Monday, September 24, 2018

Comments by pfluft

Showing 10 of 10 comments.

  • The evidence is presented (see Link below). However, despite being a systematic review, critical papers that pointed at an increased risk for suicides under antidepressants must have been omitted.
    Furthermore, this is not just any other paper on the topic. It is a major paper, coauthored by high-ranked suicidologists. It has a lot of impact.
    This is why Robert Whitakers review is so necessary!

    https://www.unioviedo.es/psiquiatria/wp-content/uploads/2017/03/Zalsman-Lancet-Psychaitry-2016.pdf

  • Agreed!
    However, see how the evidence is summarized in the Lancet review, coauthored by many high-ranked suicidologists: http://dx.doi.org/10.1016/S2215-0366(16)30030-X
    Quote from the discussion section: “Data support the use of a few pharmacological interventions in suicide prevention. First, antidepressant pharmacotherapy treatment in adults is associated with reduced suicide risk, while initiation of pharmacotherapy does not lead to an exacerbation of suicide risk. In people aged over 75 years with depression, there is a clear benefi cial eff ect of pharmacotherapy on the risk of attempted and completed suicide. In children and adolescents, increased risk of suicidal thoughts has to be taken into account when starting pharmacotherapy for depression. However, given the increased risk of suicide in untreated depression and the absence of an increased risk of suicide associated with pharmacotherapy, currently available evidence does not support the avoidance of initiation and continuation of pharmacotherapy for depression in children and adolescents. Therefore, the ongoing discussion about possible induction of suicidality in minors should not prevent physicians from prescribing SSRIs.”

  • Thanks for pointing out this interesting study. Just noted that the risk is lowest for those without “antidepressant” use at follow up: Hazard Ratio 0.45 (0.32 to 0.62). Moreover, this reduced risk remains (and even gets a little lower) when adjusted for initial depression severity, suicide attempts at baseline etc.: HR = 0.39 (0.28 to 0.55)
    With this adjusted analysis, it is very unlikely that the lower risk is explained by indication bias (i.e., those most at risk are more likely to be prescribed “antidepressants”).

  • Others have written in detail about it (e.g., David Healy, Peter Gotzsche)
    The initiation of antidepressants can lead to dangerous side-effects such as agitation, driving suicidal people towards acting out their suicidal impulses.
    Withdrawing can lead to similar symptoms. And finally, antidepressants may worsen depression in the long-term (as described by Fava and also in Robert Whitakers report on antidepressants on MIA).
    Of course, you wont’t hear such arguments in mainstream psychiatry, but it is well described in the scientific literature.

  • There is of course an association between pain and increased suicide risk. I say “of course”, because anything that makes people suffer is associated with increased suicide risk.
    See here for a review: https://www.ncbi.nlm.nih.gov/pubmed/28847525

    Research in the terminally ill who suffer a lot is very interesting: it is not the pain that is most strongly associated with the wish to die, but it is the feeling of being a burden to others because of being ill, and also the feeling of loosing self-hood (I can search for the related papers if you like).