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Dr. Harold Koplewicz

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Suicide And The Antidepressant Question

Posted: 03/09/10 05:07 PM ET

Over the last month I've read news stories about young adult suicides with alarming regularity. I'm speaking of the children of celebrities, of course, whose lives and deaths are ultimately narrated by journalists. Most recently, Marie Osmond's teenage son, Michael Blosil, leapt to his death from his apartment building in downtown Los Angeles. Imagine what he saw on the ledge, 15 stories up, peering down through the dark at asphalt and concrete, glancing at moving cars and streetlights and lit-up billboards. And imagine the pain he was experiencing to believe that jumping would bring relief. He was only 18. There's a particular arc to these stories of suicide, and while these privileged young lives don't typify the experience of being a teenager in America, the developmental tasks they must accomplish and the brain changes they undergo are typical of depressed teens everywhere.

Michael Blosil's suicide should bring to the fore a number of important points about adolescent depression as well as suicide risk. We often hear that suicide is the third leading cause of death--after accidents and homicide--among teens and young adults between 15 and 24 years of age. What we don't often hear is that over 90 percent of all young people who commit suicide are suffering from severe mental illness. Depression is the leading condition in the suicides of adolescent boys and girls. It's crucial, given these facts, that we directly confront the antidepressant question: Should we prescribe these medications to young people?

The answer, I believe, is absolutely yes--a judgment I stand by with a deep understanding of the counterarguments, and as a physician who does not receive funding from pharmaceutical companies. There are those in the research community, and certainly in social sciences and media, who will argue that the jury is still out on the efficacy of antidepressant medications. There are those who will point to articles in the popular press, of which there have been many lately, and say, "Antidepressants aren't worth the side-effects," or that we're overmedicated as a nation, or that antidepressants themselves can induce thoughts of suicide. There will always be caveats when it comes to starting a treatment course with antidepressants, but as a child and adolescent psychiatrist with nearly three decades' experience at some of our nation's best psychiatric research institutions, I can tell you that the negative messages swirling around antidepressants distort a public health tragedy and impede access to treatments, including antidepressant medications, which can protect against suicide.

When parents are faced with the question of whether to medicate their clinically depressed teen, I offer them these facts:

  • As many as 80 percent of teens suffering from depression can be successfully treated if they seek help from a doctor or therapist. The same holds true for adults, 80 percent of whom will respond to antidepressant medications, either one medication or a combination of two or more.
  • About 40 percent of adolescents with depression do not adequately respond to a first treatment course with an antidepressant medication. Persistence in finding the right medication, or combination of medications, is key to the success of any treatment regimen.
  • There is no gold-standard set of guidelines for clinicians to follow when choosing a treatment course with or without antidepressant medications.
  • Studies that compare antidepressant medications to placebos don't include subjects who are suicidal. Research has shown, however, that antidepressants effectively lift depressions in subjects with the most severe symptoms--the very patients who are most likely to attempt suicide.
  • After 2003, the Centers for Disease Control and Prevention (CDC) reported a sharp increase in the suicide rate for 10-to 19-year-olds. This dramatic increase coincided with a drop in antidepressant prescriptions for teens.

Untreated depression is the number one cause of teen suicide, and while it may be tempting to look the other way or to blame celebrity parents when a young person like Michael Blosil throws himself from his building's 15th story, I encourage you to look at this tragedy straight-on.

Recognize that adolescent angst is part of normal development, but adolescent depression is not: it's a very real illness that, left untreated, is potentially lethal. It requires both parental and medical attention.

Harold S. Koplewicz, M.D.
President, The Child Study Center Foundation, Inc.
Director, Nathan S. Kline Institute for Psychiatric Research
www.cscfound.org

 
 
 

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Over the last month I've read news stories about young adult suicides with alarming regularity. I'm speaking of the children of celebrities, of course, whose lives and deaths are ultimately narrated b...
Over the last month I've read news stories about young adult suicides with alarming regularity. I'm speaking of the children of celebrities, of course, whose lives and deaths are ultimately narrated b...
 
 
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HUFFPOST SUPER USER
Vajara
vajara
11:07 AM on 03/12/2010
The question that is being asked by doctors could also be: Do you have a self care plan to keep you balanced? Physically? Mentally? Emotionally? and Spiritually?

If they don't, help them design one that will support them through a crisis and through their life time. Just giving meds is not enough to help them improve the quality of their lives, health and relatinships.
10:54 AM on 03/12/2010
Antidepressants only work in a limited way. Maybe they can address the problem chemically to some extent, but they cannot address the root of the problem. They are not a solution in themselves and only mask what lies within. Humans are complex beings and unless a holistic approach is taken, the problems are bound to remain.
01:28 PM on 03/12/2010
It's funny you say that. Have you ever suffered from a debilitating mental disorder? If so, I am very happy for you if you are able to control the demons 'holistically'.

