Posted on 02/17/2008 12:23:43 AM PST by neverdem
AN expression of true love or raw hatred, of purest faith or mortal sin, of courageous loyalty or selfish cowardice: The act of suicide has meant many things to many people through history, from the fifth-century Christian martyrs to the Samurais’ hara-kiri to more recent literary divas, Hemingway, Plath, Sexton.
But now the shadow of suicide has slipped into the corridors of modern medicine as a potential drug side effect, where it is creating a scientific debate as divisive and confounding as any religious clash.
And the shadow is likely to deepen.
After a years-long debate about whether antidepressant drugs like Prozac and Paxil increase the risk of suicide in some people, the Food and Drug Administration in recent days reported that other drugs, including medications used to treat epilepsy, also appear to increase the remote risk of suicide. The agency has been evaluating suicide risk in a variety of medicines, and more such reports — and more headlines — are expected.
Many doctors who treat epilepsy patients said they were bewildered by the recent reports and concerned that regulators were scaring patients away from valuable medications based on limited evidence. On the other side, critics of the agency have charged that the reports were long overdue.
For veterans of the debate over the side effects of drugs, it all had a familiar odor. “Here it...”
--snip--
Not to mention that people who are thinking about it more often talk themselves out of the act, also on a sudden whim. As the G. K. Chesterton poem “A Ballad of Suicide” has it,
But just as all the neighbors — on the wall —Are drawing a long breath to shout “Hurray!”
The strangest whim has seized me ... After all
I think I will not hang myself today.
(Excerpt) Read more at nytimes.com ...
Okay. I'll bite.
5th Century Xtians killed themselves?
Since pschiatric medications are prescribed for those with psychiatric problems, and since those problems are self-reported and necessarily subjective, until such time as we achieve a Vulcan mind-meld, there is no way of knowing how many of those included in the "large body of anecdotal evidence" either did not report suicidal intent and/or would have taken their own lives with or without these medications.
...is it a coincidence that nearly every time we hear about a school shooting or high profile suicide that these medications seem to be involved?
Let's take the last three school shootings:
In the case of the U of Illinois murderer, the story is that he stopped taking his medications. Are you suggesting that if he hadn't taken the medications to begin with, and then stopped them, that he wouldn't have become homicidal? If so, the logic escapes me.
The murder of another student by the 14-year-old in California: no prescription drugs involved.
The V-Tech murderer: not known to have taken any prescription drugs, in spite of the fact that his behavior, over the course of two years, had been so threatening that he was committed by the University administration to an institution for observation, and then released on the strength of a psychiatric evaluation that he "was no threat to others." A judge ordered him into involuntary outpatient treatment, but there is no indication that he complied, as his university health records are shielded by Federal privacy laws. That hasn't obviously stopped many people from conspiracy theories, or flat-out misstatements, that the boogeyman of big pharma is somehow responsible for his satanic behavior.
Although not mentioned, the article was probably triggered by the latest shooting, and our society's current tendency to blame everything and everyone except the person who personifies ultimate evil -- not by suicide, but by cold-blooded homicide. Perhaps if we begin to put the blame where it belongs, and accept that some people actually need to be removed from society to protect others, the discussion would be more productive.
In the case of the U of Illinois murderer, the story is that he stopped taking his medications. Are you suggesting that if he hadn't taken the medications to begin with, and then stopped them, that he wouldn't have become homicidal? If so, the logic escapes me.
I somehow get the impression that you never worked or trained in an emergency room. Am I wrong? Since the arrival of Prozac, selective serotonin re-uptake inhibitors, SSRIs, have been quite a mixed bag. Although they are much cheaper than the usual "talk" therapy from psychologists and psychiatrists, the deliberate downplaying of their adverse effects, especially becoming psychotic with serotonin syndrome after starting therapy or increasing the dose, and the reverse withdrawal phenomena with discontinuation hasn't helped the medical profession, the drug industry or managed care from the insurance industry.
Performing a rigorous epidemiologic assessment of the serotonin syndrome, however, is difficult, since more than 85 percent of physicians are unaware of the serotonin syndrome as a clinical diagnosis. 10 (pdf link to "The Serotoni Syndrome," New England Journal of Medicine, 2005, Vol. 352, No. 11, P. 1112, March 17, 2005, Reference 10: Mackay FJ, Dunn NR, Mann RD. Antidepressants and the serotonin syndrome in general practice. Br J Gen Pract 1999;49: 871-4.)
Although not mentioned, the article was probably triggered by the latest shooting, and our society's current tendency to blame everything and everyone except the person who personifies ultimate evil -- not by suicide, but by cold-blooded homicide.
The article is a week old today. FDA is requiring this data now, possibly because Congress demanded it, IIRC. Big Pharma has been spoon feeding the FDA for decades using the rubric of proprietary information to withhold data from clinical trials that didn't show their new drugs in the best possible light to get FDA approval. It's not just SSRIs, but Vioxx, etc.
See comment# 6.
People with chronic illnesses have higher rates of depression...
People with chronic illnesses have access to more prescription drugs.
Doesn’t necessarily mean that they cause suicidal thought.
People with chronic illnesses have higher rates of depression...
