Mental Health Blogs

A new study out in the BMJ and authored by several FDA staffers found after examining data from 372 clinical trials and almost 100,000 patients:

“Conclusions: Risk of suicidality associated with use of antidepressants is strongly age dependent. Compared with placebo, the increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents. The net effect seems to be neutral on suicidal behaviour but possibly protective for suicidal ideation in adults aged 25-64 and to reduce the risk of both suicidality and suicidal behaviour in those aged ≥65.”

It’s of course old news at this point that anti-depressants can induce both suicidality and suicidal ideation–hence the FDA-mandated black box warnings on anti-depressants–but this study does address mounting attempts, most recently in June, by some researchers to cast doubt on the warnings, especially for young adults aged 18 to 25. Looks like they lose yet again.

While I know that 25 to 64 age cohort is standard public health accounting, it would be useful if that data were broken down into four age groups since it covers four decades. The reason I say this is because I know of many, many people who were in their late-20s and 30s and 40s who experienced massive problems on anti-depressants and, if anti-depressants are somewhat less problematic with advancing age, then it would be nice to know when that effect kicks in.

Apparently, the risk of suicidality and suicidal ideation varies among anti-depressants–no surprise there–and according to the AP:

“[T]he odds of suicidal behavior by people taking Pfizer Inc’s Zoloft, or sertraline, were around half of those who took placebo. By comparison, Forest Laboratories Inc’s Celexa, or citalopram, and Lexapro, or escitalopram, ‘seem to increase the risk of suicidal events,’ Geddes and colleagues wrote [in an accompanying editorial which I don't have access to].

I am a bit surprised to not see Paxil/Seroxat getting a mention.

Anyway, don’t be surprised to soon see a paper from defenders of anti-depressants claiming something completely different on these issues.

Now, let’s watch the AP drink some Kool-Aid:

“Many psychiatrists have criticized the warnings, saying they scare people away from effective treatment for depression, the leading cause of suicide. In fact, recent studies have suggested the warnings triggered an 8 percent rise in suicide among youth and teens in 2004, the biggest one-year gain in 15 years.”

Actually, it was only one study that made that claim, a controversial and much-criticized 2007 study by Robert Gibbons which was ripped apart by the New York Times, myself and others. Gibbons later attempted to address his critics. For the AP to pretend that the Gibbons paper is settled science is simply bad, lazy journalism.

The paper from the June Archives of General Psychiatry which I mentioned above made the wild claim that the FDA warnings were causing fewer diagnoses of depression in the US. In taking it apart, I noted:

“The thing that troubles me the most about these sorts of studies is that they rest on the assumption that ivory tower researchers know what level of depression and diagnosis of the same is “right” for America, that anything less than that level or a suitable annual increase is unacceptable and demands policy intervention, that anti-depressants are always curative and healthful, and that depression can never be allowed to go untreated with medications. And for them to act unaware of the recent WHO study on anti-depressants and suicidality (which found plenty especially among kids and teens), a 2007 study out of the STAR*D research which found over 8 percent suicidality induction in adults in the study (hell, it was published in AGP, so how could they ignore it?) and last year’s British study finding that suicide rates went down after the UK banned most anti-depressant use amongst people aged under 18 is simply blind religiosity. It’s the Nanny State run amok.”

There is now a ton of solid peer-reviewed evidence out there on anti-depressants and suicidality. It’s time for the forces of religious orthodoxy in psychiatry to fold up their tents and leave town.

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Related posts:

1. Study: Anti-Depressants Put Breast Cancer Survivors At Risk
2. Study: Anti-Depressants Linked To Increased Stroke Risk In Older Women
3. Anti-Depressants Again Linked To Birth Defects
4. Study: Fewer Depression Diagnoses "Unintended Consequence" Of Suicide Warnings On Anti-Depressants
5. Study: Anti-Depressants Ineffective For Mild, Moderate Depression