SSRIs and Suicide Risk

[sbryks]

The article does not cover the subject properly.
the risk of suicide is not addressed... i had written at length and most of my post was lost..
studies have shown taht some of these drugs create a significant risk of suicide, and in fact, some have required alerts that the drug companies fought, but which are required by law on the meds, both in Canada and in the U.S.
the DSM (diagnostic statistical manual) now in its 5th edition, is not based on statistics at all, but is compiled by a committee of psychiatrists.
There is a known and well documented history of the studies of some of these products being distorted, and there as a famous case in toronto in which David Healey a respected expert in this area had his appointment as Director at the Centre of Mental Health and Addiction and a professorship at UofT withdrawn after he gave a key talk on prozac.. Eli Lilly is a major funder at the university. He sued and was supported by University Professors association, and won a large settlement from the university .. it was a disgrace to the university.
The drugs are over-prescribed, and often as a "easy fix" rather than addressing the real underlying reasons for depresssion. There is this notion that depression is a "chemical inbalance" of brain transmitters, and this may have some basis, but most diagnoses have nothing to do with this as there is no test for this... very subjective, as is prescription of ritalin (known on the street as kiddy cocaine)..

The problem with this article is that it just does not mention, teacher or even family doctor, clergyman or a decent psychiatrist (rare, in my experience) can help people get through life by understanding and teaching tools and by support. sometimes it takes a combination of these people. If drugs are needed, it should be with great care.
I lost my 20 year old daughter to suicide one day after her dose of effexor was increased. I only learned after her death of the real risk..No one told me.. You cannot imagine the nightmare unless you are a parent who has also lost a child like this, and I know a few who have in this manner..
An honest appraisal of anti-depressants necessitates speaking to the risk openly and not, as many have done - especially the drug firms, trying to minimize the risk. My daughter's doctors were ignorant and failed her.
Be careful folks. This is a life loss that never goes away... Every time I see a baby, or a toddler, or a teenager, I see my daughter, and when I see young mothers her age, I feel the loss multiplied.
The use of anti-depressants will ultimately be seen as a shameful period for medicine. they may have use, but I don't believe to the extent that they are pushed...A doctor who used to act as a speaker for one of the drug firms promoting anti-depressants wrote an article of his experience in this in the New York Times Magazine.. a few years ago..
well worth a read to see the reality of this.

 

[David Baxter PhD]

Re: Antidepressants: A complicated picture

I am sorry to hear about the loss of your daughter.

However, your concern is already addressed in various threads in the Suicide Risk with SSRIs and Other Medications forum here at Psychlinks.

The bottom line from controlled research (rather than anecdotal reports) into the links between SSRIs and suicide is this: Depression sometimes causes suicidal thinking and or behavior; there is no real evidence that antidepressants cause suicidal thinking or behavior.

Also, consider this: During the period of time that the use of SSRIs for adolescents was limited, in response to the concern about suicide risk, the number of attempted and completed suicides among young people increased in North America after a period of time in which suicides had been steadily falling.

And finally, the use of medications in mild depression may be optional. In moderate to severe depression, they are required: No amount of talking to your clergyman or anyone else is going to manage the symptoms, including suicidal ideation, at that point.

 

[sbryks]

Re: Antidepressants: A complicated picture

David,
with respect,
there has been ample research linking an increase in suicidal ideation and actual suicides with the SSRI drugs.
This is not anecdotal and has been well reported in the literature from major studies. I don't have the time to find all these as I have not been actively involved in this discussion for some time. The study that suggested an increase in suicide due to the black box warnings was disputed as was the alarmist view that the fear raised by the black box warnings would cause an increase in suicide. This was raised in reaction to the simple benefits of the black box warnings which are not complicated in the least, but caution physicians and patients in terms of when prescriptions are started, or doses changed.. My daugher's dose was increased and she had the first increased dose pill the night before she took her own life. I know of other similar stories of real people I know who lost their children in relation to taking these drugs, and while, yes, these are anecdotal, at the same time one cannot dismiss these even if they alone are not proof. Attributing this to mere coincidence, or the longstanding mantra "well, they were depressed and depressed people commit suicide" really misses the point.

