Anti-depressants increase suicide risk in young adults, FDA warns

December 12, 2006 3:08 PM

Anti-depressants increase suicide risk in young adults, FDA warns. "When results are analyzed by age, it becomes clear that there is an elevated risk for suicidality and suicidal behavior among adults younger than 25 years of age that approaches that seen in the pediatric population." More here and here. This follows the FDA finding that anti-depressants increased the risk of suicide in young children. The FDA now requires manufacturers of anti-depressants to include warnings, and plans to meet on Dec 13 to discuss the findings further.
posted by shivohum (42 comments total)

The August 2006 issue of 'Archives of General Psychiatry' published a study linking anti-depressants with youth suicide.
posted by ericb at 3:16 PM on December 12, 2006

This reporting is completely inadequate. It seems to imply a causal relationship, when the reality is a lot more complex. IANA psychologist, and I'm certainly no fan of drug treatment for depression (unless absolutely necessary) but I'm no stranger to depression or people suffering from it.

It's been discussed here many, many times before that (anecdotally, at least) the majority of suicides are attempted when the person suffering depression feels him or herself to be "on the upswing". When people are mired in a depression, many of them can't find the energy to get dressed and head off to work, let alone plan something as ambitious as a suicide (how? when? where?). It's only when a little energy blows in, whether by dint of drugs or something else, that the risk increases.
posted by psmealey at 3:26 PM on December 12, 2006 [4 favorites]

So people suffering depression so pronounced that they've sought out medication are more likely to commit suicide? Next we'll learn that crutches increase the risk of tripping for amputees.
posted by MaxVonCretin at 3:28 PM on December 12, 2006 [1 favorite]

No, people suffering depression so pronounced that they've sought out and received medication are more likely to commit suicide than people suffering depression so pronounced that they've sought out medication and not received it.
posted by Jairus at 3:41 PM on December 12, 2006 [1 favorite]

Yes, because the anti depressants are letting them regain enough of the energy they need to go through with it. The fatigue is the body's natural defense mechanism for when it doesn't know what it's talking about. I'm getting sleepy.....
posted by IronLizard at 3:43 PM on December 12, 2006

Not to fail to take this with the requisite gravitas, but I'd kill for some paxil right now. MAN I was so happy on that stuff.
posted by bunnycup at 3:56 PM on December 12, 2006

I can see that it could happen on an 'upswing,' but anecdotally, I would not attribute it to an increase in energy as much as that (1) an upswing can be accompanied by a bit of a haunting realization that the upswing isn't necessarily going to last; (2) on an upswing one can have a sense that death ain't so bad, just a part of life after all, and might as well go out happy than sad; and/or (3) when one is accustomed to being depressed and the down-on-the-self patterns that go with it, one might feel that this burst of happiness is somewhat undeserved (because I'm a bum) or unearned (because it's attained artificially).
posted by troybob at 4:07 PM on December 12, 2006

I think it's important that instead of scaremongering against antidepressants (which I'm not accusing anyone specifically of doing) we need to emphasize that in the early stages of antidepressant usage, more observation may be necessary.
posted by callmejay at 4:25 PM on December 12, 2006 [1 favorite]

The irony escapes me.
posted by Smedleyman at 4:29 PM on December 12, 2006

callmejay got it in one.

Of course, don't tell the marketers, or the doctors who write scripts for the pills like they're magic cure-alls.

Don't tell the people who are on them because they feel they need them to get by.

And don't tell that to my friend who just attempted suicide again.

Pills and razorblades. Way to go, headshrinkers.
posted by daq at 4:38 PM on December 12, 2006

Hush now, take your soma like a good little Epsilon Minus.
posted by nightchrome at 4:49 PM on December 12, 2006

Anti-depressants increase suicide risk

That would seem to be the exact opposite of what should have happened.

Snark aside. This kind of thing doesn't really surprise me at all. Sure it could be a coincidence, but when altering the brain chemistry of people who may be unstable already, there are bound to be failures.

