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Dr. Bob is Robert Hsiung, MD,
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Posted by jrbecker76 on September 8, 2007, at 21:40:40
Web address: http://www.sciencedaily.com/releases/2007/09/070907095628.htm
related story:
http://www.nytimes.com/2007/09/07/health/07suicide.html?_r=1&oref=sloginNewer Antidepressants Led To Less, Not More, Teen Suicides
Source: University of South Florida Health
Date: September 7, 2007Science Daily — A new study by researchers at the University of South Florida and University of Illinois suggests FDA mandated warnings about suicide in teens treated with antidepressants could have the unintended consequence of placing more youth at risk.
Despite black box warnings, USF public health researcher finds antidepressants dramatically lower suicide attempts. (Credit: FDA, University of South Florida Health) NaNWhen a possible connection was suggested between teens who take antidepressant medications and a higher suicide rate, Hendricks Brown, professor and director of the Prevention Science and Methodology Group, USF College of Public Health, decided to investigate along with his colleague Robert Gibbons from the University of Illinois at Chicago.Their study appears in the September 2007 issue of the American Journal of Psychiatry, titled "Early Evidence on the Effects of Regulated Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents." The researchers report findings contrary to earlier studies suggesting a link between antidepressants and suicidal thinking and behavior in youth.
"The overall effect of these newer antidepressants is very likely that they reduce suicide risk considerably," Brown said. "Overall, the new antidepressants provide a large protective benefit. If there is any group of people who are adversely affected by taking these antidepressants, it has to be a very small group."
The findings are compelling, especially in view of the FDA's requirement in May for major black-box warnings to be placed on antidepressants for youth and young adults that advise of a potential suicide risk. The warnings, in turn, have led to a marked reduction in antidepressant use in adolescents and adults.
Suicide is the third leading cause of death in adolescents in this country, following only unintentional injuries and homicide. In real numbers, about 30,000 young people take their own lives in America each year.
These overwhelming figures, in addition to his own experiences with families who had lost loved ones to suicide, motivated Brown to devote enormous efforts to the study of teenage suicide prevention.
"People need to know if the antidepressant medication they are taking is increasing or decreasing their risk for suicide," Brown said. "It would be bad if antidepressants were causing an increase in suicides, in which case the appropriate policy would be to restrict their use in adolescents. It would be even worse if FDA policies led to less treatment of depression and more suicides."
Brown and his group examined different statistical approaches that might assess whether a widely used class of antidepressants known as selective serotonin reuptake inhibitors (i.e., Prozac, Zoloft, Paxil, Celexa) were causing more or less suicides in the teenage population.
The analysis was problematic because suicide occurs in one person out of 10,000 youth, but there were only a few thousand youth enrolled in all the clinical trials of antidepressants. And in none of these trials was there a suicide, either among those given an antidepressant, or those given an inactive placebo. There was no ability to compare rates because the number of subjects in the clinical trials was too small.
Given those limitations, Brown used several data sources where depressed individuals were treated differently with different classes of antidepressants or no medication, and he examined the rates of suicide along with the rates of antidepressant prescriptions at the county level. He also looked at the reports of suicide detailed by U.S. doctors after medication use.
Brown found that suicide attempts were dramatically lowered once antidepressant medication began, indicating an overall benefit of these newer medications. Also, very few people who died from suicide had been taking antidepressants.
He also found consistent reductions in suicide across counties as well as across countries during the time when there was increased use of antidepressants. Now that the overall level of antidepressants have decreased since the FDA warnings, there is very early evidence of an upturn in youth suicides.
"With the FDA warnings there has been a rapid lowering of antidepressant prescriptions, and there has been a corresponding increase in youth suicides" noted Brown. "We found similar results in the Netherlands once the warning was broadcast there as well."
Brown said sometimes health policy decisions are made on limited information, and it may be that the FDA warnings about suicide in youth treated with antidepressants could have unintended consequences of placing more youth at risk. The FDA is now reviewing policy decisions in the light of these data and at some point may withdraw or revise its warning.
Brown's other work involves some of the first rigorous evaluations of additional therapies and corresponding successes of teenage suicide prevention, including community-based prevention plans. One such program, Sources of Strength, was developed in North Dakota and appears to be very helpful for rural, under-served communities and Native-American communities.
