![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Phillipa on June 22, 2008, at 20:27:12
Was driving today a few hours away to buy more product for ebay business a radio show was on Sponsored by Duke University I think as It's in the area and they mentioned Duke. But they the radio said the FDA feels meds used as seizure meds may lead to suicide. Anyone else hear this? Also they said Fish Oil, Flax seed Oil great for preventing macular degeneration. Thought it intersting just wondered if any one else has heard this? They mentioned lamictal, Tegretol, and Depakote. Now this was to prevent seizures so probably high dose? Any info? Phillipa
Posted by dbc on June 22, 2008, at 20:43:04
In reply to FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by Phillipa on June 22, 2008, at 20:27:12
I think theres a suicide warning on all the mood stabilizers that are also seizure drugs like lamictal.
Posted by Phillipa on June 22, 2008, at 20:47:51
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic, posted by dbc on June 22, 2008, at 20:43:04
Wonder why they made a big deal about it like a new finding???? Interesting and thanks. Phillipa
Posted by Mc Comfortable on June 23, 2008, at 8:20:20
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic » dbc, posted by Phillipa on June 22, 2008, at 20:47:51
There is much cross-over in psych and neuro meds it stands to reason we will hear more and more warnings like this. I think it's more due to the patient population that's taking the meds.
The media appears to act like suicide was invented by meds. It was around long before. As a society, we seems to love hearing about the messy side of things - and grants are handed out to prove it in evidence based studies. I am of the opinion if meds are potent enough to have an upside, they will have a downside as well for some. I think, in light of the black box warning policy, we are beginning to find not treating mental illness ALSO can cause suicide.
Posted by blueboy on June 23, 2008, at 9:52:33
In reply to Re: FDA SAYs » Phillipa, posted by Mc Comfortable on June 23, 2008, at 8:20:20
> There is much cross-over in psych and neuro meds it stands to reason we will hear more and more warnings like this. I think it's more due to the patient population that's taking the meds.
>
> The media appears to act like suicide was invented by meds. [...]we are beginning to find not treating mental illness ALSO can cause suicide.Ain't that the truth, LOL?
I had a pdoc who told me that suicide in depressives most often occurs when the person begins to feel better. Basically, they get enough energy to do something about it! That is one possible explanation for the "suicide risk" posed by AD's that official sources seem to ignore.
I don't believe the simplistic claim that AD's "cause" suicide just because some people (especially teenagers) start taking SSRI medication, then commit suicide. For one thing, it sounds like a "post hoc ergo prompter hoc" problem. Also, there's the matter of drug co's being worried about lawyers jumping in, before anyone knows what's really going on.
However, there is an inherent problem if a doctor sees a depressed teenager for 10 minutes, gives him a bottle of Prozac or whatever, and says "come back in three weeks". A black box warning isn't going to help in that case. What is needed is a better standard of care so that the patient receives monitoring and counseling.
They need to start treating depression in teenagers and young adults like what it is: A life-threatening illness.
Posted by Mc Comfortable on June 23, 2008, at 10:23:28
In reply to Re: FDA SAYs, posted by blueboy on June 23, 2008, at 9:52:33
I agree.
I think we've figured out these meds tends to act on the motor part of the equation before the cognitive changes kick in.
I certainly think there is a case to be made for over-medication or improper medicating without proper followup but I also find a case for doing a disservice to some regarding withholding treatment options.
Posted by linkadge on June 23, 2008, at 13:15:20
In reply to Re: FDA SAYs, posted by blueboy on June 23, 2008, at 9:52:33
I will break with the flow and argue that some of these medications actually do increase the risk of suicide.
There is the convenient hypothesis that these meds just "give the patient the energy" before actually reducing their depression. I don't buy this, especially when it comes to anticonvulsants as they generally lower drive and energy.