Don't get me wrong, people seeking help for their condition, not finding what they need, and thus turning to suicide is a tragedy. But our over-reliance on drugs has led us to this place. Pharmacology is certainly a valuable and useful tool, but our apparent belief that it is some sort of cure all will inevitably lead to more tragedies like this.

Keep an eye on our over-medicated youth for more unfortunate stories like this.
posted by quin at 4:53 PM on December 12, 2006

Or on preview: more or less what daq said.
posted by quin at 4:54 PM on December 12, 2006

I took prozac for a couple years when I was a teenager. From what I can tell, combined with regular therapy, it helped me tremendously.

A few of my friends have had the opposite experience.

I don't think anyone should be making snap judgements. There are so many unknowns here, from the actual effects these drugs have, to the personalities of every individual doctor, to the peculiarities of every patient, that blaming it on one thing or another seems premature.

I think all this article demonstrates is that more investigation is required. Assuming their results weren't the fault of bad statistics though, it seems like the FDA did the right thing here.
posted by Alex404 at 5:18 PM on December 12, 2006

In other news: treating OCD with psilocybin.
posted by homunculus at 5:35 PM on December 12, 2006

The problem is both simple and fairly readily resolved, but it requires a different civilization than the one that exists in the U.S. today.

First, most antidepressants are not prescribed by psychiatrists or mental health professionals. They are prescribed be the lesser-trained (in mental health issues) GPs, family physicians, and ER docs who don't have much training in mental health issues, and in many cases, fail to emphasize the importance (nay, should be *requirement*) of followup with a mental health professional -- both for the meds (a psychiatrist) and for psychotherapy (with a psychologist or other psychotherapist).

Why is this necessary?

Because under proper care and monitoring by people who know what to look for with this stuff, I believe antidepressants can help most people who take them. But that's not how most people get their antidepressants in the U.S.

And why is don't most people get this additional care?

For numerous reasons, but two of the outstanding issues are (outside of the GP not recommending it) (a) there may be insurance issues with significant mental health coverage and followup, since most insurance companies continue to treat mental disorders unequally as all other health issues and so limit coverage and reimbursement of their care; and (b) many people believe a pill is all that is needed to fix the problem. I believe (b) is caused by a combination of many Americans' attitudes toward their own self-care (e.g., "Give me a quick and painless fix, but don't ask me to change anything about my life.") and fairly effective marketing campaigns that convince people that we understand the underlying mechanisms of depression and all they need is a pill to fix them.
posted by docjohn at 5:36 PM on December 12, 2006 [1 favorite]

Three years ago, my 16 year old slightly OCD son, was given Paxil, Prozac, and a couple of other of these wonder drugs, and complained to his doctor about having suicidal thoughts. No history here. Then, he actually attempted it a month or so later, luckily more of a suicide gesture. There was no warning, (to us), just to the doctor. Off drugs, no more suicidal thoughts. The problem was, the drugs prescribed, were not specifically cleared for use in adolescents at the time, due to the fact that preliminary indications seemed to suggest that they did increase risk of suicide in young people. The issue is they have a profoundly different affect on young people than they do on adults, no one knew the effects, yet they were prescribed anyway. So, its hard for me to agree with the notion that the FDA or the doctors did the 'right' thing.

A big part of the problem with mental illness, particularly milder forms, like my son's is that there is no clear risk reward tradeoff. A clinically depressed adult is a different story. The doctors plan was basically 'lets try this and see what happens.' Different drugs, in different combinations and dosages. I didn't feel comfortable about it at the time, but we thought 'hey, they're doctors.' Never again.
posted by sfts2 at 5:40 PM on December 12, 2006

Other wonder drugs included SSRIs
posted by sfts2 at 5:43 PM on December 12, 2006

From docjohn(a) there may be insurance issues with significant mental health coverage and followup...

