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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by med_empowered on July 19, 2005, at 3:51:28
hey! From what I understand, the college student didn't have a history of particularly serious depression--i.e. depression accompanied by functional impairment, psychosis, hospitalization, suicide attempts, self-mutilation, etc. Eli Lilly's PR people kind of spun her suicide to make it seem like a tragic incident that would have happened with OR without the medication. In all likelihood, this is a completely inaccurate interpretation without any real merit. Interestingly enough, Cymbalta hit the market right before the FDA decided to require ADs to warn patients about the risk of increased suicidality in those treated with anti-depressants vs. those not given ADs. My guess is that had Cymbalta been released during or after that period, the suicide would have been definitely labelled *medication related*. Oh, BTW--the antidepressant+suicide relationship has apparently been noticed for a long time; until recently, no one found it all that important to let patients know what was going on. Tricyclic antidepressants were often considered risky both because they could be used to commit suicide AND because sometimes patients turned suicidal (and sometimes psychotic, hypomanic, manic, or strangely aggressive). And, if you look at the SSRIs, the effect is noted as early as the famous "Listening to Prozac" by Peter Kramer. At some point in the book, Dr.Kramer points out that there is a bump in suicide rates amongst those treated with Prozac versus those not using Prozac. His explanation? The burst of energy following Prozac's kick-start in the brain preceedes any antidepressant effect, so you sometimes have a deeply depressed, lethargic, potentially suicidal patient who suddenly has pep and vigor, but still wishes to die; they use their newfound energy to kill themselves. When I read it way back when, it made sense to me; then, the more I thought about it, and the more horror stories I saw and heard, the more I realized that something was terribly, terribly wrong in a number of cases with people treated with ADs. I've had friends with mild depression or anxiety go CRAZY under Prozac, Paxil, etc....and it isn't bipolar; once the offending med was withdrawn, the symptoms went away, without the need for any long-term use of mood-stabilizing/anti-manic medications. (Although in the "crazy" phase, some docs dosed the patients up with benzos like Klonopin to keep them calm). Anyway, believe whom you want for whatever reasons you want, but my own interpretation is that this death is somehow deeply associated with, if not caused by, the use of Cymbalta.
Posted by linkadge on July 19, 2005, at 6:31:32
In reply to The Cymbalta Suicide, posted by med_empowered on July 19, 2005, at 3:51:28
Isn't that interesting that some doctors *know* that the crazy phase is related to the med, and *not* indicitive of bipolar, and will therefore prescribe a concurrent benzo.
But this will never be admitted stright out, and therefore you get other justifications such as a underlying bipolar disorder, or start-up anxiety.
After all this time with all these meds. Only two have ever been proven conclusivly to reduce the risk of suicide, and those are lithium and clozapine.If an antidepressant cannot reduce the risk of suicide, then what is it really doing ?
I just kept taking them cause my therapist told me I had a bad serotonin gene. Bad serotonin gene my *rse. Clozapine prevents suicides and it is a multiple serotonin *antagonist*
Theres more to the story folks, theres more to the story :)
Linkadge
Posted by SLS on July 19, 2005, at 8:41:38
In reply to EXACTLY, posted by linkadge on July 19, 2005, at 6:31:32
I guess we'll never know for sure the extent to which this young person was depressed before beginning the Cymbalta treatment.
A number of years ago, I stood alone here on Psycho-Babble pleading that people become more aware of the possibility that Prozac causes suicide. Of course, I implicated other drugs as well, but Prozac was the one focused on by the media. There are those that wanted to ascribe the few incidences to be found on Medline to akathisia. I found this to be a weak argument, as it seemed to me that the incidences of suicide were higher than those of akathisia.
Cymbalta caused a depressed young woman to commit suicide. Now what?
- Scott
Posted by kerria on July 19, 2005, at 10:21:56
In reply to The Cymbalta Suicide, posted by med_empowered on July 19, 2005, at 3:51:28
oh no, now i wonder if i should take Cymbalta or not. My medical dr doesn't know that i have dx of DID and i'm taking it for pain not depession and are in severe chronic pain.
Posted by kerria on July 19, 2005, at 10:28:47
In reply to Re: EXACTLY, posted by SLS on July 19, 2005, at 8:41:38
cymbalta stops the pain one way or another anyways, right? scary. Maybe should i take the Cymbalta with diazapam then? i have it- that i take as needed- not very much- only 10mg four times a week or so (therapy visits)and sleepless nights.
Posted by Racer on July 19, 2005, at 12:45:18
In reply to Re: The Cymbalta Suicide, posted by kerria on July 19, 2005, at 10:21:56
> oh no, now i wonder if i should take Cymbalta or not. My medical dr doesn't know that i have dx of DID and i'm taking it for pain not depession and are in severe chronic pain.
