Posted by Larry Hoover on May 7, 2005, at 22:00:57
In reply to Larry, how do you feel about....., posted by linkadge on May 7, 2005, at 18:06:54
> What is your general feeling on the ssri suicide connection, and about the safety and efficacy of SSRI's in general ?
I've reviewed a number of the clinical trials that are now online (the complete raw data), and all available reviews done by the FDA, the MHRA (British equivalent), the EMEA (EU agency), and numerous meta-analyses of published trials.
Virtually every headline I've ever read about increased suicide risk has not been supported by the data (i.e. was hyperbole or false), or was a misquotion or misreporting or misinterpretation of regulatory guidance.
If you'd like to read one analysis I did, you could go to: http://tinyurl.com/98odq
I also posted the actual case descriptions, if you're interested: http://tinyurl.com/ajgob
Lots more in that thread.I also wrote a review of adolescent suicide findings last September: http://tinyurl.com/crr2c
That said, there *is* a treatment-emergent increased likelihood of suicidal ideation, self-harm, and (perhaps) suicide completion with SSRIs. In broad strokes, suicidality risk on SSRIs is roughly double the risk of remaining untreated, but only during the first weeks, or at dose increases. It does not differ, though, from the increased risk of suicide seen with tricyclics. Nor does it differ from the increased risk seen with MAOIs. All known antidepressants increase these risks. It is not a novel finding, applying only to SSRIs.
In any case, this is a very short term phenomenon. Moreover, the actual baseline (untreated) risk of suicical acts is very low during this brief period, so doubling a very small number does not make the risk unmanageable. I emphasize that I place the responsibility on medical management. There is nothing novel about increased suicidality on SSRIs. All pharmacological treatments carry this risk, and of a similar (if not greater) magnitude to that of SSRIs.
By about the 3rd month of treatment, there is a robust and virtually definitive reduction in suicidality, compared to baseline (untreated).
I find it very hard to ignore compelling real-life forensic analysis like the following, just published:
Acta Psychiatr Scand. 2005 Apr;111(4):286-90.
Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides.Isacsson G, Holmgren P, Ahlner J.
Neurotec, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden. goran.isacsson@neurotec.ki.se
OBJECTIVE: To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents. METHOD: Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26,422 cases of deaths by accident or natural causes in Sweden 1992-2000. RESULTS: There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs. CONCLUSION: The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.
Since the advent of SSRI meds, suicide rates are falling. However, there are major confounders to consider. Culturally, people are talking about mood disorders and treatments and self-harm much more now, than in the past. Are outreach programs responsible for the decrease in rates? Are increased reports of adverse events due to more generally open discussion, and reduction of stigma, and increased tendency to blame those greedy blood-sucking wealthy multinational drug companies?I do not mean to sound like I am dismissive or trivializing the real suffering some people experience from medication. In fact, I am a golden example of that. Fluvoxamine (Luvox) sent me into psychotic mixed-state mania. Nefazodone (Serzone) nearly killed me, by shutting down my liver. Lithium made me profoundly suicidal. My recent trial of gabapentin (Neurontin) has been extremely draining.
In all those earlier cases, though, the adverse effects were poorly managed from a medical perspective. I did not get the close and attentive medical care I needed during those earlier incidents, nor did I have the wisdom to know to seek that care. I do not blame the drugs.
These are not unmanageable risks. These are not unmanageable adverse effects. These are powerful drugs than need to managed responsibly.
That's how I feel about....
Lar
poster:Larry Hoover
thread:494915
URL: http://www.dr-bob.org/babble/20050504/msgs/495027.html