{"id":53328,"date":"2015-01-17T10:45:21","date_gmt":"2015-01-17T15:45:21","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=53328"},"modified":"2015-01-17T18:42:31","modified_gmt":"2015-01-17T23:42:31","slug":"the-fiction-and-another-thing","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/01\/17\/the-fiction-and-another-thing\/","title":{"rendered":"the fiction – and another thing…"},"content":{"rendered":"
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The Relationship Between Antidepressant Initiation and Suicide Risk<\/a><\/div>\n
Special Reports, Psychopharmacology, Suicide<\/font><\/strong><\/div>\n
Psychiatric Times<\/font><\/strong><\/div>\n
By Robert D. Gibbons, PhD and J. John Mann, MD<\/font><\/strong><\/div>\n
December 31, 2014<\/div>\n
[full text on-line<\/a> with free registration]<\/div>\n

There has been much debate about whether certain classes of medications [eg, antidepressants] increase the risk of suicidal behavior and whether that risk is greater in children, adolescents, and young adults. In 2004, the FDA placed a black box warning on all antidepressants because of concerns that the medications increase risk of suicidal thoughts and behavior in youths; in 2006, the warning was extended to include young adults [up to age 26]. The FDA based its black box warning on results of its meta-analyses of randomized controlled trials [RCTs] conducted in pediatric and adult psychiatric and nonpsychiatric populations. <\/p>\n

Questions regarding a possible relationship between antidepressants and suicide were first raised in 1990 with the publication of a series of case reports in which the then newly introduced SSRIs were associated with the apparent emergence of suicidal thoughts and behavior. This led to FDA hearings in 1991, but no evidence of an increased risk of suicidal acts associated with antidepressants was found. In October 2004, concerns raised over paroxetine use in children and adolescents eventually led the FDA to issue a black box warning regarding antidepressants and suicide for children younger than 18 years…<\/p>\n

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This next report is from the testimony at the first FDA Hearing<\/a> about suicidality with Prozac® held in 1991: <\/div>\n
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… My husband was given Prozac on January 24 of 1990. On the evening of February 8, 1990, he killed himself. I am told his death was instantaneous, but I believe his cleat actually began the moment he took his first dose of Prozac. Before Prozac, my husband was very involved with people, our family, and his work. He was very much in charge of his business. But within days after he started taking Prozac I noticed a personality change in him. He showed sign of restlessness, akathisia, agitation, pacing, and his appearance was very drawn. He developed severe insomnia, extreme fatigue, chills, racing heart, dry mouth, and upset stomach. His hands would shake uncontrollably at times. This really alarmed him. I would ask him what was wrong and his only reply was, "I don’t know, I don’t know."<\/em><\/div>\n<\/blockquote>\n
In the article by Gibbons and Mann above, they talk about "suicidality" as if it’s an isolated phenomenon and address the question of whether it occurs with an increased incidence in depressed people on antidepressants. That’s common in articles that address this issue, but it doesn’t fit with my understanding of the question on the table, either clinically or with the Black Box Warning. What I think this is all about are cases like this one – a patient that develops what this man’s wife is describing [which I know by the term – Akathisia]. It’s another example of a confusion of tongues<\/font><\/strong><\/em> – people talking at each other without clarifying shared meanings.<\/div>\n

My own experience as a low prescriber was that when Prozac®<\/font> first came out, I had a couple of patients who took it for a day or two, then stopped saying, "That stuff made me crazy<\/font><\/em>" and "I was coming out of my skin<\/font><\/em>." I was told by colleagues that it was activating<\/em>, but I stopped prescribing it anyway. Over the years, I had occasional new patients who described the same agita<\/font><\/em> talking about being given an SSRI by someone else before I saw them. The Black Box Warning came after I retired, and I was oblivious. Not long after I started volunteering, I gave Celexa®<\/font> to an adolescent, who had an extreme Akathesia reaction with suicidal thoughts. That’s how I learned about it. Since then, I’ve seen two suicides in other peoples’ cases that I’m sure were SSRI induced, and multiple others with the Akathisia syndrome who immediately stopped the medication and it cleared quickly [I warn all<\/u> patients]. In both suicide cases, the people around them mentioned personality change as part of the picture. <\/p>\n

Here are a couple of concise descriptive references to the SSRI ·<\/strong> Akathisia ·<\/strong> Suicidality<\/font><\/em> connection:<\/div>\n