1 Boring Old Man

Antidepressant medication prevents suicide in depression
^{by Isacsson G, Reutfors J, Papadopoulos FC, Ösby U, and Ahlner J.}
Acta Psychiatrica Scandanavica. 2010 122[6]:454-460.

^{OBJECTIVE: Ecological studies have demonstrated a substantial decrease in suicide in parallel with an increasing use of antidepressants. To investigate on the individual level the hypothesis that antidepressant medication was a causal factor.}

^{METHOD: Data on the toxicological detection of antidepressants in 18,922 suicides in Sweden 1992-2003 were linked to registers of psychiatric hospitalization as well as registers with sociodemographic data.}

^{RESULTS: The probability for the toxicological detection of an antidepressant was lowest in the non-suicide controls, higher in suicides, and even higher in suicides that had been psychiatric in-patients but excluding those who had been in-patients for the treatment of depression.}

^{CONCLUSION: The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.}

[IN DEBATE] The increased use of antidepressants has contributed to the worldwide reduction in suicide rates.
^{with Isacsson G, Rich CL, Jureidini J, and Raven M.}
British Journal of Psychiatry. 2010 196(6):429-433.

^{Numerous ecological studies have shown an inverse association between antidepressant use and suicide rates and a smaller number of individual-based studies have shown an association between current antidepressant use and reduced suicide risk. Such evidence is often cited in support of the notion that antidepressants prevent suicide. However, more recently, the premises underlying this proposition, namely that suicide is caused by depression and that antidepressants relieve depression, have been challenged and the potential harm caused by antidepressants has been highlighted. In this article, Goran Isacsson and Charles Rich debate with Jon Jureidini and Melissa Raven the notion that the increased use of antidepressants has contributed to the worldwide reduction in suicide rates.}

Retraction notice. "Antidepressant medication prevents suicide in depression"
^{Retraction of Isacsson G, Reutfors J, Papadopoulos FC, Ösby U, and Ahlner J.
in Acta Psychiatrica Scandanavica. 2010 122[6]:454-460.}
Acta Psychiatrica Scandanavica. 2012 125[5]:419.

^{At the request of the authors and in agreement with the Editor-in-Chief and Wiley-Blackwell, the following article “Antidepressant medication prevents suicide in depression”. Acta Psychiatr Scand 2010;122:454–460 has been retracted. The retraction has been requested and agreed due to unintentional errors in the analysis of the data presented.}

Authors retract paper claiming antidepressants prevent suicide
Retraction Watch
by ivanoransky
March 19, 2012

^{…The original paper linked “data on the toxicological detection of antidepressants in 18,922 suicides in Sweden 1992–2003″ to “registers of psychiatric hospitalization as well as registers with sociodemographic data.” It found:}

^{The probability for the toxicological detection of an antidepressant was lowest in the non-suicide controls, higher in suicides, and even higher in suicides that had been psychiatric in-patients but excluding those who had been in-patients for the treatment of depression.}

^{Its conclusion was a bit convoluted:}

^{The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.}

^{The paper has been cited just four times, according to Thomson Scientific’s Web of Knowledge. But we understand that other  studies by lead author Goran Isacsson are often used by those who support the idea that antidepressants cut down on suicides, and as evidence that the FDA’s “black box warning” on antidepressants should be rewritten… We’ve contacted Isacsson as well as the editor of Acta Psychiatrica Scandinavica to find out what the “unintentional errors” were, and whether any other papers will be affected, and will update with anything we find out.}

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^{Update, 11:45 a.m. Eastern, 3/19/12: Isacsson tells us:}

^{We discovered lately that there was a coding error regarding diagnoses in the database we utilized for the 2010 paper. When corrected, antidepressants were detected in depressed suicides as often as could be expected and  not less than expected which was the crucial finding in the paper. This means that no conclusion can be drawn from the study regarding antidepressants’ effects on suicide risk in any direction. The database has not been used for other studies so no other papers are affected.}
^{Hat tip: Bernard Carroll}

Psychiatrist Goran Isacsson withheld and destroyed unwanted research data about antidepressants and suicide
by Janne Larsson
January 3, 2013

