't like to press my aunt or my cousin's wife for further details) and I know both my aunt and my cousins wife still struggle with their own guilt because they think they failed him somehow and despite how much we love the people in our lives we aren't privy to their every thought or impulse no matter how hard we try.

    I hope my opinion and experience with this subject may help to shed some light on this for you as I can't even begin to fathom what you've been through but I hope you find some way to make peace with it.
    Being at peace with yourself is truly living.

  2. #12
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    Re: SSRIs and Suicide Risk

    Thanks for your response Budoaiki,

    I do appreciate your comments a lot.

    As a matter of clarification, the SSRI anti-depressants do not reduce production of serotonin, rather they reduce re-uptake of the neurotransmitter, thereby actuall increasing the amount that can reach the specific neuronal cells.

    In this way, the mood is raised.
    I have not reviewed the literature on this recently, but I know from previous studies there was a clear effect increasing suicide ideation. There is a website for a petition by Effexor users that has about 15,000 or more signatories describing impact of this drug on people's lives.

    I don't dispute that this helps many people, but there has been a careful review of how drug companies will tailor testing, and tend to not report ill effects. There was an article by a doctor in the New York Times Magazine a few years ago describing how he was hired by a drug company to give testimonials about one of these drugs, and he eventually quit because it troubled him ethically.

    While these drugs help many, they are risky for the young people from adolescents to about 22 years old, and this has been demonstrated in studies and it is mentioned in warnings on the drug. This happened only because of regulatory agencies making it mandatory. The warnings are only a very few sentences and if the reason for prescription are substantitive, then a patient or their family can make a reasonable decision of use, but also know to be aware. As I was not informed of this, (the warnings actually became public only a few days after my daughter's death, and the prescribing physician didn't advise us of ANY risk).

    I don't have the time right now to review the current literature, but I have neard nothing in the media to suggest that the warnings have caused more deaths, and these are complex studies dealing with large populations, with all sort of impacts on suicide. Economic downturns have been known to result in an increase in suicides and the periods noted certainly have had that. One has to look at who supported the research as well. This is a tricky area in terms of interpretation, and the reaction to the black box warnings was a kind of "look what's going to happen because of these warnings", that some studies seem to be echoing, but not the ones I saw that looked at the risk.

    I can only tell you, when this kind of risk factor happens to an individual, the family is not going to say "oh, you shouldn't have warned us because it might reduce use of the drug for others..." Had I known this, I would have behaved differently the day after my daughter got her first increased dose. she took her life that day.. one day after getting her increased dose. I still remember speaking to the doctor who recommended this drug, and advising her of my daughter's history, and she gave no indication of the risk..

    I can bet if it had been her own daughter, she would have been on the alert, but we didn't have that benefit..
    I even asked a pharmacy if they advised of this risk, and the pharmacist said "no, that is up to the doctor" and the reason being, they didn't want to face backlash had a patient reacted to this.

    really sad..

    bottom line, it may be necessary and help many, but the risk is there, and it needs to be known... Lives can be saved, not lost, by awareness. I really question the studies that suggest that the warnings caused an increase due to not using the anti-depressants. So many other factors including inadequate care.
    best wishes.

    Sam

  3. #13
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    Re: SSRIs and Suicide Risk

    I don't expect to convince you, sbryks, and I suspect that you are disinclined to even entertain the possibility that your conclusions are wrong.

    All I can do is direct other people to the research reports and threads in this forum and to reassure others that your conclusions are indeed incorrect. Any suggestion that SSRI medications are dangerous does a disservice to the millions of people world-wide who can benefit from such medications or who have already benefited from those medications, not to mention the people whose lives have been saved by taking them.

  4. #14
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    Re: SSRIs and Suicide Risk

    Dr. Baxter, the disservice is not mine but yours.

    I do not spend full time researching this, but it is clear from the tone of your posts that your position on this was established from the start as you do not even give any credibility to risk but would rather deny the risk, and would have recommended against the warnings. Obviously, my comments did not result in your seeing the impact on those who suffered losses attributed to the effect of these drugs and thousands of people have reported the impact on their lives in the effexor petition online. I don't know how you can ignore thousands of patient reported experiences.

    I have never said that the drugs are not appropriate in many cases, but I have made it very clear that warnings are appropriate, and scientists in FDA and Health Canada have agreed with this.

    the proposition that the warnings caused excessive deaths is not proven.

    The disservice is to not advise people of the real risk to adolescents and young adults, so that family can act with appropriate cautions. This has indeed been proven in clinical studies. There is on record the death of a young woman by suicide in a clinical trial on one of these drugs who did not have any history of depression.
    it is not sufficient to make a statistic, but it was something certainly alarming and of concern, and subsequent studies have indeed borne out that there is a risk..

    Your position that "depression caused the suicide" is really the classical excuse I have heard more than once, and it is really empty and when anti-depressants are involved, it is a false premise.

    You did not seem to have the ability to acknowledge the risk. That is sad, and really it is the reason you do disservice. Whenever a medication is given, there is a risk/benefit aspect to this. No one would take the risk of radiation or of chemotherapy were there not a worthwhile benefit, even if it were only a few months of extension of life to be with loved ones. Some have taken extreme on vaccines as too risky and causing autism while there is no evidence to this effect, notwithstanding some people have had bad reactions to vaccines or in the case of the Salk Vaccine there was a bad batch resulting in some deaths, but people still were vaccinated as the benefit outweighted the risk.