Absolutely this is the case in the US. There is great pressure from managed care and the insurance industry on psychiatrists to write a script and kick the patient out the door. It's getting harder and harder to get reimbursement for "talk therapy," and it's too expensive for most people to pay out of pocket. You do get the occasional follow-up visit, but a patient that is depressed enough to warrant a prescription for one of these powerful psychoactive medications needs more than occasional visits; this patient needs ongoing help from a mental health professional and close monitoring, and it's just not available for most people anymore.
posted by Mister_A at 6:05 PM on December 12, 2006

I'm wondering if some of this has to do with the limited power and control a young person might have with his/her treatment (i.e. with parents making the decisions or doctors not taking their feelings and perceptions seriously enough.)

Some of these meds make you feel darn weird or uncomfortable the first week or so that you take them. Others don't work that well for particular individuals. As an adult I can dialogue with the doc and choose for myself what and when I take something. A teen might have to deal with a parent saying "no, you have to take this," or "no, you don't need to try something else" etc.

I know that my experience on meds as a young person was totally wretched and horrible. Thank God mom listened to ME even when the doctors did not. As an adult I do just fine but it took time and effort to get me there-something that as an adolescent I might not have been able to accomplish.
posted by konolia at 6:29 PM on December 12, 2006

My wife was on Prozac and Paxil for a while, but stopped taking them because she said it stopped making her feel real feelings.
"I won $500 in the lottery."
"That's nice."
"Your cat got run over by a car."
"That's too bad."
"Your mother was in a car accident."
"She should have been more careful."


I, myself, was on Ritalin from age 7 till 18.
Now I can't feel up or down about really anything.
Now I self-medicate with pot and whiskey.

I get more emotional about the latest Bush Fiasco than I did when my daughter was born. It's probably better this way.
posted by Balisong at 6:43 PM on December 12, 2006

Also, My wife has had several suicide attempts before I met her. Had to call the paramedics, etc. Now she just deals with "mood swings" without medication.
I still haven't cried for 10+ years.
posted by Balisong at 6:45 PM on December 12, 2006 [1 favorite]

hardly new news
posted by caddis at 7:11 PM on December 12, 2006

You're all glib, stop being glib. You don’t know the history of psychiatry. I do.
posted by Pollomacho at 7:53 PM on December 12, 2006

Undiagnosed food allergies are probably the cause of a good deal of mental illness in children.
posted by Burhanistan at 8:00 PM on December 12, 2006

You're all glib, stop being glib. You don’t know the history of psychiatry. I do.

Fuck you, Tom!
posted by ericb at 8:07 PM on December 12, 2006

it's pretty new caddis - Dec. 06.
posted by Mister_A at 8:10 PM on December 12, 2006

But our over-reliance on drugs has led us to this place.

Utter and complete fucking bullshit, that statement. Irrational nonsense. Throwing the baby out with the bath water. Knee-jerk, brainless response, etc. etc. I get so tired of this vapid sentiment coming up any time of mental health drug issue comes up.

Hush now, take your soma like a good little Epsilon Minus.

This one makes me feel saying: fuck right the hell off, you fucking prick.

You are talking about real people, with problems you obviously haven't the slightest fucking clue about. So how's about you just keep your mouth shut?

It's long been a known phenomenon. Seriously depressed people often have trouble getting their shit together, to the point that they can't organize a suicide. Drugs like SSRIs help people get better. BUT, there's a point where the person is still very depressed, yet has gotten back enough of their faculties to organize a suicide attempt.

We've known this for years, and it's not unique to drugs. Many successful suicides come after the depressed person has hit the bottom, and has actually started to get better, for the reason given above, regardless of whether or not they are on an SSRI.

That's why seeing a psych is so important. But folks don't like to do that because they often have to pay for it out of pocket, and then they get to listen to folks like nightchrome tell them their broken or crazy or just proles on soma.
posted by teece at 9:15 PM on December 12, 2006

Yo teece, let's roll that obscenity train back a moment;

But our over-reliance on drugs has led us to this place.

Utter and complete fucking bullshit, that statement. Irrational nonsense.

A good friend not too long ago tried to end himself. He was on about 6 different meds. Interestingly, once he stopped the regiment that was prescribed, his urge to die seemed to fade. It may be circumstantial, but it's real in my world, and that's important to me.