Why is it not possable for these meds to increase suicide? Just because a med is called an "antidepressant" or a "mood stabilizer" doesn't mean it needs to live up to its title. And besides, how did it get the title in the first place? From data! If data is capable of supporting the safety of a drug, then it should be equally capable of questioning the safety of a drug. If the data starts uncovering new facts about a drug, why would we not listen?
Data comparisons of lithium to depakote for instance, show that lithium has clear antisuicide effects while depakote apears to increase suicide slightly.
Most of the anticonvulsants are essentially function like benzodiazapines with much less abuse potential. The benzodiazapines have been shown to increase the risk of suicide especially in the depressed patient population. The anticonvulsants are great for mania but it is well known they do little for depression.
Many of the anticonvulsants are slightly neurotoxic, they tend to decrease hippocampal neurogenesis and decrease stem cell proliferation. They also interfere with important mood regulating nutrients like folic acid.
Keep in mind that a number of these studies are controlled too. Its not just some researcher comparing a group of psychiatric patients on a drug to health controls (of course that would show a higher suicide rate). So, the argument "the patients are ill, its not the drugs" may not be correct. Instead, the studies generally compare equally sick psychiatric patients assigned to the active drug and a placebo. If this type of study shows that the active drug increases suicidal tendancies, then it might be a good idea to listen.
Just my 2 cents worth.
Linkadge
Posted by linkadge on June 23, 2008, at 13:20:07
In reply to Re: FDA SAYs » blueboy, posted by Mc Comfortable on June 23, 2008, at 10:23:28
>I think we've figured out these meds tends to >act on the motor part of the equation before the >cognitive changes kick in.
Keep in mind that this is just a theory.
Also, keep in mind some of the more controversial studies done by David Healy. He showed that you could make *healthy controls* experience extreme akathesia and thoughts of suicide by administering SSRI medications!! BTW Healy is not against psychiatric medications.
Linkadge
Posted by Mc Comfortable on June 23, 2008, at 14:03:19
In reply to Re: FDA SAYs, posted by linkadge on June 23, 2008, at 13:20:07
> >I think we've figured out these meds tends to >act on the motor part of the equation before the >cognitive changes kick in.
>
> Keep in mind that this is just a theory.
>So is what most of you have posted.
I long lost the desire to take you on. You are entitled to your feelings as others are to theirs.
Posted by linkadge on June 23, 2008, at 15:13:52
In reply to Re: FDA SAYs » linkadge, posted by Mc Comfortable on June 23, 2008, at 14:03:19
>So is what most of you have posted.
>I long lost the desire to take you on. You are >entitled to your feelings as others are to >theirs.
Hey, I agree with that. The FDA's decsion to put the black box suicide warning on SSRI's was based on data however. Should they decide to do the same with the anticonvulsants (or maybe they have already) it will be based on trial data too.
There has been no proven antisuicide effect of SSRI's or any antidepressant for that matter. The only two drugs that have well established antisuicide effect are clozapine and lithium. Its unfortunate, but true.
Linkadge
Posted by dbc on June 23, 2008, at 17:12:02
In reply to Re: FDA SAYs, posted by linkadge on June 23, 2008, at 15:13:52
Downregulation of glutamate is going to cause lower levels of catechlomines which in turn will lead to worse depression in some individuals. You have to also keep in mind the the target audience for mood stabilizers arent stable or they wouldnt need to be on the drug.
Posted by bleauberry on June 23, 2008, at 18:41:05
In reply to FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by Phillipa on June 22, 2008, at 20:27:12
Psych meds can make someone feel so bad they kill themselves. Pretty simple concept. It is no more complicated than that. No academic arguments or explanations need attempt.
I believe this because I have been there done that. Those outside the box who try to second guess it, or figure it, or pose an explanation, have never been there.