>Cymbalta is not unique in being associated with suicidal ideation or action, so I wouldn't worry too much about it -- but I would put into place some sort of safety net, if I were you. Nothing major, just someone you can call to say, "Uh-oh, I'm thinking it looks like an alternative" if need be. Your therapist is probably the best resource for this, so just keep her updated, huh?
Is there any reason that your PCP doesn't know about your psychiatric dx? That sort of thing really can be relevant to your physical health, and it would probably be in your best interest to let him/her know about this. Just my two cents worth, and cheap at half the price.
Posted by SLS on July 19, 2005, at 13:08:02
In reply to Re: EXACTLY, posted by kerria on July 19, 2005, at 10:28:47
Posted by linkadge on July 19, 2005, at 16:10:35
In reply to I agree with Racer (nm) » kerria, posted by SLS on July 19, 2005, at 13:08:02
I often found that the more celexa I took, the more coffee I had to drink in order to remember who "I was".
The SSRI's just made me so "uncomfortable" being myself.
Linkadge
Posted by Phillipa on July 19, 2005, at 18:52:17
In reply to The dopamine connection ?, posted by linkadge on July 19, 2005, at 16:10:35
Sometimes I get so confused here. I don't know whether to take the luvox or not. One day I do one day I don't! Fondly, Phillipa
Posted by linkadge on July 19, 2005, at 19:05:53
In reply to Re: The dopamine connection ?, posted by Phillipa on July 19, 2005, at 18:52:17
I can't answer that for you. It might help you I don't know.
Linkadge
Posted by blueberry on July 19, 2005, at 19:46:36
In reply to The Cymbalta Suicide, posted by med_empowered on July 19, 2005, at 3:51:28
A high percentage of psychiatric meds actually make me feel worse instead of better. I have become profoundly intensely deeply depressed on meds. I never got suicidal, but I can see how it could happen. Thankfully I finally found a couple my system likes, prozac and zyprexa. But even too high a dose of either of them can make me more depressed again. It's almost as if I have a therapeutic window, and maybe other people do too, and maybe common starting doses of meds shoot people way past the window way too fast. I don't know. I can see though how someone could have a paradoxical or adverse reaction and kill themselves, not being of sound mind when they do it.
Posted by Mistermindmasta on July 22, 2005, at 0:12:17
In reply to Re: EXACTLY, posted by SLS on July 19, 2005, at 8:41:38
> I guess we'll never know for sure the extent to which this young person was depressed before beginning the Cymbalta treatment.
>
> A number of years ago, I stood alone here on Psycho-Babble pleading that people become more aware of the possibility that Prozac causes suicide. Of course, I implicated other drugs as well, but Prozac was the one focused on by the media. There are those that wanted to ascribe the few incidences to be found on Medline to akathisia. I found this to be a weak argument, as it seemed to me that the incidences of suicide were higher than those of akathisia.
>
> Cymbalta caused a depressed young woman to commit suicide. Now what?
>
>
> - ScottJust want to point out that myself and several others agree that akasthisia is EXTREMELY underreported in the literature. I have NEVER had suicidal thoughts until I took compazine a few years ago for nausea. The restlessness was so incredibly horrible, but I'm lucky I was a psychologically healthy person at the time and was able to wait it out. Also, having never experiences such feelings, I had a hard time describing the way I was feeling.
However, I think another part to this suicide thing is that some people can become more impulsive / agressive while on SSRI's, if they happen to have a certain brain circuitry predisposition. Prozac I believe has the strongest effects on 5-HT3 receptors (might be wrong on that one), which can decrease dopamine in the nigrostriatal zone, causing restlessness. Combine that with some more energy and impulsive aggression in someone who's had a messed up life and there ya go...
I don't believe cymbalta's effects on other receptors are as nearly well studied as it's effect on norep and 5-ht reuptake. Maybe I just haven't come across them yet..
Posted by Mistermindmasta on July 22, 2005, at 0:19:09
In reply to The Cymbalta Suicide, posted by med_empowered on July 19, 2005, at 3:51:28
Just want to comment that there are some people who only become manic while on SSRI's or antidepressants. I believe they want to name it "bipolar III" or something like that. I think there are some people who don't ever become manic normally, but switch over while on antidepressants, and can actually be classified within the bipolar spectrum.
I wouldnt be at all surprised if cymbalta caused the suicide. However, giving a benzo seems like the wrong choice. In keeping with my bipolar III theory, it seems like the logical option would be a mood stabilizer. I wonder how many less people would commit suicide if all SSRI's were given with a lower dose mood stabiliser of some sort?