If one visits the Effexor Petition site and sees the tens of thousands of posts about side effects, and people becoming "addicted" to some of these drugs due to side effects, though some have argued about the definition of "addiction" in this regard.

I make two simple points.. It is about risk management and risk benefit. Risk management in the importance of informing family of the total picture, benefit and risk, and risk benefit in not prescribing these drugs too lackadaisically and without care and caution, as if the young patient were YOUR OWN CHILD.

It is not as simplistic as you put it David.

And for some very risky clinical conditions such as Borderline Personality Disorder, treatment by cognitive behaviourial therapy or if possible dialectical behaviour therapy has far better outcomes and reductions in risk, than depending on the drugs. The human brain is considered to be the most complex entity in the known universe, and we are at early stages of understanding drug treatment for mental illness. Yes, for some conditions, as schizophrenia, and bipolar disorder, there are known benefits that are clear, but even there, management of patient care is critical. The typical prescribing of anti-depressants is very often lackadaisical as an "easy" fix, and that needs to stop as a common medical practice. We need better care, and sometimes a clergyman can be far better than the SSRI pill, as the help is more sustaining.. I am not religious at all, and only used the clergy as a model of the classic "it takes a village, to raise a child" and that is very true about caring for people.. I am not saying anti-depressants don't have a place, but I do say.. BE CAREFUL FOLKS... and don't make it seem as if we are treating polio with a vaccine. It is nothing at all like that..

It is a bandaid solution, and not the real solution in many, many cases.

Take care,
Sam

 

[Daniel E.]

Re: Antidepressants: A complicated picture

Well, another correlation worth considering: When Prozac was first introduced, the suicide rate went down for the first time in a long time.

And for some very risky clinical conditions such as Borderline Personality Disorder, treatment by cognitive behaviourial therapy or if possible dialectical behaviour therapy has far better outcomes and reductions in risk, than depending on the drugs.

I would agree with that, though the treatments are certainly not mutually exclusive and everyone is different.

Even though disorders are generalizations, it is true that people with BPD and OCD, for example, are more likely to be "treatment resistant" when it comes to medications. OTOH, therapy is also well-known for "client resistance."

 

[sbryks]

Re: Antidepressants: A complicated picture

OK, thanks David,
appreciate your comment. your statement is very true.
many, many lives can be saved through more patient care in a real "team" effort involving family, and if family is part of the problem, then the "village" of our society needs to be there and commit to the people. I know it is not easy, but the problem is there are too many professionals out there who are into a wrong modality of patient care.
I was a parent who struggled for 8 years with my daughter's illness, and at end, I failed her in spite of my efforts. In hindsight, if I had had one caregiver who was willing to work with us as a family and address the issues, she might still be alive today. Instead, we trusted advice of many selfish practictioners, in my case against my own better judgement, and instead of her issues being addressed, she was plied with drugs that I believe killed her.. I know from my experience in this some clinicians forget about the patient when the meeting is over, and don't think of them again till the next "session". I did my own post-mortem psychological autopsy of my daughter's death - I forget the exact term, and have seen parents have a child's death by suicide reviewed by a coronor's investigation in similar circumstances, with many of the same elements of failure of practice. That is why I always ask those who are caring for troubled children in the clinical context to give them the same care as if the child was their own child. That is the quality of medical care needed. Anything less, is really incompetency.
In these cases of suicide, if it is a child, we are left with having failed our child for the rest of our lives. My daughter was legally an adult, but at core she was still a child.
Something to think about David.

Sam

 

[Daniel E.]

Re: Antidepressants: A complicated picture

Incidentally, it was I who replied to you last, not Dr. Baxter.

