Posted on 07/21/2004 9:34:21 PM PDT by neverdem
Amid an international debate about the side effects of drugs taken for depression, a large-scale analysis of British medical records has found little difference in rates of suicidal behavior among patients given some of the most commonly prescribed medications. The risk is highest when patients begin taking the drugs, as doctors have long suspected, and tapers off quickly after that.
The study, which is being reported today in the Journal of the American Medical Association, found no evidence that withdrawal from the drugs put patients at an increased risk of suicide.
The analysis, conducted and financed by the Boston University School of Medicine, is the largest to compare the suicide risk of the antidepressant drugs Paxil and Prozac with that of older medications like amitriptyline. All the drugs have been commonly prescribed for people with severe depression.
Patients were three to four times more likely to report thoughts of suicide or attempts at it in the first month of treatment than they were after three months on the drugs, the analysis found. The findings were similar for each medication, whether prescribed for adults or children.
Experts said the study should reassure psychiatrists and other doctors concerned about hidden differences between the risks of the newer antidepressants, like Prozac, and the older varieties. The experts also said that it confirmed the importance of watching patients closely when they begin treatment.
"It's starting treatment itself, more than what drug you start with, that's the important factor," said Dr. James A. Kaye, an author of the study along with Dr. Hershel Jick and Dr. Susan S. Jick. Most psychiatrists believe that the drugs reduce the overall risk of suicide.
The analysis does not help answer the central question underlying the safety debate: Do some people become more suicidal on the drugs? Compared with those on placebos, depressed children in particular have reported an increase in suicidal thoughts when taking antidepressants during some clinical trials.
"This study does not speak at all to taking the drugs versus not taking them," said Dr. Jeffrey A. Lieberman, a professor of psychiatry and pharmacology at the University of North Carolina.
Concerns that the drugs might increase the suicide risk for some children prompted the Food and Drug Administration to caution doctors earlier this year that young patients should be monitored carefully, especially during the first weeks of treatment. Late last year, British health officials banned the use of all drugs but Prozac for treating depression in patients younger than 18.
The Boston University doctors analyzed the computerized medical records of 159,810 patients treated for depression between 1993 and 1999 in Britain, which keeps a detailed database of health information on millions of its citizens. The patients ranged from 10 to 69 years old and could have taken only one brand of antidepressant: Prozac, from Eli Lilly; Paxil from GlaxoSmithKline; amitriptyline; or dothiepin, which is not available in the United States.
Among these patients, the researchers found 555 had showed signs of suicidal thinking or behavior for the first time in the months after they started on antidepressants.
Regardless of age or sex, they were four times more likely to begin acting suicidal in the first 10 days of treatment than they were after 90 days. And they were three times more likely to show such signs during the rest of the first month of treatment than later on.
It did not matter much which drug they took. The risk of suicidal behavior for those who started on Paxil was slightly higher than for those on the other drugs, but the difference was so small that it could have been due to chance or to something the researchers did not take into account, they said. For instance, Dr. Kaye said, Paxil, the newest of the drugs, may have been prescribed for suicidal cases more often than the others.
Researchers do not know why the risk of suicidal behavior was highest during the first weeks of treatment. The most likely explanation, they said, is that patients are at a low point when depression is diagnosed and they start on a drug.
PING
This would be brutal to prove anyway. A certain number of depressed or mentally ill just kill themselves, regardless of what you give them. So how would you prove it was drug X, rather than their crippling depression?
The radio report said that the risk of suicide is increased 4-fold. If you're starting out with a tiny percentage, then that will still be a tiny percentage.
This is less helpful to me than it could be. My son wasn't taking the med for depression, but for anxiety. I wonder if a person already "keyed up" because of the anxiety is at an even increased risk...and how many fewer people kill themselves because of anxiety vs depression.
Such a small population will likely never be studied. I'm coming to grips with the fact that this whole lousy episode in our lives is unlikely to be explained.
You realize the problem, don't you, neverdem? If I can't prove the med was responsible by 1000%, then I have to worry that it might happen again. And that sucks.
Thanks for the link.
There's some overlap in the signs and symptoms of anxiety disorders and major depression.
I don't like to sound trite, but there are no guarantees in this world. All you can do is to try your best, and hope for the best. Good luck and may God bless you and your family.
Predicting suicide would seem to be easy. There are certain variables such as age, alcohol/drug abuse, severity of the illness and the presence of suicidal thinking or threatrs that statistically augur for suicide. The problem is that on an individual basis no statistical means has ever been devised that successfully predicts suicide. Vince Foster would be one good example--while possibly mildly or moderately depressed he never ventured suicidal thoughts (85% of people who suicide have threated or discussd suicide) yet, according to conventional wisdom and investigations, he did commit suicide.
The point of this is that if you are looking for a 1:1 cause of suicide you will have a hard time supporting this according to any reasonable data evaluation.
Furthermore, the NYT article is extremely misleading about this study's independence when it states: "The analysis, conducted and financed by the Boston University School of Medicine,......"
This study was indeed funded by the Boston Collaborative Drug Surveillance Program (headed by Hershel Jick) of Boston Univ. However, what the article does not say is that this program is funded largely by drug companies. According to the Integrity in Science Database, The BCDSP "is supported in part by grants from AstraZeneca, Berlex Laboratories, Boehringer Ingelheim, Boots Healthcare International, Bristol-Myers Squibb, Glaxo Wellcome, Hoffmann-La Roche, Janssen Pharmaceutica, RW Johnson Pharmaceutical Research Institute, McNeil Consumer Products, and Novartis Farmacéutica SA."
Continuing best wishes for you and your son.
1. For a very concise critiques of why large databases are not useful in studying a phenomenon like drug-induced suicidality emerging in a small percentage of patients on a drug, see T. Van Putten, W. C. Wirshing, et al., “Fluoxetine [Prozac] Akathisia [agitation] and Suicidality: Is There a Causal Connection?,” Archives of General Psychiatry 49(1992): 580-81.
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