Antidepressants Vindicated?
Antidepressant use is declining and youth suicide is rising -- should the linkage between these events be viewed as some huge surprise, as the media now imply in the wake of yesterday's Centers for Disease Control report?
Three years ago I wrote an article for New Republic (it's here, subscription required) arguing that blaming antidepressants for suicides among the young overlooked the central fact that until that year, youth suicide rates had declined during the very period of increased antidepressant use. The article reviewed the theories of why suicide had been declining, concluding, "I'm going to put my money on what seems the most obvious explanation -- the decline in suicide is being caused by increased use of antidepressants."
Perhaps, like vaccines, antidepressants occasionally and tragically backfire, but also like vaccines mainly are boons to public health. I wrote, "Antidepressants help millions of men and women cope with the unhappiness that so often is the human condition; they also probably prevent significant numbers of suicides, while causing small numbers of suicides." I called for a central system of adverse-reaction reporting, so that physicians and psychiatrists could figure out which types of patients were likely to be harmed rather than helped by antidepressants and avoid giving the pills to the risk group, while continuing to extend the benefits of antidepressants to most patients. My New Republic article noted that the U.S. media and litigation systems tend to focus exclusively on occasional harm done when pharmaceuticals backfire, ignoring the benefits achieved in most usage. Finally the piece warned that if, owing to media hype and lawsuits, patients stopped taking antidepressants, or physicians and psychiatrists stopped prescribing them, suicide incidence would likely rise.
So yesterday the Centers for Disease Control reported that the youth suicide rate rose in 2004, latest year for which statistics are available. The rise seems to have begun almost to the moment of an early 2004 Food and Drug Administration warning to physicians that essentially told them to prescribe fewer antidepressants. That is: all the very-poorly-thought through media and legal hysterics against antidepressants backfired by increasing the youth suicide rate. News story after news story of the early 2000s implied that antidepressants were causing suicides without mentioning the headline-spoiling fact that suicides were declining in the United States. "It is possible that antidepressants may increase the risk of suicide in some depressed youngsters but save others from taking their own lives," the New York Times editorializes this morning, as if this were a striking new thought that the paper -- one of many to have run prominent anti-antidepressant stories -- could not possibly have known in the past. Media types refused to consider that antidepressants may on balance be good for the depressed, because this spoiled the preferred holy-cow narrative about the evils of Big Pharma.
Now, it seems, Big Pharma wasn't so evil -- and the Times buries the basic news story on this score on page A22, hoping readers won't notice.
Suicide remains an underreported public-health dilemma -- today more Americans aged 15 to 24 die in gun suicides than gun homicides. Suicide should be openly discussed, in the press and in education, as studies show that open discussion encourages those suffering suicidal ideation to ask for help, and help usually works. (If you're depressed, ask for help -- statistics say there is a two in three chance you will get better.) But it's time for the media, political and litigation systems to have a look in the mirror about antidepressants. People on high horses wanted antidepressant use to decline. Use declined, and suicides rose.
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I may be wrong but it seems that children that contemplate suicide don't do so because they are depressed. They do so for very childish reasons: they do it because they want everybody's attention. Or they wish to punish their parents : "Just wait till I'm dead! You'll all be sorry you were mean to me!". I say this as a person who is on antipressant therapy, and, in addition, who was once a child.
Again, leave us not confound the issue any more than it is. The STAR*D Study was 4,000 people, ages 18-75, over an 8 year period. That doesn't even count the years of international and meta-data studies.
We can discuss research indefinitely, but the fact remains that the talk therapy people are the ones prescribing the medications. It would be counterintuitve and completely illogical for them to do it, if research found it to be of no assistance or detrimental. This includes the recommended practices of the American Psychiatric Association and the American Psychological Association.
Look... I hold no love whatsoever for pharmaceutical companies and insurance companies who are trying their damnedest to convince the general public that depressed or bipolar people (highest risk for suicide) should get a prescription and go home and pull themselves together.
I hold less than no love for practitioners who prescribe psychoactive medications off-label. Which I think you were alluding to.
And I believe it is criminal to dither with the neurotransmitters in the developing brain of a child, except in the most extreme of situations. I am aware, and I believe that Arianna has also posted, that many summer camps for kids have "prescription breaks" after breakfast. Where the kids pick up their ritalin or mood stabilizer for the day.??????