"There are valuable treatments available and ways that people can cope and thrive with adversity, rather than just survive in this world," Brown said. "There are ways for people who have suicidal thoughts and attempts to get help."
Note: This story has been adapted from a news release issued by University of South Florida Health.
Posted by linkadge on September 8, 2007, at 21:50:01
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
Eh? I'm not sure. People have been trying to heal the black box warning wound for a while.
Just because suicides went up after the reduction in antidepressant use, doesn't mean that antidepressants were reducing suicide.
It could be a negative placebo effect at work, whereby patients precieve the warning has reduced their options (which is has in a way).
So, if I was young and suicidal, hearing that antidepressants might lead to suicide might make me feel more hopless.
So it may not actually the fact that fewer younger people are taking antidepressants that leads to more suicides, more that the preception of the situation leads to more suicides.
Ie.
It could be that antidepressants cause more suicides than placebo, but that both antidepressant and placebo still reduce the rate of suicide. So taking a patient off an antidepressant increases the risk of suicide similar to taking a patient off placebo.
Linkadge
Posted by Phillipa on September 8, 2007, at 21:58:22
In reply to Re: News - Antidepressants Vindicated?, posted by linkadge on September 8, 2007, at 21:50:01
Also said that less adults are taking ad's so what does that mean we're getting smarter? Or that so many people found they just don't work that they are not taking them maybe using alternative treatments. Excercise, diet, therphy? I don't know speculation? Phillipa
Posted by sam123 on September 9, 2007, at 0:43:03
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
Interesting it is a global finding that AD's reduce suicide. The Netherlands saw black box warnings reduce AD use and also saw the rate of suicide go up.
Brown used several data sources where depressed individuals were treated differently with different classes of antidepressants or no medication, and he examined the rates of suicide along with the rates of antidepressant prescriptions at the county level. He also looked at the reports of suicide detailed by U.S. doctors after medication use.
Brown found that suicide attempts were dramatically lowered once antidepressant medication began, indicating an overall benefit of these newer medications. Also, very few people who died from suicide had been taking antidepressants.
He also found consistent reductions in suicide across counties as well as across countries during the time when there was increased use of antidepressants. Now that the overall level of antidepressants have decreased since the FDA warnings, there is very early evidence of an upturn in youth suicides.
"With the FDA warnings there has been a rapid lowering of antidepressant prescriptions, and there has been a corresponding increase in youth suicides" noted Brown. "We found similar results in the Netherlands once the warning was broadcast there as well."
Posted by simcha on September 9, 2007, at 2:01:10
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 0:43:03
This is just logical. Depressed people are more prone to commit suicide. Anti-depressants work for many depressed people. Thus anti-depressants reduce the risk of suicide.
I often get tired of hearing about how "bad" psychopharmacology is. I think that the stigma attached to actually identifying and treating mental illness is our main obstacle to effective treatment. The drugs themselves are tools in our arsenal to help us combat depression and other mental illnesses. Until we as a society start to recognize mental illness as what it is, a serious group of illnesses that can be treated, people will reject treatment because they believe that mental illness doesn't exist, drugs cause illness, and if one is labelled as having a mental illness then one is somehow less of a person.
That's a giant societal problem. Drugs are only one tool in our arsenal. For depression the medicine works best when combined with psychotherapy. This is a fact. And, if you do nothing to treat people (including children) who are suffering from depression you are neglecting them to the increased possibility of suicide.
As a mental health professional I think the black box warnings are detrimental to getting needed treament for people who are depressed. The black box warnings were politically motivated and not based on hard medical science. When will people finally accept that mental illness is like any other illness? When will we as a society force insurance companies and health systems to treat mental illness with parity?
Posted by Riley on September 9, 2007, at 10:13:53
In reply to Re: News - Antidepressants Vindicated?, posted by Phillipa on September 8, 2007, at 21:58:22
> Also said that less adults are taking ad's so what does that mean we're getting smarter?
So, do you imply, by question, adults taking ad's are not as smart?And could you clarify who the "we" are, in your question, that may be getting smarter by not taking ad's?
I'm trying to understand your post.