Posted by kerria on July 22, 2005, at 1:09:30
In reply to Re: The Cymbalta Suicide » kerria, posted by Racer on July 19, 2005, at 12:45:18
Hi Racer,
Thank you - yes- i'll try cymbalta and see if it helps at all. i haven't yet because of a severe migraine since Tuesday but when /if? it gets better i'll start. Many of the AD that i tried started migraines so i need to be careful.
i don't tell anyone that i have DID. The few persons that found out by accident it was so much a disaster. Now i don't tell anyone. There is nothing to gain and everything to lose.
Drs don't believe DID or they don't understand DIDIt would be good if they did because it's so difficult to have to hide in order to have good treatment- but i've found that they don't. i don't go to any of the drs anymore that found out.
Posted by Racer on July 22, 2005, at 7:37:12
In reply to Re: EXACTLY, posted by SLS on July 19, 2005, at 8:41:38
>
> A number of years ago, I stood alone here on Psycho-Babble pleading that people become more aware of the possibility that Prozac causes suicide. Of course, I implicated other drugs as well, but Prozac was the one focused on by the media. There are those that wanted to ascribe the few incidences to be found on Medline to akathisia. I found this to be a weak argument, as it seemed to me that the incidences of suicide were higher than those of akathisia.
>
>
>
> - ScottHmmm....
I think that MisterMindMasta (and why do I want to add "Flash" at the end of that? Or am I showing my age?) is onto something: a lot of people may not have the words to describe what they're feeling. I know that I told Dr EyeCandy (a/k/a Dr GraduatedLastInHisClass) last year that I was feeling "jittery" and that I was fidgeting my feet a lot -- but it was only later that I realized that the feeling that my legs were on fire unless I kept them moving might be akathesia. I suspect that if I had said the word "akathesia," he'd have jumped on it -- first to make a mental note that I was a hypochondriac, as proven by knowing that word; and then to consider doing something about it. As it was, my description of not being able to stop fidgeting, and that it was aggravating my arthritis, probably didn't even register. Or maybe it was just lumped in to a general catagory called "Anxiety."
The point of that, of course, is that akathesia is probably underreported, both because the doctors don't quite register what patients are saying, and because that's not necessarily something that some patients would bother bringing up to a doctor.
Just a thought...
On the other hand, I don't know. And maybe there is a direct causal relationship between ADs and suicidal ideation and action? Guess more research might give answers to that question...
Posted by SLS on July 22, 2005, at 8:59:36
In reply to Re: EXACTLY, posted by Mistermindmasta on July 22, 2005, at 0:12:17
> Just want to point out that myself and several others agree that akasthisia is EXTREMELY underreported in the literature.This is surely true. I don't think many doctors would recognize an inner tension as akathisia if it weren't accompanied by the patient rocking in a chair or pacing or shifting weight from one foot to the other while standing. However, I am *sure* that the appearance of akathisia is not necessary for the provokation by an antidepressant suicidal ideation. I have had several antidepressants make me feel worse. It is as simple as that. Depending on where I am at psychologically at the time, this might be all that is needed to push me over the edge. It does seem that an increase in anxiety does contribute to suicidality. Prozac in particular, but other drugs too, produce anxiety early in treatment.
> However, I think another part to this suicide thing is that some people can become more impulsive / agressive while on SSRI's, if they happen to have a certain brain circuitry predisposition.
Your description of an increase in impulsivity and agression evolving with antidepressant treatment figures very prominently in the evolution of suicidality. JJ Mann, MD has done quite a bit of work in this area. These are things that can occur in the absence of akathisia. So, we have more than one route by which SSRIs can provoke suicidality. It is paramount that psychiatry recognize this and develop a strategy to identify it and treat it when it happens.
- Scott
Posted by ed_uk on July 22, 2005, at 13:49:21
In reply to Re: EXACTLY, posted by Mistermindmasta on July 22, 2005, at 0:12:17
Hello!
>Just want to point out that myself and several others agree that akasthisia is EXTREMELY underreported in the literature.
I agree. Antipsychotic-induced akathisia is very common. One would expect it to have received a massive amount of attention in the psychiatric literature but in reality it's received virtually none. It scares me to think how many doctors will have increased the dose of the antipsychotic in reponse to their patient becoming agitated due to undiagnosed akathisia. I would imagine that this is particularly common in patients who are unable to express how they are feeling eg. patients who've had a stroke, people with dementia, people who are paralysed etc.
>The restlessness was so incredibly horrible....
It's just awful, what can I say.
>Also, having never experiences such feelings, I had a hard time describing the way I was feeling.
The worst thing is that many doctors probably don't understand that antipsychotics can induce severe agitation. If I hadn't told the ER doctors that I was suffering from akathisia they wouldn't have made the correct diagnosis. They just didn't have a clue. Thank God they didn't give me a Haldol injection.
>Also, having never experiences such feelings, I had a hard time describing the way I was feeling.