I am not Donald Rumsfeld saying "Ya go to war with the meds ya got, casualties be damned". And I am not doing his stand-up routine on "What we know that we don't know."
The research shows that nobody can predict what will work for any given individual. So they are developing research based methodology to attack on both the chemical and talk fronts. Some people will cure out chemically. Some people will cure out on talk. Many more will cure out the quickest within the bell curve of some balance of the two.
The sad conclusion is about time. The longer it takes, and the more meds and/or talk it takes, the less likely you are to ever recover.
We are talking about children here. There is a balancing of risks. However, over 80% of all antidepressants are prescribed by Family Physicians who are not trained in psychiatry. SSRIs can exacerbate an underlying bipolar condition. I have witnessed children go into a manic state with SSRIs. The clinical experience is not possessed by many of the Family Physicians to do follow up. These medications are dangerous - so is depression - but there is no simple fix unfortunately.
The comments on this are really interesting, and a lot of people are very focused on how the drug may hurt or help, but I've got to say, the base problem is why would our girls rather die than live in our society?
I think it's possible that the loud public arguments about abortion and 'woman's place', saturating the media and also shoved into their faces in 'abstinence education', might have some influence here. Girls that age have a very difficult time with self-image and trying to figure out their role socially.
They are given too many messages that they must reach two opposite goals simultaneously: that they are required to be 'sexy' but chaste; that they are 'responsible' to harness and negate the sex drives of the males around them and that they must keep the man 'happy' so they can 'hold on to him'; that good grades are very important so they can go to college but that they shouldn't outshine and embarrass the boys; that their only important goal in life is to be a mother but that if they get pregnant too soon they are 'promiscuous' and don't 'deserve' to be a mother.
Looking forward a lifetime of this kind of cognitive dissonance, it's a wonder more of them don't kill themselves.
I, for the first time, agree with something on Huffington. Greg Easterbrook is absolutely correct. In the past, the plaintiffs' bar has demonized a drug or other therapy, by suing over some rarely occurring negative reaction. The basis should be the ration of negativity to the number times used. Antidepressants have saved my life. Yet, if the FDA had listened to the Tom Cruises or John Edwards of the world, I would probably be dead, because antidepressants would have been pulled off the market. And you people on the left who agree with the opinions expressed here would have no one to set you straight. The "suers" of the world and the crowd that want perfection, have to realize that the more people helped, the better. Let's not forget, John Edwards became rich, suing over injuries, using junk science. Much as he uses junk economics.
Bach Flower Remedies can work for depression and other mental maladies
CharlesMac says "The best facts we have based on solid research show that medications help some. Talk therapy and vigilance by a qualified professional helps some. The combination of the two works best." The combination worked best in short term studies of 8 to 12 weeks just in the window when medication does work at its best; the best long term outcome has actually been demonstrated to be talk therapy alone -- least relapse and rebound. These medications cause dependency and create difficult withdrawal (or discontinuation as the drug companies like to call it) that is often far worse than any initial mood problems. And antidepressants have been demonstrated to induce so called de novo suicidal ideation, that is suicidal thinking in people who have never had it before and even in those who are diagnosed with something far different than depression. Remember these drugs are handed out for all sorts of crazy issues (no pun intended). The fact is hundreds of people are dying on antidepressants who would NOT be dying otherwise. I promise you I have been witness to scores of examples in my work as a drug awareness advocate. On this basis alone I think black box warnings are very well placed and should in fact be extended to all ages.
ALL I know is that when I started taking
antidepressants I had this sudden attraction
for wine. I also remember reading that the side
effects of antidepressants was sexual
dysfunction estimated to be in 1% to 3% of
males. The actual figures turned out to be much, much higher. Lilly deliberately low balled
that key stat. None of the many anti-d drugs
worked on me. All they did was exchange a low grade depression for a low grade fog.
Ileana Arias at CDC. "One of the things that I think is important is for all of us to recognize, what we know on the basis of the science that is available. Suicide is a multi dimensional and complex problem. As much as we would like to attribute suicide to any single source, so that we can fix it quickly, unfortunately, we can′t do that. And so while things such as antidepressant medication may have a role in either ideation or actual fatal suicide, probably is not the only factor".
I genuinely appreciate the intention of this post. Heaven knows all of the ways hope has been denied to the mentally ill.