If you have never suffered from a mental disorder, then respectfully, you have no idea what you are talking about. Sometimes the 'root of the problem' as you put it, IS a chemical imbalance that the AD's help put back into balance. Are they perfect? No. But sometimes they are a hell of a lot better than the alternative.

If people like you who seem to have all of the answers could know what it's like to live in my brain off of AD's for just one day, then maybe you'd understand. I think that it's you who thinks it's just a simple matter of taking a 'holistic' approach, as though taking some herbs, doing some cardio, and getting some sleep (like that is possible when you are in the grips of the mood disorder) will solve all of your problems. You act as though those of us who are taking AD's haven't tried that, or take AD's in order to sidestep living a healthy lifestyle.

I, for one, take AD's in order to be able to work hard, achieve my physical goals (I participate in endurance sports), and live a healthy lifestyle. It isn't so I can sit on my a** in front of the TV all day and do nothing. I take AD's to avoid that.
01:36 PM on 03/12/2010
::applause::
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Esmeralda Williamson-Noble
Activist, Writer
09:39 PM on 03/26/2010
Dear Bexband, I lost my 20 year old son Andrew to suicide in November. I agree with you.
Although I am taking antidepressants at the moment, I also believe that getting our children (and ourselves) to practice yoga and meditation from is the way to prevent not only mental ilnesses, suicide... but every other dis-ease known to man.

www.foreverinvicuts.com
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inthedesert
Those who never question will fall for anything.
08:21 PM on 03/11/2010
It's been proven that some people have brain chemistries that just make them depressed and unable to cope with day to day living. The SSRIs were designed to help with this problem. Prozac was the first and then Zoloft and now there are probably others out there too. Many people have some kind of problem with taking an antidepressant. I have a friend who should most definitely be on something but he refuses to accept the fact the he is basically a very depressed and profoundly unhappy person.
It's sad. I have taken Zoloft for over 16 years and feel great. YES, I can STILL get sad and depressed over a movie or a book but it's not the overwhelming depression that crippled me socially and emotionally before Zoloft. I give kudos to those people who can "work through" their depression without professional help or meds. I could NOT. Life is just too short to be crippled by depression and dysfunctionalism.
10:46 AM on 03/12/2010
I totally understand. I suffer from severe anxiety that leads to depression, and nothing worked to alleviate it until I started on Effexor XR. After suffering for so long (these issues started in childhood) I was amazed how this drug cut out the worst of the issues so I could actually just function.

After being on it for 6 years I decided to try going off of it. I weaned off of it rather easily, but within six months of being off of it I was right back where I was when I decided to go on it in the first place. No amount of exercise (I was training for a marathon, for goodness sake) or 'healthy eating' could keep the demons at bay. I went back on the Effexor XR, and the severe anxiety and depression decreased again.

Some people need these drugs. And contrary to what many might want to believe, these drugs have helped a lot of people.
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inthedesert
Those who never question will fall for anything.
08:03 PM on 03/11/2010
Any psychiatrist who knows what he's doing and is honest will tell you that he has no idea how you will respond to a particular antidepressant. I did not respond well at all with the first antidepressant I was given about 16 years ago. Then I was given Zoloft at a low dosage(50 mgs)and the change in me was monumental. It was like a dark veil had been lifted from my life. I was more outgoing, had far fewer problems at work and began to like myself and those around me. Of course, I did six months of one on one counseling with the shrink which is very important. I take 100mgs daily now and feel great.
I have gone off the Zoloft a couple of times(which was my own idea)and it was a disaster. Not to be too cliche here but I felt like the Susan Boyle song: I felt like the person I was always supposed to be.
And..it was wonderful.
09:22 AM on 03/11/2010
I had a friend who took Lexapro. It didn't make him feel suicidal but he said it made his emotions off the charts- huge highs and huge lows. Just extreme emotions that led him to attempt suicide. He was in his early 30's then. As soon as he stopped taking Lexopro his mood balanced out.
02:29 AM on 03/11/2010
Anti-depressants are to be used to get the patient over the very worst part of the depression - until the patient is able to moderate their personal life, exercise & diet, to achieve a healthier series of choices and way of being-ness. The Anti-depressants were NEVER designed to be a lifelong addiction. There is a direct link between anti-depressants and suicide in patients who use them longer than a decade.
09:00 AM on 03/11/2010
There is a direct link between depression and suicidal tendencies, period.
04:39 PM on 03/11/2010
Is there really a 'direct link' between AD's and suicide in patients who use them longer than a decade? What is your reasoning behind this theory? Do you have anything to back it up?

I get so sick and tired of people blaming AD's for any issue that someone who already HAD a mood disorder is having. I also get so sick and tired of people speaking for those of us who use AD's as though they know what it's like to be us. Like we are somehow lesser people because we rely on a prescription drug instead of 'moderating our personal life' through 'exercise and diet', as though we don't already eat healthy, exercise, etc.

