{"id":19476,"date":"2012-02-10T09:30:59","date_gmt":"2012-02-10T14:30:59","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=19476"},"modified":"2012-02-11T18:54:16","modified_gmt":"2012-02-11T23:54:16","slug":"sometimes-4","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/10\/sometimes-4\/","title":{"rendered":"sometimes&#8230;"},"content":{"rendered":"\n<p align=\"justify\"><u><strong><a href=\"http:\/\/blogs.psychcentral.com\/my-meds\/2012\/02\/kids-antidepressants-suicide-could-the-stats-cancel-each-other-out\/\" target=\"_blank\"><font color=\"#200020\">Kids, Antidepressants &amp; Suicide: Could The Stats Cancel Each Other Out?<\/font><\/a><\/strong><\/u> is a thoughtful blog post by a person who was apparently really helped by anti-depressant medication as an adolescent. Reading Dr. Gibbons&#8217; article [<a target=\"_blank\" href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/reprint\/archgenpsychiatry.2011.2048\"><u><strong><font color=\"#200020\">Suicidal Thoughts and Behavior With Antidepressant Treatment<\/font><\/strong><\/u><\/a>], she asks, &quot;<em><strong><font color=\"#200020\">Could The Stats Cancel Each Other Out?<\/font><\/strong><\/em>&quot;&nbsp; After reading it, I think that I&#8217;ll weigh on the debate, in spite of saying I wouldn&#8217;t [changing one&#8217;s mind is one of the great prerogatives of human life &#8211; way under-utilized]. <\/p>\n<div align=\"justify\">We have before us a hypothetical kid, an adolescent who is very depressed. We&#8217;ve taken a careful history, looked in all the nooks and crannies for situations that might have something to do with the depression, and we&#8217;ve been unable to find anything we can help them do something about. In fact, we&#8217;ve decided that our hypothetical adolescent is too depressed to even be able to engage in an ongoing exploration of &quot;why&quot; she is depressed as is sometimes the case. Here&#8217;s what we know:<\/div>\n<ul>\n<li>\n<div align=\"justify\">Statistically, antidepressants aren&#8217;t a panacea for depression in adolescents [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\" target=\"_blank\"><font color=\"#200020\">a book review&hellip;<\/font><\/a><\/strong><\/u>, <u><strong><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2011\/07\/22\/tuning-the-quartet\"><font color=\"#200020\">tuning the quartet&hellip;<\/font><\/a><\/strong><\/u>]. <\/div>\n<\/li>\n<li>\n<div align=\"justify\">Sometimes they help [as in the case of Kaitlin, the blogger above].<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Sometimes they don&#8217;t.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">And sometimes, they can cause a real problem &#8211; an akathisia&nbsp; that can be accompanied by violent or suicidal thinking, like in my case in the last post [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\" target=\"_blank\"><font color=\"#200020\">a book review&hellip;<\/font><\/a><\/strong><\/u>]. Even if we haven&#8217;t seen such a case, we know that can happen because there&#8217;s a Warning right there on the package insert provided by the FDA. It says, &quot;<em>Antidepressants increased the risk compared to placebo of suicidal thinking and behavior [suicidality] in children, adolescents, and young adults in short term studies of Major Depressive Disorder [MDD] and other psychiatric disorders.<\/em>&quot; What &quot;<em>increased the risk<\/em>&quot; means is that it sometimes happens &#8211; not always, not frequently, but sometimes.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">We&#8217;ve looked into that risk and we know that the kind of problem that Warning is about occurs early in the treatment with these drugs. It&#8217;s an <a target=\"_blank\" href=\"http:\/\/www.thefreedictionary.com\/idiosyncratic\">idiosyncratic<\/a> reaction to the drugs.<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">So what do we do? We do what doctors have been doing since the dawn of time &#8211; act as informed advisors. We sit down with the patient and the parents and tell them all of what we know. If we can all agree that circumstances are such that our patient can watch herself and be watched carefully and that she wants to give it a shot, we start the antidepressant. If she&#8217;s already dangerously suicidal, she probably needs hospitalization for the drug trial. In any case, we keep a close eye on things, see her frequently. We worry more <font color=\"#200020\"> than usual<\/font>. And we all see what happens [it&#8217;s why we call what we do &quot;practice,&quot; and the people we treat &quot;patients&quot; &#8211; because they have to be just that &#8211; patient]. That&#8217;s not &quot;informed consent&quot; as in &quot;cover your ass&quot; or gratuitous like all those mumbles at the end of television <em>ask-your-doctor<\/em> ads. That&#8217;s just doctoring&nbsp;101.  <\/div>\n<hr width=\"75%\" size=\"1\" \/>\n<div align=\"justify\">So what&#8217;s all the fuss about? Ever since that Warning was issued, it has been attacked:<\/div>\n<ul>\n<li>\n<div align=\"justify\">Dr. Nemeroff et al [<a href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/content\/full\/64\/4\/466\" target=\"_blank\"><u><strong><font color=\"#200020\">Impact of Publicity Concerning Pediatric Suicidality Data on Physician Practice Patterns in the United States<\/font><\/strong><\/u><\/a>]<\/div>\n<\/li>\n<li>\n<div align=\"justify\">the people at the <a target=\"_blank\" href=\"http:\/\/www.sourcewatch.org\/index.php?title=National_Bureau_of_Economic_Research\"><u><strong><font color=\"#200020\">National Bureau of Economic Research<\/font><\/strong><\/u><\/a> [<u><strong><font color=\"#200020\">News coverage of FDA warnings on pediatric antidepressant use and suicidality<\/font><\/strong><\/u>]<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Dr. Libby et al [<a target=\"_blank\" href=\"http:\/\/ajp.psychiatryonline.org\/article.aspx?Volume=164&#038;page=884&#038;journalID=13\"><u><strong><font color=\"#200020\">Decline in Treatment of Pediatric Depression After FDA Advisory on Risk of Suicidality With SSRIs<\/font><\/strong><\/u><\/a>]<\/div>\n<\/li>\n<li>\n<div align=\"justify\">and now Dr. Gibbons with his ninth article related to the topic [<a target=\"_blank\" href=\"http:\/\/archpsyc.ama-assn.org\/cgi\/reprint\/archgenpsychiatry.2011.2048\"><u><strong><font color=\"#200020\">Suicidal Thoughts and Behavior With Antidepressant Treatment<\/font><\/strong><\/u><\/a>].<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">They tried to say that the Warning actually increased adolescent suicide rates, but that allegation didn&#8217;t pan out for them. They point to the fact that the Warning dramatically decreased the prescribing of antidepressants in adolescents, implying that teenagers are being under-treated because doctors are afraid to give the medications. That&#8217;s a hard argument to justify, because it&#8217;s hard to even show efficacy for these drugs in adolescents [<u><strong><a href=\"http:\/\/1boringoldman.com\/index.php\/2012\/02\/09\/a-book-review\" target=\"_blank\"><font color=\"#200020\">a book review&hellip;<\/font><\/a><\/strong><\/u>, <u><strong><a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2011\/07\/22\/tuning-the-quartet\"><font color=\"#200020\">tuning the quartet&hellip;<\/font><\/a><\/strong><\/u>]. But even if it&#8217;s true, that doesn&#8217;t change the fact that &quot;<em>Antidepressants increased the risk compared to placebo of suicidal  thinking and behavior [suicidality] in children, adolescents, and young  adults in short term studies of Major Depressive Disorder [MDD] and other  psychiatric disorders.<\/em>&quot; That&#8217;s simply the truth. I&#8217;ve seen it with my own eyes happen to someone I wrote a prescription for with my own pen. It&#8217;s an unusual <a target=\"_blank\" href=\"http:\/\/www.thefreedictionary.com\/idiosyncratic\">idiosyncratic<\/a> reaction that can be fatal &#8211; one that a lot of doctors didn&#8217;t [and don&#8217;t] know about. If doctors were prescribing antidepressants to adolescents too casually and cut back when warned, good for them. If doctors are afraid to use the medication at all because of the Warning, teach them how to use the medication responsibly [and prove that it works]. But if the real problem is that drug sales are down because of the Warning, that&#8217;s neither a problem for doctors or patients to be involved with.<\/div>\n<p align=\"justify\">So back to Kaitlin&#8217;s question, &quot;<em><strong><font color=\"#200020\">Could The Stats Cancel Each Other Out?<\/font><\/strong><\/em>&quot; &#8211; could the decreased suicidality in patients who respond to the medication equal or even exceed the incidence of suicides caused by reactions to the drugs? If that were the point, we&#8217;d have SSRI dispensers in convenience store bathrooms or packages lining the over-the-counter shelves of our pharmacies. We wouldn&#8217;t need doctors to be involved at all [Depressed? Try Paxil OTC!]. Medical statistics are just that &#8211; statistics. A better approach with real cases is to use medications with a statistical downside only in cases justified by the risk-benefit ratio, and then under circumstances that are appropriately mindful of that risk &#8211; no matter what the frequency. The solution is <u>not<\/u> to keep doctors in the dark about the risk. <\/p>\n<div align=\"justify\">And for completeness, we would be remiss to ignore the conflicts of interest in each of those listed articles, in order &#8211; notoriously industry-tainted KOLs, studies financed by a member of Eli Lilly&#8217;s Board, an industry financed study [again Eli Lilly], and a professional expert witness for Pharmaceutical Companies. On the other side, forces that want to warn doctors and patients alike that sometimes, these drugs can be lethal. This is just not that hard&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Kids, Antidepressants &amp; Suicide: Could The Stats Cancel Each Other Out? is a thoughtful blog post by a person who was apparently really helped by anti-depressant medication as an adolescent. Reading Dr. Gibbons&#8217; article [Suicidal Thoughts and Behavior With Antidepressant Treatment], she asks, &quot;Could The Stats Cancel Each Other Out?&quot;&nbsp; After reading it, I think [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-19476","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19476","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=19476"}],"version-history":[{"count":8,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19476\/revisions"}],"predecessor-version":[{"id":19581,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19476\/revisions\/19581"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=19476"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=19476"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=19476"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}