It remains that the same type of vague and statistically inconclusive research which started the blackbox warnings may provide the same type of unsupported conclusions for opposition.
It's too complicated to assess.
The best facts we have based on solid research show that medications help some. Talk therapy and vigilance by a qualified professional helps some. The combination of the two works best.
Which brings me to the big point... proper treatment for mental illness is nowhere near as accessible as it is for physical afflictions. The absence of treatment for PTSD of the soldiers lays in bold relief the symptom of the horrific problem.
Simply put, we do not want to have to pay for "those people" in our insurance premiums.
And the mentally ill have no way of protecting themselves. It amounts to politico/economic Social Darwinism. The bill for Parity has languished in Committee for 8 years.
Mental illness treatments are capped annually. Imagine if a diabetic had an annual cap for 300 days of insulin. Lifetime caps in insurance are also punitive. Equivalent to a gall bladder and appendix operation. Then no more surgery?
Because there is poor compensation to care providers, the first thing to be rolled back in any economic driven hosptal/pa
Closings have reached record proportions since 2001.
Let's talk about the real problem.
I totally disagree!
Anyone who has seen a lot of things in life has seen the WHIP LASH EFFECT.
Kids started using drug then kids start dieing.
FDA isses warnings some kids stop but kids still dieing.
FDA issues stronger warning more stop but kids keep dieing.
FDA makes it a priority and kids stop taking it more and more stop but kids keep dieing.
Suddenly drug is not to blame.
Kids who died did take the drug.
Kids minds screwed up from drug is my thoughts.
When kids are off the drugs for 5 years then we will know not before then.
But the profit machine won't wait 5 years will it?
Great Article Gregg Easterbrook. I always love to come across these kinds of articles here. It is such a great break from the political insanity we are experiencing these days.
But it is also involved with it. We shape culture, culture shapes us. and back and forth. Depression may not only be caused by tweaked blood chemistry, but chemistry can be tweaked by Depression, which is tweaked by the culture either micro or macro, and now that there is more and more depression (and addiction) how will that be shaping the culture which will then shape those who live in it.
I just thought of mr.bush and his alcoholism which has never been treated. Alcoholism
wow wee, pretty scary.
I'm too tired to tie all that up in something coherent. Anyway, if he isn't coherent how am I supposed to be when talking about him? This whole area is very fascinating.
Thanks for the article.
I look forward to reading more.
I wonder if I really understand this post properly but I think Mr. Easterbrook is saying -- so it's okay for a few hundred people to kill themselves on these drugs as long as a few million others are taking them and benefiting (although please note the criteria by which they are benefiting are very subjectively assessed). As someone who lost a loved one to an antidepressant induced suicide I think that's a lousy justification for all those lost lives. There are other ways to heal depression besides taking an antidepressant and it really is not clear that antidepressants provide long term benefit in any case. Doesn't the Hippocratic oath say "First do no harm"? It is not at all clear that the increase in suicide is really due to fewer people being "treated" especially with antidepressants. Didn't we just have a news report a few days ago that there has been a 40x increase in the diagnosis and treatment of bipolar in the past few years in children? And stimulant use is up by some exponential amount. The treatments for bipolar, atypical antipsychotics, in particular, and stimulants have both been associated with suicide inducing behaviors. No one should naively rule these trends out and focus all the spotlight on a slight decline in antidepressant usage in some age groups which don't even correlate with the groups which are showing an increase in suicide. We don't even know for sure what percentage of these suicides were in fact treated and medicated before they died. Whether or not antidepressant usage is going down in children and teens, it is clear that overall psych med use is soaring. I say the increase in suicide correlates quite precisely with the exponential growth in off label use of antipsychotics in innocent children.
Have you people learned nothing from the bush admin? The lessons we learned from 9/11 is that it isn't important anymore how many Americans die. It's important that those living are fearful and nonaggressive. Are you afraid?Remember 9/11 and everything makes sense. I haven't caught a trophy trout since 9/11. That's good enough for me to give up my rights.
Where are the worldwide numbers? Or are only american kids suffering with this disease?
Or is there something wrong with this country?
Just as some people have pancreas problems, others have brain problems. Some therapies for the pancreas involve changing the environment, some are pharmaceutical; the same with the brain.
Why we insist on locating the brain somewhere outside the body is a mystery to me.
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