I have suffered from severe anxiety disorders since I was a child. My parents did nothing to help the issue. They did not want to admit that their child was 'damaged' and I got really good at hiding my problems until I had a serious breakdown in my 20's. I went on AD's after years of trying the exercise, diet, massage and relaxation crap and NOTHING WAS CHANGING! The AD's literally saved my life. They do not make you happy, they do not make everything bad go away. They make it so that you can function normally.

I do not take AD's to avoid having to 'eat healthy and exercise'. I take them so that I CAN eat healthy and exercise. It isn't a convenience thing for me.
11:53 PM on 03/10/2010
what about the people whose lives were saved by these medications?
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09:17 PM on 03/10/2010
Mary Ann walks into my office. As with most of my patients, she brings in a wealth of suffering with her. Her boyfriend drinks and beats her regularly. The money that should go to paying bills goes to alcohol. She sometimes drinks with him because it numbs the fear and worry. Their three small children cower in their rooms. She's one problem away from losing her job because of work she's missed taking care of the kids. She's depressed.

What to do? We spend time going over her situation. She acknowledges not doing so well in High School - college seems a reach. The community she lives in has 40% unemployment - she feels lucky to have the job at the counter at the gas station.

The counselors at the clinic see so many patients that they will be lucky to see her every month. She will be lucky to be able to get together childcare for her children. I will be able to see her for 15 minutes at the next visit.

Guess what's available to her? Prozac. Pretty cheap these days. And to those who have been there - effective. And to make things more complicated - the Prozac will likely get her feeling better enough to stick around "and work it out with him - I know we can." So she stays.

Is this an overmedication problem? Or a social problem? Or a not enough therapy problem?
08:48 AM on 03/11/2010
The problem is when the prescribing doctor does not know very much about the realities of Prozac and is not able to identify strange behaviors & thoughts caused by Prozac and is not aware of how serious the withdrawal effects can be if not titrated very slowly and carefully, and when the patient puts total trust into the doctor as an authority.
04:52 PM on 03/10/2010
end the war on marijuana!
those that use it do not commit suicide!
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09:29 PM on 03/10/2010
Jeff - you're wrong. There are a lot of reasons why marijuana should be legalized - preventing suicide isn't one of them. Plenty of people around hooked on weed - legalizing it doesn't make it non-addictive or damaging - just limits the damage and generates some funds for treating it.
10:33 PM on 03/10/2010
Weed is NOT addictive! And saying it is does not make it so. Sounds like you refrain from acknowledging the damage of insincere treatment also.
12:57 PM on 03/10/2010
Harold S. Koplewicz, M.D. or any other doctors --
Regarding "tell your doctor if you are experiencing suicidal thoughts"
--what happens next?
10:45 PM on 03/10/2010
They sell you some drugs and decide that they don't really want to talk to you.
08:40 AM on 03/11/2010
Well, Doc, it's the drugs that are causing my suicidal thoughts. And withdrawal will make things worse. Now what?
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JayZee
Biofilm Slayer
11:59 AM on 03/10/2010
Most if not all of the drugs prescribed for depression or bi- polar have suicidal and homicidal mania as a side effect....Those drugs also cause drug induced Diabetes.
So even if you are one of the lucky ones who gets a good response from the awful pharmaceuticals, in time, you will still have a messed up sugar metabolism to throw it all off?!?

Study after study proves diet is the problem with children's brains and behavior - add adhd, juvenile delinquents.Study after study after study shows the best way to correct these issues is the "art "of subtraction.Removing unhealthy food from your diet is cheap and EASY."

I'd like to see Dr. K, who believes children should be medicated, forced to take the Feingold diet too.
http://www.feingold.org/

The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 NYC Public Schools
http://www.trifeedmybrain.com/html/images/clinical3.pdf

Dr.K has nice ties.
http://people.forbes.com/profile/harold-s-koplewicz/25699
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Samalabear
10:30 AM on 04/01/2010
The Feingold Diet did amazing things for my son and was working, but then his teachers in school would complain when I would not allow him to have soda, candy or a piece of cake -- that I was depriving him. This was in the 80s. It's comical to read that now school districts are actually trying to ban these sort of foods from the classroom.

Even if you don't follow the Feingold Diet religiously you can get great results. It wasn't easy for me to be able to afford the food you need for this diet at that time. It is much easier now if you know where to shop.

I already discussed my run-in with this "pill" doctor in the comment section of his latest blog. I met him for an evaluation of my son in the early 90s when he was at Long Island Jewish. Someday I am going to create a blog and write every single experience my son went through, including the brief nightmare with this doc. It's just been too painful and I am still recovering from own nightmare experience with Paxil.
11:18 AM on 03/10/2010
Could it be that generational use of alcohol sets the stage for depression in future generations?

