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Re: News - Antidepressants Vindicated? jrbecker76

Posted by Larry Hoover on September 12, 2007, at 10:51:00

In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40

> Web address: http://www.sciencedaily.com/releases/2007/09/070907095628.htm
>
> related story:
> http://www.nytimes.com/2007/09/07/health/07suicide.html?_r=1&oref=slogin
>
> Newer Antidepressants Led To Less, Not More, Teen Suicides

I'd like to drag the discussion back to the original topic.

The FDA invoked the black box warning based on what I believe to be a political decision, because we want to protect our children from any plausible harm. But the facts do not support the decision made.

In the entire dataset for pediatric antidepressant trials, there was not a single completed suicide. In the many tens of thousands of subjects, there is not one single case from which to generalize. And yet we did.

Prior to the warning, statistical analyis of the adolescent suicide data across the U.S. had shown a clear protective effect of SSRI prescription with respect to suicide. In fact, the relationship was sufficient to develop a regression equation of the form y= mx + b, where y is suicide incidence, m is a negative value (-0.23 suicides/1% increase in SSRI utilization), and b (the intercept) the probably non-zero suicide rate if all vulnerable subjects were treated.

Factorial analysis of the predictors of adolescent suicide have never been shown to even include SSRI use. Alcohol use is a powerful predictor, however. Why do we view these two drugs so differently?

I looked at the whole thing back in 2004 http://www.dr-bob.org/babble/20040915/msgs/392320.html, back before the FDA warning came out, and I haven't seen any reason to reconsider.

I've said it many times before, and I'm going to say it again: The problem is not in the drugs themselves, but in how they are managed. The drugs are blunt instruments, which although powerful, can be used safely. I'll close with the concluding statement of the authors of the study which opened this discussion:
"If the FDAs goal is to ensure that children and adults treated with antidepressants receive adequate follow-up care to better detect and treat emergent suicidal thoughts, the current black box warning is not a useful approach; what should be considered instead is better education and training of physicians."

Lar

 

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poster:Larry Hoover thread:781684
URL: http://www.dr-bob.org/babble/20070911/msgs/782428.html