^{The article “Antidepressant medication prevents suicide in depression” was retraced by the journal Acta Psychiatrica Scandinavica in March 2012. The reason for the retraction was said to be “unintentional errors in the analysis of the data presented”. But what was wrong and what were the correct data in the study? Well, it took a five month legal process to force the author psychiatrist Goran Isacsson and Karolinska Institutet in Stockholm to release the correct data about antidepressants and suicide. It went like this:}

^{Goran Isacsson built his seven pages long article from 2010 on his finding that “only” 15.2% of a group of 1077 persons who had been admitted for psychiatric care for depression had measurable amounts of antidepressants in their blood at the time of suicide. Isacsson compared this figure with the percentage of antidepressants in suicides in other patient groups, which was around 35%. In the article he concluded: “The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.”}

^{The article was filled with speculations and assumptions, and as in all his other papers Isacsson came to the conclusion that antidepressants protected against suicide – despite everything that has emerged in clinical trials about these drugs causing suicidal behavior. Isacsson’s findings from 2010 were widely published in Swedish newspapers, with headlines like “Antidepressants prevent suicide” (Dagens Nyheter), where it was said: “He [Isacsson] means that many become provoked to hear that depression is a deadly disease and that suicides can be prevented with medicines”. And, said Isacsson: “Therefore, it is important to show that antidepressants actually prevent suicide.”}

^{In June 2012 I made an FOI request to Karolinska Institutet (where Isacsson is working) to get the corrected figures in this research project. I specifically wanted to get the document containing the correct percentage of antidepressants for those “who committed suicide and who had previously been treated at a psychiatric clinic for depression” (the earlier mentioned group of 1077 persons). The answer from Karolinska Institutet: This is confidential information, no data can be released. It took a five month legal process to get access to the correct data. During this whole process Karolinska Institutet claimed that all the data in this research project were confidential. In a final statement to the court, after having to answer specific questions, Karolinska Institutet stated that the correct figures did not exist at the time of the FOI-request – remember that they were said to be confidential at the time – but that the correct figures now had been produced. Karolinska Institutet stated to the court: ”that information has now been produced … The result shows that ‘the correct percentage’ is 56, meaning that of the persons who had been treated for depression in psychiatric care in the last five years before suicide, 56% had antidepressants in their blood when they committed suicide.” So finally we got to know that the 15.2% in actual fact was 56% – an increase of 268% (from 164 persons to 603).}

^{We had a seven pages long scientific article, with great impact in media, where doctors and the public got the message that antidepressants protect against suicide – an article built on Isacsson’s faulty finding that only 15.2% in the group had antidepressants in their blood when they committed suicide. And so the correct data, which completely defeated Isacsson’s speculations and conclusions in the original article, “published” in a short statement to the court in Stockholm, where no doctor, no patient and no other researcher could find it. But still, the data were produced – again. The correct figure, 56%, was of course produced before, and was the very reason the original article (with 15.2%) had to be retracted. It was after that, by Isacsson and Karolinska Institutet, said not to exist, and emerged again in the statement to the court. So I reasoned: If it now was produced – again – it must of course exist in documented form in the research material at Karolinska Institutet. I made a new FOI request to get that document with the correct data (which could not possibly this time be rejected with bizarre arguments about confidentiality).}

^{And so we come to the end of this story when Karolinska Institutet through its lawyer and with a statement from Goran Isacsson, says: “I have now been told by Goran Isacsson that a document showing the corrected fact 56% is not made up at Karolinska Institutet … The data were produced owing to the request from the Administrative Court of Appeal and are not saved in any document. As the requested documents do not exist at Karolinska Institutet they cannot be released.” As shown above, those for Goran Isacsson very unwanted research findings have not been published anywhere – and what is worse: crucial data on the relationship between antidepressants and suicide have been destroyed (disappeared) from the research material. No other researchers can request a document from Goran Isacsson’s research material in which the correct data about the relationship between antidepressants and suicide (in the above described group) can be found. And this for the simple reason that there is no such document “saved” at the Swedish Medical University Karolinska Institutet.}