    It may be that in the majority of prescriptions of anti-depressants the benefit outweights the risk, but there is a view that these drugs are over-prescribed, and they are certainly not a foolproof protection against suicide.

    The use of these drugs is not very sophisticated - mood altering, and the neurophysiology is not well understood in terms of the overall impact on the CNS. It is rather tantamount to giving a patient aspirin for a headache. It works usually, but no one knows exactly why.

    I caution anyone who is recommended these drugs, or who has family members - especially adolescents - young adults, to be aware of risk, and as the warnings say.. if you feel or note suicidal ideations in a family member, seek help and if necessary take the family member to a hospital where they can be protected from self-harm.
    Dr. Baxter, that is what you are doing I surely hope to protect your own patients.

    Sam

  5. #15
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    Re: SSRIs and Suicide Risk

    Quote Originally Posted by sbryks View Post
    Dr. Baxter, the disservice is not mine but yours.

    I do not spend full time researching this, but it is clear from the tone of your posts that your position on this was established from the start as you do not even give any credibility to risk but would rather deny the risk, and would have recommended against the warnings. Obviously, my comments did not result in your seeing the impact on those who suffered losses attributed to the effect of these drugs and thousands of people have reported the impact on their lives in the effexor petition online. I don't know how you can ignore thousands of patient reported experiences.
    I did not ignore the reports. I have spent considerable time over the years since the concerns first surfaced looking at the EVIDENCE related to the issue and my conclusions are drawn from that evidence. Anecdotal reports and online posts are not evidence, not facts. Correlation does not equal causation. Superstitious associations do not equal causation.

    Frankly, I find your comments and your tone insulting.

  6. #16
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    Re: SSRIs and Suicide Risk

    As a matter of clarification, the SSRI anti-depressants do not reduce production of serotonin, rather they reduce re-uptake of the neurotransmitter, thereby actually increasing the amount that can reach the specific neuronal cells.


    Thank you for the clarification I guess that's an example of why I shouldn't write about these things when I am tired. (Because I already knew this and still made the error.)
    Being at peace with yourself is truly living.

  7. #17
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    Re: SSRIs and Suicide Risk

    Dr. Baxter,
    I did not set the tone, you did. You basically considered my comments as putting people at risk if they did not take anti-depressants. I am not as expert at this as you are, but I presume you are a practicing psychiatrist and therefore you are certainly in a specific interest group with respect to the use of these drugs. I happen to be a parent who lost a child due to incompetent care and the possibility of the change in dose of an SSRI creating the horrid "tipping point" that enabled an impulse to kill her.
    I have spoken at a conference on Suicide, as well as at a workshop to professionals on supporting Suicide Loss Survivors as one of those who suffered the ultimate horror life could bring.
    My comments are not complicated but suggest caution and the importance of care rather than focus on drugs.
    I have not had time of late to keep up with the literature, but I have read extensively on the subject, and I know from famous cases involving pharmaceutical industry behaviour in relation to marketing their drugs, and on research.
    I stand by my comments and I think they are reasonable. I know a young man who became schizophrenic and turned to me in one of his episodes by telephone. I am told I saved his life, by meeting him and getting him to a safe place after talking to him in a coffee shop for about an hour. He is on drugs that help him, and I am glad of that. My point is that I am not against proper drug use, but I consider the use of anti-depressants as being too easy and too common, and I am not the only one who holds this view.. it is held by some famous researchers in the field.
    your unwillingness to acknowledge my comments and your too too easy "depression not drugs killed your daughter" show how fixated you are on this..
    I am sorry, but you have led this to here..
    I have been very open and honest about this from the getgo..
    Perhaps you will gain more by understanding, than by feeling insulted.
    My comments here will hardly change the world, or put anyone at risk.
    They might save a life.
    Sam

    ---------- Post added at 03:08 PM ---------- Previous post was at 02:59 PM ----------

    Dr. Baxter,
    i find your comment about "superstition" insulting. I have a M.Sc. and am a scientist in another discipline.
    I am emotionally involved in the issue, that is very clear, but I do not approach it from superstition, nor to I deem anecdotal evidence as the basis of empirical research, however, anyone who dismisses the comments of thousands of patients, is blinkering their field of view. If someone took that posted data, and did some analysis, it could become a research piece using qualitative parameters. some weakness of course, but lots of things are researched from this kind of data. I don't doubt that these drugs help many, but for some drugs it can be a terrible ordeal as it can mean a lifetime of usage or facing some terrible side effects at withdrawal.
    I don't have much time now, but I will review your bibliography and do some current searches on the issue.
    hopefully, i will find a balanced review article to bring me up on this.
    Sam

  8. #18
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    Re: SSRIs and Suicide Risk

    Quote Originally Posted by sbryks
    Dr. Baxter,.......I presume you are a practicing psychiatrist
    Dr. Baxter is a Registered Psychologist in private practice in Ottawa

  9. #19
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    Re: SSRIs and Suicide Risk

    Thanks Steve,
    I am presuming that registered Psychologists have prescription rights or am I mistaken?

    Sam

  10. #20
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    Re: SSRIs and Suicide Risk

    No, I do not have prescribing rights. I do, however, make recommendations to physicians for my clients.

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