Posted by Deputy 10derheart on September 9, 2007, at 11:12:35
In reply to Re: News - Antidepressants Vindicated?, posted by Phillipa on September 8, 2007, at 21:58:22
>>Also said that less adults are taking ad's so what does that mean we're getting smarter?
Please be sensitive to the feelings of others (such as those who take ADs) buy not posting anything that could lead them to feel put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
10derHeart, acting as deputy for Dr. Bob
Posted by linkadge on September 9, 2007, at 12:20:58
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 0:43:03
There are a number of different takes. I don't think the notion that antidepressants reduce suicide rate is universal.
http://biopsychiatry.com/suicide.html
Linkadge
Posted by linkadge on September 9, 2007, at 12:21:58
In reply to Re: News - Antidepressants Vindicated?, posted by simcha on September 9, 2007, at 2:01:10
>Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
Placebos work for many people too.
Linkadge
Posted by sam123 on September 9, 2007, at 12:52:27
In reply to Re: News - Antidepressants Vindicated? » Phillipa, posted by Riley on September 9, 2007, at 10:13:53
> > Also said that less adults are taking ad's so what does that mean we're getting smarter?
>
I would like to hear your logic as to how you arrived at this statement. You are skating on thin ice, consider what you say in yout zeel to answer every post.
Posted by sam123 on September 9, 2007, at 12:54:25
In reply to Re: News - Antidepressants Vindicated?, posted by linkadge on September 9, 2007, at 12:21:58
> >Anti-depressants work for many depressed people. >Thus anti-depressants reduce the risk of suicide.
>
> Placebos work for many people too.
>
> LinkadgePerhaps it is that AD's do not work for link, so they cannot work for anyone else ?
Posted by linkadge on September 9, 2007, at 13:43:45
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
I am just playing the devil's advocate here as I often do. There is plenty of literature on the topic of how antidepressants fair in comparison to placebos.
There have been plenty of studies which try to determine the overal effect of the placebo by analyzing previous clinical trials and studies.
You can get an idea of the gravity of the placebo effect by typing in antidepressant + placebo into your favorite search engine.
I am not going to argue that antidepressants don't work, because that is impossble, but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
Linkadge
Posted by linkadge on September 9, 2007, at 13:46:38
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
The black box warning was placed on antidepressant use in kids for two reasons.
1) The possability of increased suicidialty.
2) The general lack of data supporting the
efficacy of antidepressants in children.Trends of suicide go up and down, one cannot form an oppinion so close to the time after the warning was issued.
http://www.mcmanweb.com/FDA_suicide.htm
Linkadge
Posted by linkadge on September 9, 2007, at 13:48:22
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:54:25
http://www.mcmanweb.com/FDA_suicide.htm
>The FDA acted on the strength of a report by its >lead investigator into the drug trials, Andrew >Mosholder MD. The report suggested evidence of >an increased suicide risk in kids based on a >review of 25 pediatric trials, 16 related to >depression. The report also found that only >three in 15 pediatric depression trials had >succeeded, thus putting the issue of benefits vs >risk on the table.
Linkadge
Posted by Larry Hoover on September 9, 2007, at 14:12:13
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
> Web address: http://www.sciencedaily.com/releases/2007/09/070907095628.htm
>
> related story:
> http://www.nytimes.com/2007/09/07/health/07suicide.html?_r=1&oref=slogin
>
> Newer Antidepressants Led To Less, Not More, Teen SuicidesHere's the full-text of the original research:
http://health.usf.edu/nocms/publicaffairs/now/gibbons_ajp_200709.pdfI think the figures are compelling.
Lar
Posted by Phillipa on September 9, 2007, at 17:29:37
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:52:27
Knowledge is power learning leads to new knowledge. That's why and asking questions is how you learn. Phillipa ps every post yields new knowledge to me. Maybe one day that moment of Ahhh that's me exactly will happen as posts seem sometimes to veer off the topic never know where they will lead.