What causes people to be born with less of the neurotransmitters than are necessary for a happy life?

These antidepressants in some cases are hooking up to opiate receptor sites. Venlafaxine (Effexor) is similar chemically to tramadol (Ultram) ,a synthetic narcotic. In fact, Ultram is used to help ease the withdrawals from Effexor.

So, if the antidepressants are functioning like opiates, why not just brew a cup of poppy tea from leaves of the papaver somniferum? It couldn't possibly be any worse in the long run than taking the synthetics, and probably easier to stop using.
11:52 PM on 03/10/2010
I appreciate what you are trying to say here but I think you missed the mark. I have been on antidepressents as well as poppy derived opiod narcotics including the tramadol like you mentioned. Being dope sick from opiate withdrawls is 100 times worse than the discontinuation syndrome you get from prozac or zoloft. I would prefer to treat myself with pap sav tea, but I think we all know where that would go.
09:45 AM on 03/11/2010
Everyone is totally different when it comes to how things effect us. Ultram was the hardest thing I ever tapered off from, after having been prescribed it for arthritis. It was during that time that I realized what an effective antidepressant it was. Visited various forums where I read comments by users of Ultram and Effexor, it sounded like people were having a harder time getting off Effexor with worse, longer lasting symptoms. My theory is that people whose ancestors consumed lots of alcohol are the ones with the tendency to depression, through the agency of epigenetic markers. Wish scientists would study that.
11:06 AM on 03/10/2010
The antidepressants can be useful, but long term use seems to bring on other problems, requiring even more drugs. Then there is the addiction factor, which they call "discontinuation syndrome" so they won't have to call it addictive. The letdown back into depression is sometimes way worse than than one that sent you to the doc in the first place, and that letdown depression leads to suicide.
09:03 AM on 03/10/2010
The way most psychiatrists see the solution to teen depression as something that can be cured by medication and not addressing the cognitive behavioral psychology aspects of depression in teens angers me more than most anything going on in medicine today. I was a depressed teen (way back when), and it wasn't until I learned to break the patterns of thinking that kept me in that state of depression - and nothing at all to do with medication -- that I turned my life around. For me (and others who suffered depression when its not a chemical imbalance thing) the act of feeling bad about oneself or feeling depressed in itself becomes a coping mechanism -- its a learned behavior. Since people seem to accept an excuse or give some sympathy when a person is depressed, it seems to give us comfort to resort to negative feelings. I could go on, but I really hope more doctors start doing their own research and stop taking the lazy way out with medication. I know too many people (teens and adults alike) who are stuck emotionally because their doctors won't deal with the underlying psychological problems and focus too much on meds. I'm sure many teens who commit suicide after medication often do so because doctors are usually not addressing the mental needs of the patient, which in some cases may mean a Dr. Phil or Tony Robbins kind of in-your-face approach to snap them out of the spiral of negative thought
10:12 AM on 03/10/2010
Are you at all familiar with DBT or CBT?

They do wonders, and there are many programs available for adolescents.

Dr. Phil and Tony Robbins are only interested in the $$$ they can generate.

Read up on Marsha Linehan.
11:28 PM on 03/09/2010
Don't the Black Box warnings on antidepressants for children and teens say that they may cause suicide? Let's not use these tragedies to sell more drugs which is most likely what these poor kids were already on. I've had a friend kill himself on antidepressants and another ready to before I literally stopped him. So you can say I know first hand the negative power of these drugs.

http://www.ssristories.com/index.php
08:39 AM on 03/10/2010
The black box warnings were put there as just that, a warning, and they are there for a myriad of reasons. The data doesn't back up Sara Bostock's assertions, or yours.
http://www.cdc.gov/violenceprevention/suicide/statistics/trends02.html

That said, Sara and Cecily Bostock's story is tragic.
http://www.pbs.org/newshour/bb/health/jan-june04/depression_5-28.html
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HUFFPOST SUPER USER
JayZee
Biofilm Slayer
12:09 PM on 03/10/2010
Those black box warnings are why these harmful drugs were taken OFF the market for "children" in the more enlightened industrial countries.

Go Team USA!
12:29 PM on 03/11/2010
MNmommy,.. May I suggest , that, you read the September 2004 Congressional Record in regards to the safety and efficacy of antidepressants in the pediatric population, Pharma documents are posted, and testimony was given under oath. Wyeth and GSK the makers of two antidepressants, sent out Dear Healthcare provider letters that specifically state, do not prescribe our antidepressant to anyone under the age of 18, clinical trials have demostrated that these drug increase the risk of violence and suicide, and are not efficacious,.. so the question remains, why is this Dr. advocating the prescribing of these drugs, knowing full well the manufacturers are telling them not to?