Antidepressants Do Prevent Suicides

David Baxter PhD

Late Founder
Antidepressants Do Prevent Suicides, Researchers Contend
By Amanda Gardner, HealthDay

Study refutes notion that SSRIs such as Prozac boost the risk to users

MONDAY, June 12 (HealthDay News) -- Countering recent reports that they might boost suicide risk in users, a major new study finds that antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

The benefits of SSRIs were particularly pronounced among females, said the authors of an independent study appearing in the June issue of the journal PLoS Medicine.

"As the number of [SSRI] prescriptions go up, the number of suicides are going down," said Dr. Julio Licinio, chairman of the department of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. "I don't see how these drugs could be causing suicide if the rates [of suicide] are actually going down."

Licinio was lead author of the study, which was conducted while he was at the University of California, Los Angeles.

The findings seemed to dovetail with other psychiatric workers' clinical experience.

"I've seen the SSRIs help people tremendously," said Helen Stavros, a clinical social worker in the department of psychiatry at Ochsner Health System in New Orleans. "I've never seen anyone become suicidal as a result of being on antidepressants." Stavros started working at Ochsner in 1987, shortly before the first-ever SSRI, Prozac, was approved.

Another expert called the finding interesting, but added a caution.

"The results of this study are consistent with previous reports. Fortunately, suicide rates have been declining since the early 1990's. While this correlates with the increased use of SSRI antidepressants, including fluoxetine, this finding does not, by itself, demonstrate a causal relationship," said Dr. David Fassler, a clinical professor of psychiatry at the University of Vermont College of Medicine in Burlington.

He added, "There are numerous other intervening variables, including socioeconomic factors, access to drugs, alcohol and firearms, and improvements in emergency medical care."

The past few years have witnessed a prolonged debate about the safety of antidepressant use, especially in children and teens.

In October 2004, the U.S. Food and Drug Administration directed manufacturers of SSRIs to revise their labeling to include a "black box" warning that alerts health-care providers to an increased risk of suicidality in children and teens.

In July 2005, the FDA issued a public health advisory that raised the possibility that the risk of suicidality also applied to adults taking SSRIs, after several studies pointed to that possibility.

Meanwhile, the European Medicines Agency (EMEA) ruled Thursday that children as young as eight can be given Prozac.

The group said that the drug was safe for young people to take, despite concerns that it can trigger suicidal feelings in patients. The ruling added that Prozac should only be given to children with moderate to severe depression who have not responded to several sessions of psychological therapy. It also said the drug should only be given in small doses and must be used alongside counseling.

British health authorities have also declared that all antidepressants except Prozac should not be used by children or adolescents.

Major depressive disorder, for which SSRIs are often diagnosed, afflicts about 10 percent of American men and 20 percent of American women during their lifetimes. At any one point in time, 3 percent of the population has the disorder (10 percent of the elderly).

For this study, the authors analyzed federal data on suicide rates since 1960, along with sales of fluoxetine (Prozac) since it became available in 1988. Analysis was continued through 2002.

"We used Prozac as a benchmark for the class of drugs," Licinio explained.

Between the early 1960s and 1988, suicide rates held relatively steady, fluctuating between 12.2 per 100,000 and 13.7 per 100,000.

Since 1988, however, suicide rates have been on a gradual decline, with the lowest point being 10.4 per 100,000 in 2000. During the same time frame, Prozac prescriptions rose, from 2,469,000 in 1988 to 33,320,000 in 2002.

Using mathematical modeling, the investigators estimated the rates of suicide if the pre-1988 trends had continued.

"On average, we estimated that there would have been an additional 33,600 suicides if the pre-1988 trends had been maintained," Licinio said. "We think that this [SSRIs] has had a substantial impact on the number of suicides."

With that in mind, moves to restrict the use of SSRI antidepressants could have a harmful effect, the authors stated.

"I don't think these claims that antidepressants increase suicide have a solid base," Licinio said. "If you have a drug that's supposed to be causing something, the more of the drug that's used, the more of the bad outcome you would have. What we show is the converse."

One troubling trend noted by the authors of the article is that the number of antidepressant prescriptions seem to be declining as a result of the recent controversy. That bothered other experts as well. "I see a lot of people being afraid of taking drugs when they could be really helpful to them," Stavros said.

Licinio is now planning a study to observe the effect of anti-depressants on suicidal thoughts and behaviors, because much of the available data comes from studies whose primary objective was something other than suicidality.

"Nobody, to my knowledge, has done this," he said. "Usually in science, the best idea is to test the point and not treat it as a by-the-way. Suicidality has [up until now] been assessed as a secondary factor."

Fassler agreed that more study is needed. "The finding is interesting, and somewhat reassuring, given the frequency with which these medications are currently used," he said. "Clearly, this is an area where additional research is warranted."

According to the authors, Eli Lilly -- the maker of Prozac -- was unaware of and not involved in the study, which was funded by a grant from the U.S. National Institutes of Health and the Dana Foundation. Licinio did, however, accept an offer to consult for Lilly after this research was accepted for publication.