Worse than just feeling so absolutely bad and hopeless, the drugs twist the mind's logic enough that the present state of disaster feels as real as a grenade and as permanent as the moon. Just as alcohol will remove inhibitions, morphine will remove pain, the wrong psych drug for a person will remove hope. Recovery from the present dark torturous dungeon does not seem ever possible. It is forever. Death is better. Even Hell would have to be better than this. That is the pattern of thinking the drugs can do.
Thankfully the outcomes are generally not that bad. Thankfully the drugs actually improve millions of lives. I have not statistics, but my best guess is maybe 1% kill rate on any psych med, many of them under-reported or blamed on something else. I am here to say it was not the newfound energy, it was not side effects, it was not a change in life's environment, it was a direct effect of how that drug severely impacted that person's emotions and rationale. It is an extreme example of reality to a saying we hear at pbabble all the time..."Mileage Varies".
Posted by Mc Comfortable on June 23, 2008, at 18:59:57
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic » dbc, posted by Phillipa on June 22, 2008, at 20:47:51
> Wonder why they made a big deal about it like a new finding???? Interesting and thanks. Phillipa
The FDA posted the findings 01/31/2008
Posted by Phillipa on June 23, 2008, at 19:37:30
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic » Phillipa, posted by Mc Comfortable on June 23, 2008, at 18:59:57
Thanks. Now that same program stated that fish oil or flax seed oil helped depression so the FDA is maybe seeing improvements with supplements. Deplin is one of the med/foods that that FDA recently approved. Interesting. Phillipa
Posted by dbc on June 23, 2008, at 19:48:44
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic » Phillipa, posted by Mc Comfortable on June 23, 2008, at 18:59:57
> The FDA posted the findings 01/31/2008
Why are they suddenly reposting it though? This has been known for years. Benzos and mood stabilizers increase suicidal ideation in some people.
Posted by Mc Comfortable on June 23, 2008, at 20:28:52
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic, posted by dbc on June 23, 2008, at 19:48:44
> > The FDA posted the findings 01/31/2008
>
> Why are they suddenly reposting it though? This has been known for years. Benzos and mood stabilizers increase suicidal ideation in some people.
>
>
>I don't really know but there is usually a catalyst. Generally it comes out of consumer advocacy hearings or re-hearings or litigation findings.
As an aside but highlighting how stuff is with the FDA, the FDA was petitioned two years ago to ban Darvon and Darvocet (propoxyphene) by a consumer advocacy group - I'm waiting to hear how that one will go and if that will hit the media circuit. That painkiller has been around forever.
Posted by linkadge on June 23, 2008, at 20:30:00
In reply to Re: FDA SAYs, posted by dbc on June 23, 2008, at 17:12:02
>You have to also keep in mind the the target >audience for mood stabilizers arent stable or >they wouldnt need to be on the drug.
Yes, but if you take a group and create a random assignment to active drug and placebo, and the active drug produces more suicidal thoughts, acts, etc, then it is possable to conclude that the drug was infact inducing such behaviors.
Linkadge
Posted by linkadge on June 23, 2008, at 20:39:52
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by bleauberry on June 23, 2008, at 18:41:05
I agree. Of course my story is not proof either, but a number of antidepressants made me feel much worse. This wasn't just increased energy, it was taking the core disorder and amplifying it and intensitfying all of the worst thoughts an emotions. When I stopped taking the drug, the feelings improved drastically.
I can't speak for everybody and every drug, but I have felt worse and have been pushed to the edge after starting certain drugs. I don't buy the increased energy theory because the SSRI's made generally made me more lethargic and apathetic. I went from low energy to zero energy, staring at a wall for the entire day without moving. Its like the drug is pushing you away from yourself. Even when you are depressed I felt like a human being. When starting the drugs I felt nonhuman. Like somthing was coming into my body and kicking me out of it. Citalopram start up was the worst. Esp at 20mg when I was 16 and drug naive.
The increased suicidiality was a feeling like the drug was completely blocking all emotion and reception of pleasure. It was like what little pleasure I was experiencing was squelched out. The akathesia is a very active emotion. Its a feeling that you just cannot tollerate existing. Its much more than getting up and moving will quench.