Posted by Phillipa on September 9, 2007, at 17:32:27
In reply to Please be sensitive » Phillipa, posted by Deputy 10derheart on September 9, 2007, at 11:12:35
l0der I also take ad's just trying to learn more. Reworded to mean why are adults taking less antidepressants. Sorry about this. Phillipa
Posted by Phillipa on September 9, 2007, at 17:40:34
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
Reread your thread and looks like you want to concentrate on teens. So sorry about that. As I certainly am no teen. I know my grandson couldn't take them he was knocking boxes all over the stores off the shelves by mistake. So the pdoc did remove him from all medication. But that is only one person. He has defiant personality so maybe don't know ad's do not work for this condition. So for about five years he's med free. Phillipa
Posted by Phillipa on September 9, 2007, at 18:36:31
In reply to Please be sensitive » Phillipa, posted by Deputy 10derheart on September 9, 2007, at 11:12:35
Reread again can't use an I word as I take ad's????Phillipa
Posted by sam123 on September 9, 2007, at 21:57:31
In reply to Re: News - Antidepressants Vindicated? » sam123, posted by linkadge on September 9, 2007, at 13:43:45
>
> I am not going to argue that antidepressants don't work, because that is impossble, but I can argue that placebos work as well as antidepressants in most clinical trials becuase that is fact based.
>And yet in the real world suicide rates for teens and children are at the highest rates in more than a decade during a period where prescribing AD's for this age group declined.
Posted by Schess81 on September 10, 2007, at 0:25:56
In reply to News - Antidepressants Vindicated?, posted by jrbecker76 on September 8, 2007, at 21:40:40
What I have come to believe is that anti-depressants are a brilliant(and maybe even beneficial) way to package and sell the placebo effect; as long as we have a medical establishment that generally believes that these substances have an effect on the biology of depression, the lay person who trusts his doctor will always have a chance to benefit from the drug. Not because the AD actually targets the correct biological source of the depression, but because of his faith in modern medicine hes likely to benefit from a genuine placebo effect regardless.
What I believe Link is simply trying to argue is that if all popular ADs in the world were secretly replaced with sugar pills and no one was aware, the success rates of these pills would continue be the same. (Some comprehensive, impartial studies of big pharmas drug trials seem to imply this)
Now the deal with the black box- less people are taking their ADs; (placebo pills, if you will, for the sake of arguement) Because they are afraid of the suicidal side effects, they miss out on the placebo therapy they might have received had they taken the drugs. In other words, according to the data, it could be argued that the while the ADs might increase suicides in some cases, the incidence of the placebo effect is far greater and is preventing far more suicides.
This is not an argument that Major Depression is not biological or a genetically predisposed condition- it clearly is in my opinion. The question is whether these popular drugs are the result of weak science and biased drug company research, which is also part of what Linkage is trying to debate.
Unfortunately, the pharmaceutical industry may be actually stifling true innovation in the treatment of depression by endlessly developing "me too" drugs who's trials can easily be manipulated to show satisfactory effectiveness. They have been following the same paradigm for the last few decades with no real improvement in drug effectiveness- according to clinical trial data, new drugs are no more effective that the older tricyclics and such. Not only that, but no matter how different the modes of action are on these different drugs, when the trials come out they all seem to perform about the same...
All in all, I guess we are probably better off without the black box labels on our ADs [or prescription placebos- if I can call them that :p]
Posted by sam123 on September 10, 2007, at 0:57:59
In reply to Depends on your point of view, posted by Schess81 on September 10, 2007, at 0:25:56
My personal experience is that AD's are very effective, For me the improvement is dramatic.
Posted by Deputy 10derheart on September 10, 2007, at 1:03:57
In reply to Re: Please be sensitive » Deputy 10derheart, posted by Phillipa on September 9, 2007, at 17:32:27
Posted by Deputy 10derheart on September 10, 2007, at 1:12:53
In reply to Re: Please be sensitive » Deputy 10derheart, posted by Phillipa on September 9, 2007, at 18:36:31
> Reread again can't use an I word as I take ad's????
I'm not sure what you're asking me here, but the issue wasn't so much with making an "I" statement, but with characterizing adults who do/don't take [less] ADs, as smarter, or not smarter.....even if you are including yourself in the group.
Hope that helps. - Deputy 10derHeart
Posted by Deputy 10derheart on September 10, 2007, at 1:28:08
In reply to Re: News - Antidepressants Vindicated?, posted by sam123 on September 9, 2007, at 12:52:27
>>You are skating on thin ice, consider what you say in yout zeel to answer every post.
Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
10derHeart, acting as deputy for Dr. Bob
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