 

[sbryks]

Re: Antidepressants: A complicated picture

OK Daniel,, I didn't realize this.
Are you a clinician?
in any case, that's the way it is.
Sam

---------- Post added at 05:49 PM ---------- Previous post was at 05:47 PM ----------

OK. Daniel, read your profile..
my best wishes to you.
Sam

 

[David Baxter PhD]

Thread split from http://forum.psychlinks.ca/prescrip...31-antidepressants-a-complicated-picture.html

 

[David Baxter PhD]

I too have lost a daughter, sbryks. When that happens, we naturally look for something to make sense of the loss, something to blame perhaps, a cause.

But as I said in my first response to you, please read through the threads here: Suicide Risk with SSRIs and Other Medications

Medication did not kill your daughter. Depression did.

 

[sbryks]

I am very sorry for your loss David..

I cannot agree with your view that depression killed my daughter. Although I cannot prove it was the anti-depressant as this is not possible scientifically after the fact, the circumstances give a VERY strong likelihood that this is what happened.
From a clinical perspective, victims of Borderline Personality Disorder have a very high risk of suicide completion compared to the general population, and their risk therefore of acting on the influence of a drug like effexor is higher than the general population. The fact that the prescribing physician was not even aware of the risk, and the recommending psychiatrist refused to meet family to discuss my daughter's situation nor were we advised of the basic precautions by anyone speaks very loudly to the fact that we could have saved her life by being with her had we known of these facts.
The statement that "it was not the drug but her depression that caused her death" is a familiar mantra I hear from the psychiatric profession, and I think it is just a flimsy excuse in the face of the fact that these drugs DO cause an increase in suicide ideation, and are considered a risk factor.
You cite studies proving that they save lives, but i have seen quite a few studies showing that they increase risk of suicide. It also depends on whether the population under review is older or younger. The risk factor for ideation is especially high among younger people.. adolescents to young adults.
You are correct in that suicide loss survivors such as myself and many others struggle to cope with the overwhelming loss and guilt. I lived in that and still do but I researched this with care, and it is not as simplistic as you put it.
The facts of this don't mitigate my feelings of guilt that will be with me forever, but I also can't ignore these facts nor the work of people like David Healey and others.
I wish that psychiatrists would stop trying to make it seem as if these drugs are without risk and are the great lifesavers. The pharmaceutical industry has been shown to be less than upright when these risks threaten their revenues.
I still hold the view that better care and less reliance on the "quick fix" is better medicine. I saw a psychiatrist after my daughter's death and he once threatened to stop seeing me if I would take anti-depressants. I refused, and shortly after stopped seeing him because of his inherent selfishness. It became very clear to me who he was about.
I did find other help willing to work with me to help me get through my own suicide ideations.
Every day was a nightmare for me. I plodded on in my work, and had close friends there for me. I somehow got through it. Perhaps partly because I couldn't do to my elderly father, what had happened to me and because of a lady friend's begging me to not consider this because of impact on them. (I was a divorced single parent and my daughter's main care-giver). I am sure you know how difficult BPD victims can be in their struggle to somehow find themselves through the pain of their condition.
We need better care and commitment,and a societal effort to help victims not so much reliance on drugs.
I did research this considerably David, and i am not alone in my views on this. I have not looked at the literature for a while as I eventually moved on, and am busy in my work, but I know that the SSRI's can be dangerous and can indeed cause suicide ideation and completion. Unfortunately most suicides are not investigated beyond the obvious - that the cause of death was suicide. It is only the rare case when parents or family demand a forensic investigation relating to mental health and circumstances, that this is brought to the fore, and there have been cases like that in the media in Ontario where we are both from.
with respect,
Sam

---------- Post added at 03:20 AM ---------- Previous post was at 03:17 AM ----------

David,, error in my post
the psychiatrist threatened to stop seeing me if I refused to take the anti-depressant, not opposite.
sorry for the error..

 

[Budoaiki]

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.

 

[sbryks]

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

 

[David Baxter PhD]

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.

 

[sbryks]

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

 

[David Baxter PhD]

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.

 

[Budoaiki]

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.)

 

[sbryks]

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

 

[Retired]

Dr. Baxter,.......I presume you are a practicing psychiatrist

Dr. Baxter is a Registered Psychologist in private practice in Ottawa

 

[sbryks]

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

Sam

 

[David Baxter PhD]

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