Linkadge
Posted by bulldog2 on June 24, 2008, at 9:31:34
In reply to FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by Phillipa on June 22, 2008, at 20:27:12
> Was driving today a few hours away to buy more product for ebay business a radio show was on Sponsored by Duke University I think as It's in the area and they mentioned Duke. But they the radio said the FDA feels meds used as seizure meds may lead to suicide. Anyone else hear this? Also they said Fish Oil, Flax seed Oil great for preventing macular degeneration. Thought it intersting just wondered if any one else has heard this? They mentioned lamictal, Tegretol, and Depakote. Now this was to prevent seizures so probably high dose? Any info? Phillipa
This is something Phillipa heard on the radio. We need to see the study to draw any conclusions. Also the levels used for seizure control are much higher than those used as a mood stabilizer. So at this point until someone reads the details of this study we have a blurb heard on the radio. So we can't draw any conclusions.
Posted by Bob on June 24, 2008, at 12:35:17
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suicide » bleauberry, posted by linkadge on June 23, 2008, at 20:39:52
> I agree. Of course my story is not proof either, but a number of antidepressants made me feel much worse. This wasn't just increased energy, it was taking the core disorder and amplifying it and intensitfying all of the worst thoughts an emotions. When I stopped taking the drug, the feelings improved drastically.
>
> I can't speak for everybody and every drug, but I have felt worse and have been pushed to the edge after starting certain drugs. I don't buy the increased energy theory because the SSRI's made generally made me more lethargic and apathetic. I went from low energy to zero energy, staring at a wall for the entire day without moving. Its like the drug is pushing you away from yourself. Even when you are depressed I felt like a human being. When starting the drugs I felt nonhuman. Like somthing was coming into my body and kicking me out of it. Citalopram start up was the worst. Esp at 20mg when I was 16 and drug naive.
>
> The increased suicidiality was a feeling like the drug was completely blocking all emotion and reception of pleasure. It was like what little pleasure I was experiencing was squelched out. The akathesia is a very active emotion. Its a feeling that you just cannot tollerate existing. Its much more than getting up and moving will quench.
>
>
> Linkadge
Linkadge... may I ask what, if any, drugs you are ingesting currently?
Posted by linkadge on June 24, 2008, at 17:16:13
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by bulldog2 on June 24, 2008, at 9:31:34
>Also the levels used for seizure control are >much higher than those used as a mood stabilizer.
Depression in epilepsy is very common. Many researchers have suggested that this infact the effect of the anticonvulsants.
Linkadge
Posted by linkadge on June 24, 2008, at 17:17:42
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suicide » linkadge, posted by Bob on June 24, 2008, at 12:35:17
I am taking medications but I really don't think it is relavant. My path isn't necessarily another individual's path.
Linkadge
Posted by yxibow on June 24, 2008, at 20:32:21
In reply to FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by Phillipa on June 22, 2008, at 20:27:12
Its the politics of fear. I'm sure lots will disagree with this statement, but that is what sums up FDA warnings on not just one, but EVERY medication prescribed for sleep including OTC medications, EVERY antidepressant, and I guess now EVERY seizure medication.
Yes, in adolescence we have to watch out for suicidal behaviour not seen before by someone with a medication. Yes, we have to watch that, especially in the older population, that people don't wander sleepwalking on a sedative. And yes, I suppose we have to also monitor suicidal behaviour never seen before in an individual on an AED.
But, in a way, this is "*ss protecting". Solvay dropped Luvox like a hot potato when Columbine happened.But if one remembers the gory details of the case, this was a suburban family not monitoring and perhaps even contributing to their behaviour (I forget, there have been several revolting incidents like this) by the lack of proper monitoring of their children due to workload and the passe nature of suburban life.