Read what I said again. I'm not against drugs, what I oppose is the blind, useless prescriptions that seem to have taken precedent over discussion and therapy (something you seem t support as well...). See Mister_A, and Balisong's points above. Drugs help. but only when additional therapy is available. The thing is, that extra step seems to be more and more phased out of our attempts to help people. Doctors just seem to want to write a script and move on.

It's not just anti-depressants, it's our attempts to get rid of OCD and hyperactivity. We are drugging our kids with some really powerful stuff that one day could come back to haunt them.

Off the record: Balisong, thanks for sharing your story. I've long enjoyed your comments and I'm sad to see they might have come from a place of pain.

In other words, you may be fucked up, but your my kind of fucked up :)
posted by quin at 11:16 PM on December 12, 2006

seem t = seem to...

ugh.
posted by quin at 11:18 PM on December 12, 2006

Overreliance and overprescription aren't a problem anymore? GREAT! Time to talk to a doctor about my RESTLESS LEG SYNDROME.
posted by mek at 12:08 AM on December 13, 2006

Luvox, the drug taken by Eric Harris, belongs to same class of antidepressants as Prozac, Zoloft and other newer medicines used to treat depression and variety of other psychiatric conditions; psychiatrists say there is no clear evidence linking that class of drugs, selective serotonin reuptake inhibitors, with increased suicide risk. ^{-April 30, 1999}

"I was sitting on a hill outside the school eating lunch with my best friend when Eric Harris came over and started shooting me," Taylor recalled, "I was shot between seven and 13 times. No one really knows the exact number because there were so many bullet tracks. Most of the bullets just went right through me. After I was shot I just lay there, playing dead, and could see others being shot," Taylor recalled.

It has never been revealed if Dylan Klebold was on any legal drugs at the time of the shootings, but an autopsy revealed that Harris was on the psychotropic drug Luvox, a selective serotonin reuptake inhibitor (SSRI).

Taylor's attitude toward the teen who nearly killed him is surprising. He told O’Meara, "I'm suing Solvay because I believe that Eric Harris did what he did because of this drug."

posted by prostyle at 7:23 AM on December 13, 2006

He was on about 6 different meds. [...] I'm not against drugs, what I oppose is the blind, useless prescriptions that seem to have taken precedent over discussion and therapy

Yes, I read what you wrote, quin.

Look at that [...], in which you make a fantastic and ridiculous jump.

On aggregate, psych drugs are not useless, nor are they over-prescribed, nor do they do more harm than good. Those are all fact-free "truthiness" bits that pervade American popular thought.

Health care in America generally sucks, but mental health care in America sucks much worse. The kind of thing you mention, which is pure anecdote and apropos of not much, is attributable to the state of mental health care in America, not some pernicious ever-reliance on psych drug therapies.

The primary problem that some people face has nothing to do with psych drugs: it has to do with very poor access to psych doctors, and patients having to foot the bill themselves, and the still very powerful stigma associated with mental illness that drives patients to GPs.
posted by teece at 7:31 AM on December 13, 2006

The real problem underlying this is that people with depression or other mental health issues should probably be seeing psychologists.

To use a completely horrid analogy, just because your computer is buggy and slow running windows, it doesn't mean that same hardware will be buggy and slow running linux or MacOS. Again, the analogy sucks, but given how little medicine understands the physical nature of thought, perhaps screwing around under the hood isn't the best answer. For example, it turns out that a common side effect of Paxil, a social anxiety drug, is uncontrollable yawning. The side effect isn't drowsiness, just yawning. Now unless medical science can exaplin how the hell yawning and social anxiety are physically connected in the brain to the level of specificity that they could have predicted this side effect before ever testing the drug, maybe doctors should be a bit more judicious about doling it out.

It may suprise people to know that most psychiatrists have little or no training in psychology. They may take a few courses here and there, the way any undergrad might, but they are medical doctors first and foremost and the doctor's approach is to treat things as physical problems.