SOURCES: Julio Licinio, M.D., chairman, department of psychiatry and behavioral sciences, University of Miami Miller School of Medicine; Helen Stavros, LCSW, Ph.D., clinical social worker, department of psychiatry, Ochsner Health System, New Orleans; David Fassler, M.D., clinical professor of psychiatry, University of Vermont College of Medicine, Burlington; June 2006 PLoS Medicine
 

Retired

Member
Research to provide guidelines to physicians on this important and controversial aspect of SSRI therapy is long overdue. Even the use of SSRI's in pediatric use is unclear, though many physicians appear to use their own clinical judgement and experience in this regard.

In the early days of benzodiazepines, (minor tranquilizers such as Valium, Ativan etc) there were concerns expressed about their use in depressed patients because of concerns about suicidal ideation. I don't know if these concerns were ever addressed in follow up studies, because after the introduction of SSRI's much of the clinical interest shifted to these new medications.
 

foghlaim

Member
i recently went onto a site. drugs.com. looking up the medications I'm on and it does warn of suicide thoughts as a result of taking some of the drugs, including some of the SSRI's. so it's hard to know what t think. Maybe my own suicidal thoughts are increased because of the meds.. in any event they are real whether related to the meds or not.
 

Retired

Member
NSA,

Information sites like Drugs.com are helpful to provide an overview of specific medications, but they do not necessarily include the information approved by the respective regulatory agencies based on the studies submitted by the manufacturers. In addition sites like Drugs.com and others like it, sometimes include commentary by their own consulting staff, which has to be taken in context of other ongoing research.

These sites are useful to provide a general overview on medications, but each of us should rely on the advice of our own doctor for dealing with our own particular situation.

Our own doctor is familiar with our medical history and it is on this basis that a treatment plan is provided. If you are experiencing suicicdal thoughts, you need to contact your treating physician and what is happening.

If these thoughts persist, please share your feelings with someone close to you who can keep you safe until you can get to your physician.

If there is no one you feel you can speak to, then please contact a local crisis help line.

Do you have someone you can talk to?
 

foghlaim

Member
thanks for the info TSOW. as for my suicidal thoughts, well no i have no-one other than this forum in which to share them and it does help. i see psych on Thurs, but they just usually write script and say come back in 2 wks, on the 20th i see my previous psych and i can be honest and open with him. thank you for your concern, much appreciated.

nsa.
 

Retired

Member
NSA,

May I suggest that when you see the doctor on Thursday, that the first thing out of your mouth when you walk into the interview is to say "I am having thoughts of suicide and I need help".

The medical system is strained to the limit, and sometimes the doctor assumes you are there just to get a prescription renewed. However it's up to you to make known any concerns or report important information.

You may wish to privately rehearse saying the phrase to yourself before your appointment, so you can be ready as soon as the doctor comes in the room.

This technique of privately rehearsing what you are going to say is often used by people going into a business meeting or other presentation. It helps to become accustomed to saying the words and getting one's thoughts in order.

I'll be eager to hear outcome of your Thursday appointment.
 

foghlaim

Member
TSOW: at last apt 2 weeks ago, i mentioned this and the fact that i has thought of self injury.. he wasn't bothered by it.. i have written about this in another thread, can't remember the name of it now, anyway, i have no faith whatsoever in these guys, i just have to attend them cause of the area i live in and i was under their care in the hospital. So although i thank you for your advice, i will be waiting till the following Tues when i see the previous guy.

again i thank you for your concern and support.
 

Retired

Member
I understand the situation and see your point.

Just for information, is the person who seems to be avoiding your reports a physician, if so is it a student physician or a staff physician..and is it in the private office or in a clinic?

Though I asked before, I'd like to ask again..is there anyone you can think of close to you whom you could call and who would stay with you or stay in contact to help keep you safe?
 

David Baxter PhD

Late Founder
"I've seen the SSRIs help people tremendously," said Helen Stavros, a clinical social worker in the department of psychiatry at Ochsner Health System in New Orleans. "I've never seen anyone become suicidal as a result of being on antidepressants." Stavros started working at Ochsner in 1987, shortly before the first-ever SSRI, Prozac, was approved.

I've been following the comments and research on this controversy, first with the concerns about adolescents and later with the issue expanded to adults, since the beginning.

Like Helen Stavros, I've never seen anyone become suicidal as a result of taking an SSRI. The reports that raised the concerns were anectdotal only, not scientific research. The studies that appeared initially to support the claims were small and poorly designed. Later studies continue, in my opinion, to demonstrate pretty clearly that suicidal thinking or suicidal impulses are not caused by the drug but by the conditions the drugs are used to treat, primarily depression.

Depressed people do think about suicide sometimes. That's one of the symptoms of depression. It was true for you before you went on these medications, nsa, and the medications take time to work.