People with chronic illnesses have access to more prescription drugs.
Doesn’t necessarily mean that they cause suicidal thought.
Some people become psychotic, homicidal and suicidal on SSRIs. Read the links in comment# 6, especially the one to "The Serotonin Syndrome" from the NEJM.
However correlation is not the same thing as causation.
There are a million variables. You would have to compare suicide attempt rates prior to SSRI’s for a given population.. You have to stratify for gender.
Men traditionally use fire arms women use more drugs.
You have to compare completed suicides to attempts. SSRI’s came into vogue because the previous generations of antidepressants Tricyclic antidepressants and MonoAmineOxidase Inhibitors were extremely effective at causing death in suicide attempts.
It is profoundly rare for anyone to die on a pure SSRI overdose.
As far as becoming homicidal...How do you stratify for the effects of culture.....
Concurrent with the use of SSRI has been the culture of death...Abortion, euthanasia... loss of religion in schools...all of these things come into play with life being less valuable.
Prior to antidepressants at all there was shock therapy..Drug therapy was a huge improvement over it.
It is easy to blame a drug...just like it’s easy to prescribe a drug inappropriately.
You have no argument from me about them being dispensed a little liberally.
You also have the problem that residential psychiatric centers have largely been shut down...The State hospitals used to house most of the schizophrenics but they have been mainstreamed....
It is not simple and straight forward.. Complex issues do not become more transparent by eliminating pertinent variables.
One variable that became obvious with many of the school shootings was that many of these kids were taking SSRIs alone or in combination with stimulants for ADD/ADHD. If you check many of the stories the SSRI dose was recently increased or just started. It sounds like the black box warning when therapy is started or the dose increased. Read the NEJM article on "The Serotonin Syndrome." IIRC, it mentions that some people have different cytochrome P450 genotypes, and they metabolize SSRIs more slowly than others.
Genetic Markers of Suicidal Ideation Emerging During Citalopram Treatment of Major Depression
Those risks, Healy perceived, included horrific withdrawal symptoms, such as dizziness, anxiety, nightmares, nausea, and constant agitation, that were frightening some users out of ever terminating their regimen—an especially bitter outcome in view of the manufacturers' promise of enhancing self-sufficiency and peace of mind. The key proclaimed advantage of the new serotonin drugs over the early tranquilizers, freedom from dependency, was simply false. Moreover, the companies had to have known they were gambling wildly with public health. As early as 1984, Healy reports, Eli Lilly had in hand the conclusion pronounced by Germany's ministry of health in denying a license to fluoxetine (later Prozac): "Considering the benefit and the risk, we think this preparation totally unsuitable for the treatment of depression."
As for the frequently rocky initial weeks of treatment, a troubling record not just of "suicidality" but of actual suicides and homicides was accumulating in the early 1990s. The drug firms, Healy saw, were distancing themselves from such tragedies by blaming depression itself for major side effects. Handouts for doctors and patients urged them to persist in the face of early emotional turmoil that only proved, they were told, how vigorously the medicine was tackling the ailment. So, too, dependency symptoms during termination were said to be evidence that the long-stifled depression was now reemerging.
The most gripping portions of Let Them Eat Prozac narrate courtroom battles in which Big Pharma's lawyers, parrying negligence suits by the bereaved, took this line of doubletalk to its limit by explaining SSRI-induced stabbings, shootings, and self-hangings by formerly peaceable individuals as manifestations of not-yet-subdued depression. As an expert witness for plaintiffs against SSRI makers in cases involving violent behavior, Healy emphasized that depressives don't commit mayhem. But he also saw that his position would be strengthened if he could cite the results of a drug experiment on undepressed, certifiably normal volunteers. If some of them, too, showed grave disturbance after taking Pfizer's Zoloft—and they did in Healy's test, with long-term consequences that have left him remorseful as well as indignant—then depression was definitively ruled out as the culprit.
Healy suspected that SSRI makers had squirreled away their own awkward findings about drug-provoked derangement in healthy subjects, and he found such evidence after gaining access to Pfizer's clinical trial data on Zoloft. In 2001, however, just when he had begun alerting academic audiences to his forthcoming inquiry, he was abruptly denied a professorship he had already accepted in a distinguished University of Toronto research institute supported by grants from Pfizer. The company hadn't directly intervened; the academics themselves had decided that there was no place on the team for a Zoloft skeptic.
Antidepressants and Violence: Problems at the Interface of Medicine and Law by David Healy*, Andrew Herxheimer, David B. Menkes
Competing Interests: DH has been an expert witness in nine cases involving antidepressants and suicide or violence. He has given views that the antidepressant was unlikely to be involved in approximately 100 further cases. He has been a consultant or speaker for most of the major pharmaceutical companies. AH has been an expert witness in 12 cases involving antidepressants and suicide or violence. He has given views that the antidepressant was unlikely to be involved in approximately two further cases. DBM has been an expert witness in six cases involving antidepressants and suicide or violence. He has given views that the antidepressant was unlikely to be involved in approximately 20 further cases. He has received research support from Roche and Eli Lilly, and has spoken for most of the major pharmaceutical companies.
David Healy has finally seen the light. It's not murder if it is done in a state mandated psychosis.
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