It's very difficult to describe. You really have to experience it to know what it's like. The textbook descriptions of 'restless legs' are pathetic, they make it sound so trivial.
~ed
Posted by Declan on July 22, 2005, at 16:22:48
In reply to Re: EXACTLY » Mistermindmasta, posted by ed_uk on July 22, 2005, at 13:49:21
There used to be a viewpoint that akathesia and other side effects of APs actually got less at higher doses. Any truth in this? This was in the 70s.
After my experiences with APs I lost interest in them, and thank God I don't need them. They were just frightful.
And you're right Ed. Difficult to handle stroke victims. Easy to imagine.
Declan
Posted by ed_uk on July 22, 2005, at 16:41:58
In reply to Dose related akathesia, posted by Declan on July 22, 2005, at 16:22:48
Hi Declan,
When I took Largactil, very low doses causes no akathisia, a moderate dose caused INTENSE akathisia.
>There used to be a viewpoint that akathesia and other side effects of APs actually got less at higher doses. Any truth in this?
I guess it might be true when comparing *very* high doses of high potency neuroleptics with *exceptionally* high doses! Say, 200mg Haldol might cause less akathisia than 100mg because the higher dose would be more anticholinergic. D2 antagonism would already have pretty much 'maxed out' at 100mg.
In general, akathisia gets much worse as the dose is increased. Decreasing the dose can often resolve the akathisia.
>And you're right Ed. Difficult to handle stroke victims. Easy to imagine.
It's often claimed that patients with schizophrenia are more tolerant of AP side effects than patients who don't have schizophrenia. I'm not convinced! IMO, patients who suffer from schizophrenia are simply more likely to have difficulty expressing their side effects to their pdocs....their side effects are more likely to be attributed to their underlying illness and ignored.
~Ed
Posted by Phillipa on July 22, 2005, at 18:45:22
In reply to Re: EXACTLY » Mistermindmasta, posted by SLS on July 22, 2005, at 8:59:36
Scott, did you say that prozac causes anxiety early in tx? Because when it first came out available only in 20mg capsules I was Rx'd it. I took it the first day and had lots of productive energy, next day experienced anxiety not too bad, but the third day I was in a complete panic and stopped the med. Three days of upped dose xanax to bring me down. Now when the pdoc heard of what he called "my dramatic response", he begged me to take it every three days. I refused. My pdoc now will Rx even prozac liquid. What do you think, do you feel it might work? I'd love to feel good again. Fondly, Phillipa
Posted by spriggy on July 22, 2005, at 20:27:51
In reply to Re: EXACTLY, posted by Phillipa on July 22, 2005, at 18:45:22
Up until I was put on Lexapro for a panic attack- I had never known depression, suicidal thoughts, or the extreme and horrific mental torment of akathasia.
I was also given Compazine once in my IV while pregnant and it made me feel very, very bizarre and uncomfortable almost immediately. I could only tell the doctor, " Please help me. I feel really weird." I wanted to jump out of my skin or climb the walls.
They gave me a benadryl flush and I fell fast asleep. I still had those feelings for a day or two but not nearly as intense.
When I started the Lexapro, I noticed that same feeling only it was magnified by 100 and it also came along with the most horrific, darkest, deadly depression I have ever felt.
I would lye in the floor on my face weeping and weeping and begging God to let me die. I would imagine all the ways I could kill myself.
If not for my faith in God and having two young son's to care for, I have no doubt I would be dead right now because of my reaction to Lexapro.
After 6 weeks on the stuff, my husband recognized how bizarre I was acting and how depressed I was and took me to a hospital. After 4 days there the psych diagnoed me with akathasia and sent me home with benzo's (and told me to never again take an SSRI).
Because of my above experience and my family history of bipolar (father and paternal grandmother), my regular GP tried to tell me that *I* was also bp.
If I am/were/was bp why did it only appear after SSRI's? Why did the horrific depression disappear about 6 weeks off the Lexapro?
I still have anxiety but am learning how to cope with it on my own.
It's just frustrating. I would warn anyone who is considering SSRI's to watch themselves CLOSELY and have someone else monitoring them for strange behavior. If not for my husband, I think I would be dead.
Posted by Declan on July 24, 2005, at 18:06:48
In reply to Re: Dose related akathesia » Declan, posted by ed_uk on July 22, 2005, at 16:41:58
Hi Ed
from memory, this is 30 years ago, the shrink was talking about 50mgs/d Anatensol. (Another lovely name!)
Declan
Posted by ed_uk on July 25, 2005, at 14:21:41
In reply to Re: Dose related akathesia, posted by Declan on July 24, 2005, at 18:06:48
Hi Declan,
50mg fluphenazine? Arghhhhhhhhhh! Sounds awful.
~Ed
This is the end of the thread.
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