Individuals with high anxiety also think about depression sometimes, more as a way of just ending the anxiety. Again, this is the nature of certain anxiety disorders. The medications used to treat anxiety do not cause suicidal thinking. Anxiety causes suicidal thinking.

But of course you will see warnings on web sites and in the drug manufacturer's literature. This is, first, simply being responsible and warning people that a concern has been raised. It's also required by organizations such as the FDA in the US and Health Canada in Canada. The fact that the warning appears does not mean that the manufacturer or the web site agrees with the warning - it is required by law and formulated by organizations whose job it is to protect the public interest and public safety.
 

foghlaim

Member
Hi david: guess i was looking to blame something other than myself for thinking of suicide, even if i was thinking it before i started on meds. sounds really stuppid doesn't it. I thought by now (maybe) i wouldn't have these thought any more and reading the web site well i kinda latched onto the idea that the meds were actually increasing these thoughts.

i would think tho that the warning would put ppl off taking certain meds, ppl like me, uneducated on the subject. even if the warning is only there because of the laws of the land, ppl like me wouldn't necessarily know that.

thank you for putting me straight, as it were.

nsa.
 

David Baxter PhD

Late Founder
No, it doesn't sound stupid at all, nsa. I do worry that all the publicity about this, since the newspapers splashed it all over the place with apparent glee, might turn people off using medications that could help them. That's why I've been highlighting articles I find that debunk the myth.

I don't as a rule blame agencies like the FDA or Health Canada for being cautious - that's their job. On the other hand, sometimes they go too far, as with the recent banning and then unbanning of one of the nonstimulant treatments for ADHD in Canada (it was either Concerta or Strattera) when the evidence for concern in the first place was slim to none.

In the case of the suicide concern with SSRIs, I do agree they needed to act. I think at this point the responsible thing to do would be to retrract or scale down the warnings to make them less alarmist but I think they are worried about liability issues if they do.
 

foghlaim

Member
I think they are worried about liability issues if they do.
what you really mean is they are covering their asses. is that okay to say on here??

by the way it just came to mind, my psych ((original) did warn me about the potential of suicidal thinking or as in my case suicidal thinking getting stronger when he first prescribed cipramil. just thought i'd mention that, so you can debunk that one too, please. (not being sarcastic, just in case u think i am)
it was the first med he prescribed along with the xanax. ina any case i'm not on it now but just thought i'd mention it .

I don't blame health or gov agencies for doing their jobs,,, but they need to get it right.

nsa
 

David Baxter PhD

Late Founder
what you really mean is they are covering their asses. is that okay to say on here??

Yes, that's probably true, and yes it's OK to say that. :)

by the way it just came to mind, my psych (original) did warn me about the potential of suicidal thinking or as in my case suicidal thinking getting stronger when he first prescribed cipramil. just thought i'd mention that, so you can debunk that one too, please.

Cipramil (citalopram, aka Celexa) is another SSRI so really he had to warn you about that - he would have been remiss in his responsibility as a physician not to have done so. On the other hand, if your doctor truly believed it was a significant or real risk, he wouldn't have prescribed it, would he? Doctors aren't in the habit of intentionally prescribing medications they think will kill their patients.
 

foghlaim

Member
Doctors aren't in the habit of intentionally prescribing medications they think will kill their patients.
not unless they are like the infamous dr.Sheppard??

i take your point David. :) no he wouldn't.
 

foghlaim

Member
thanks steve.. will have to look at it later tho.. almost time i was outta here..


you sure are fast with the links steve.. like magic they appear :) well done.

nsa
 

ThatLady

Member
NSA, I think what Dr. Baxter said is very important. When doctors prescribe medications, they are responsibile to tell their patients the good side and the bad side of the medication, including all possible side effects. There's reason behind that. If you don't know the possible side effects, you might not realize that the medication COULD be the cause of some new symptom you're having, or the worsening of an existing symptom. Just as it's important for the doctor to tell you about the possible side effects, it's just as important for you to tell the doctor if you're experiencing anything unusual. Be sure to tell your doctor that you feel your suicidal ideation getting more problematic. It's critical that he know this. :)
 

foghlaim

Member
thanks TL.. i know i should tell him,, but guess what, i'm actually afraid i'll wind up in hospital again and i don't want that to happen so soon or ever again for that matter. but i understand what you are saying and what Dr.B has said.

i think i'll see how things go on the 20th and take it from there.
I realise that it's me, my own thoughts\feelings and not the meds are to blame for the way i feel.

thank you for the info..

nsa
 

ThatLady

Member
I hear what you're saying, hon, and I understand where you're coming from. The problem is, if you DON'T tell him, and things get worse, you can bet your bippy you WILL end up back in hospital. If you DO tell him, that gives you a chance to work on the problem proactively and find a solution. Having been there myself, I learned the hard way that to stay out of hospital, one must be totally honest with one's doctor and stay ahead of the problems. It's a lot easier than trying to pick up the pieces later.
 

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