In my view, the brain is different than anything else because the exact same physical brain is capable of extraordinarily wide swings in mood, thought, emotion, behavior etc. Back to the horrible analogy - the same hardware can run lots of different software.

Psychologists are trained to get you to think about how you think, so you can start to be aware of the things that trigger you to feel certain ways, or for you to recognize what in your past is the root of some behavior or outlook you have now. Basically they solve mental problem by trying to create more mental activity - to create a sort of neutral thrid person perspective of yourself that watches and comments on everything you are doing. You work things out through your own internal dialogue - the psychologist is there to help set up that dialogue.

I am not a mental health professional in any capacity, but my feeling is that if you are taking any one of these drugs and not seeing a psychologist - one who has studied extensively and trained to work on mental problems mentally rather than with drugs - then you are playing with fire.
posted by Pastabagel at 7:55 AM on December 13, 2006

Seriously depressed people often have trouble getting their shit together, to the point that they can't organize a suicide. Drugs like SSRIs help people get better. BUT, there's a point where the person is still very depressed, yet has gotten back enough of their faculties to organize a suicide attempt.

Never having had these problems this struck me as quite insightful. It seems to suggest that for very depressed people, there is an extremely high risk period just after starting the drug whether the patient needs more close monitoring by a shrink until the drug begins to work on the root problem.

No one's posted it, so here you go - the top 500 prescription drugs of 2004. The top ten includes two antidepressants and one anti-schizophrenic (how many schizophrenics are there?) Prozac is not on this list because it was off patent in 2004 and it's previous #2 position was spread out among a number of generics, and thus fell off the list. And those sales figures are for 2004 only, in billions.

I now realize I'm in the wrong line of work.
posted by Pastabagel at 8:09 AM on December 13, 2006

Of course after I post I find the stupid chart.

A comparison of the top ten selling prescription drugs of 1999 with a side by side comparison of the prices of those drugs in the US and elsewhere. Note Prozac.

and before anyone goes off half cocked. Those other countries are single buyer systems - i.e. the govt negotiates the price for that drug, thus they have bargaining power. The reason the drug price is so high here is in part to offset the low price elsewhere. It costs approximately $800 million to bring a new drug to market, but the drugs that do make it to market also have to recover the costs of drug research that failed or didn't get FDA approval. In short, it's complicated.
posted by Pastabagel at 8:15 AM on December 13, 2006

Perhaps my own sordid experience can help weigh in on this discussion. Starting at my first suicide attempt at age 9 until my last at 19 I underwent fairly intense therapy, both talking and drug. During the decade I was diagnosed with bipolar, severe depression, thought/mood/borderline disorders, and a few others; i was medicated with SSRIs, mood stabilizers (the highest dose of lithium allowed), and anti-psychotics. I cant blame my mom since her dad offed himself so she was naturally worried about her son. My last attempt wound me caged in a cruel psych ward against my will until I lied my way out. The last session involved a shrink yelling "You failed! Youre a failure!" effectively ending my stint with therapy. I had one great shrink in those years who taught me a bit about psychological work. The drugs made my swings go from highs and lows to flats and lows. The urges still entered because suicide is more than thought, it is a drive. So now 10 years later, with no therapy, meds or attempts, what happened? I realized I had to do this on my own with psychological work. I view this as a workable method. As regular and rigorous as physical exercise, this involves meditation, hot baths, exercise, admittedly weed, wine, mushrooms and recently ayahuasca which I highly recommend. This "work" simply entails confronting faults, worries, fears etc. until they are seen for what they are: thoughts and moods to be reigned. I don't see this catching on within medical establishments not just because of its un-profitability, but because such psychological work yields independence, creativity and critical thinking, all dangers to a sheepish "support the troops" society. Still, it works for at least one very unstable person. Sure the bell jar descends and no stopping its crushing weight, no lack of hopelessness and pain, but no shortage either of love, laughter and discovery.
posted by sarcasman at 8:46 AM on December 13, 2006 [1 favorite]

Pastabagel- the $800 million figure is substantially inflated, in most case, as the drug companies roll promotional and marketing costs into the cost of "drug development". The other thing that's misleading about this figure are the assumptions behind it - the figure is based on the total cost of development, including research, pre-launch educational/promotional activity, and commercial product launch, for a "blockbuster" brand. Note that most "blockbuster" drugs these days are not first-in-class, nor even best-in-class (see Nexium, or the COX-2 inhibitors for instance); many are developed simply to fill the shoes of products that are going off patent. These drugs are generally deployed in a crowded marketplace, and require huge, expensive studies and huge, expensive ad campaigns, not to mention huge, expensive sales forces, to succeed.

