The simplest way to think about SSRIs is this: They give the patient back his energy before they give him back his mood. Many, many people who have both moderate to severe depression and suicidal ideation are literally too depressed to kill themselves. They want too, but they're too detatched to even be bothered to go through with an attempt. Once you start them on an SSRI, there is a short period of time, roughly one to six weeks, where they medication will be effective enough to give the patient some of his energy back, but not effective enough to relieve the underlying depression. Obviously, in those who are already thinking about suicide, this can be an extremely dangerous period of time, because it gives them a window in which they'll have both the desire to kill themselves and the wherewithall to go through with it.
Chad Brownel, Matt's only close friend at Harmony, said that Matt mentioned suicide ''hundreds of times'' during the six months that they'd known each other. And toward the end of the school year, when Roxana Rogers asked Matt about his plans for the summer, Matt said that if his parents sent him away to camp, he would kill them and then kill himself.
The solution, however, is incredibly simple: All patients with even the slightest hint of suicidal ideation (like the subject of this article) should be monitored 24 hours per day for the first few weeks after being started on an SSRI. You don't have to lock them up for the duration, but you can't just toss the bottle of pills at your kid and continue with your daily routine during this time.
Assuming this article is telling the truth about what occurred (a giant if, given the source), the doctor should have made this very clear to the parents. But in any case, for all the bloviating in the MSM about this issue over the last few months, the reality is that doctors and scientists have known that SSRIs act this way for pretty much as long as they've been in existence. The only reason these medications are getting black box warnings is because there are so many doctors and parents out there that simply don't want to take any responsibility any more.
Both of you make excellent points - the key here seems to be that these drugs for many people may be *too dangerous* in the first month or so without hospitalization. But insurance companies won't pay for 4-6 weeks of hospitalization (they usually provide only 10 days or so.) Obviously for some it's not enough.