Niche drugs, and drugs that you just don't advertise DTC, like chemotherapies, do not cost as much to develop, for a few reasons -

1. It is easier to get approval for a drug that fills an actual unmet medical need. Many cancer agents are fast-tracked because hey, even if 10% of patients go into remission, that's a "win" in many advanced cancers. Also, oncology studies, particularly for therapies that address the underlying condition, as opposed to symptomatic or palliative treatments, generally require smaller study populations than, say, blockbuster cardio drugs. The bar is higher in trying to get the FDA to approve yet another proton pump inhibitor.

2. You don't have to work as hard to "sell" a physician or patient on a life-saving or life-changing therapy, as you do to sell people on yet another boner pill. Go back to that list of popular drugs. Most of them are not things that people will die without. Even Lipitor - the number needed to treat (NNT) in order to prevent one event is quite high (don't have the figure in front of me now, sorry)- compare this with insulin, where the NNT is one. There are generic statins, but Lipitor is heavily commoditized; people have been convinced that they need Lipitor, not just that they need to lower their blood cholesterol.

Medical research is still expensive, though, and there is no doubt that Pharma companies invest billions in actual R&D - for every approved product there are literally hundreds of dead-end compounds and formulations. I'll even say that Pharma companies deserve to be rewarded for their efforts; but if you look at where most of their effort is going, it's focused on the development of replacements for successful drugs in crowded categories. Physicians and patients are bombarded with messages that new=better, and it ain't always so. More government-sponsored research, starting with head-to-head comparisons of existing drugs, is all I want for Christmas.
posted by Mister_A at 8:50 AM on December 13, 2006

for the record, meds can help at least short term, but without creating pragmatic methods of working through episodes I know personally that eventually the body chemistry adapts, and new doses or drugs become necessary. Psychology has been a concern for great thinkers since the first ape felt the first sense of deep loss. It will be with us until the last ape croaks and daily doping will not be the catch-all. Besides, if mental illness had no evolutionary advantage we'd have done away with it.
posted by sarcasman at 8:53 AM on December 13, 2006

The anti-anti-depressant people are pretty much like the anti-lawyer people--you hate them until you need one, and then you tend to be grateful. Having had probably the best year ever, and optimistic about the next one, I know I am.

Given the popularity of the medications, I don't know why--the same way we would say that obesity and heart problems are the natural result of bad eating and failure to exercise--we can't say that conditions like ADD and depression are a natural response to the trends of increased isolation and sped-up, high-pressure lifestyles. I tend to wonder if it's the people who can breeze through it all relatively unaffected who are really fucked up.
posted by troybob at 9:20 AM on December 13, 2006

A recent best-selling drugs list. Note that there are two atypical antipsychotics in the top ten. These drugs are often prescribed for bipolar disorder and other mood disorders.
posted by Mister_A at 9:21 AM on December 13, 2006

a problem with anti-depressants is that the discussion is from the onset dishonest. All war-on-drugs drugs are bad, all or many meds are good. That isnt honest. And as most people who arent pansies about drugs know, it isn't accurate either. "But a little weed makes me more objective about my problems with less emotional attachment and no shakes, headaches, sweating, heart palpitations, threats of parkinsons..." "No. Marijuana is bad." I had that conversation so many times and never once got an open ear, much less honest discussion. Would that emotional issues were so easily solved with a pill a day, I fear life really shouldn't be worth much.
posted by sarcasman at 10:19 AM on December 13, 2006