(And I'm sure there will be tons of posts of opinions, its impossible not to make one's own personal generalization of this case because of their own strong beliefs and social morays)
This wasn't even the first incident like this in the country. The Bath Township School disaster in 1927 in combination was actually the deadliest incident involving a school in the US, but was not attributable to a pupil.
One will choose their own belief in how medications should have warnings. Of course, there should be informed consent, but that lies in the very practice of outpatient work itself -- one agrees to take medication based on an opinion, since they are not locked in an institution.If one saw "Depression: Out of The Shadows," which in my opinion though dark at times and giving false hope because of lack of medical parity access (discussed briefly) to cutting edge technology, was in the end a good documentary.
It had the support of doctors of NIMH as well as NAMI, which I scarcely hear anything about on Dr Bob in fact -- the National Alliance For the Mentally Ill, a long standing advocate organization for those marginalized by mental (now known more as biochemical imbalances)-- it mentioned the notion of increased warnings and how they may actually contribute to decreased use of potentially life saving medication.
Sure, when SSRIs first came on the market, the idea of downing one for a panacea of disorders could be predicted in the US, as the FDA does not regulate off label use by doctors for almost all substances except investigational ones that must have a license, but for numerous people they gave the first hope for a lessening of their symptoms.
One has to remember that biochemical disorders come with the psychodynamics and psychological components of ideation of suicide. It is no surprise that they occur.And that is my point of argument -- for the largest part, suicides of people, even those "protected" in part by medication, occur anyway, because if one is determined to do oneself in, there really is no way for a doctor to prevent it other than to restrict the amount of medication available to the patient.
Suicide really is the fear of living, living with an illness that is a daily struggle, at least in part. This could be a projection -- other people have probably a completely different ideation. As noted in the documentary, patience is also something that is so important in reaching a goal of finding what works for oneself.
That doesn't come as an easy statement for people who have been through a number of medications and may have TRD (which is of course a moving target as we slowly plod towards more knowledge, which falls behind work on other diseases in this country, which, naturally cause major mortalities, e.g. heart disease, etc.)I guess I conclude its an open argument, and one to be examined in place with one's doctor and situation, but it is a huge generalization. When enough medications are used for a particular disorder class, one of two things happens, a) legitimate flaws are discovered, and b) the medications... are... prescribed, simply, which leads to a whole loop of possibly unnecessary danger-will-robinson for everything.
-- a viewpoint
-- tidings-- Jay
Posted by Bob on June 24, 2008, at 23:58:51
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suicide, posted by linkadge on June 24, 2008, at 17:17:42
> I am taking medications but I really don't think it is relavant. My path isn't necessarily another individual's path.
>
>
> LinkadgeSorry if I offended you. It didn't have to do with your path's relevance to anyone else's, I have just noticed that you are extremely knowledgeable about many drugs and have pointed out many serious drawbacks to all classes, so it caused me to wonder whether you were off all meds, or were actually braving meds despite the serious negatives for you.
Posted by linkadge on June 25, 2008, at 20:26:25
In reply to Re: FDA SAYs Seizure Meds May Or Can Lead to Suic, posted by yxibow on June 24, 2008, at 20:32:21
>It had the support of doctors of NIMH as well as >NAMI, which I scarcely hear anything about on Dr >Bob in fact -- the National Alliance For the >Mentally Ill, a long standing advocate >organization for those marginalized by mental
>(now known more as biochemical imbalances)-- it >mentioned the notion of increased warnings and >how they may actually contribute to decreased >use of potentially life saving medication.Thats one way to look at it. I'm all about data though. Antidepressants are like the 'Emperor's new cloths' in my mind. Some company gets some drug approved based on one sucessful trial out of 100 and then everbody just goes along with the idea. If its called an "antidepressant" it must help depression right? I don't think that SSRI's have done much to reduce suicide (or even depression for that matter).
>Sure, when SSRIs first came on the market, the >idea of downing one for a panacea of disorders >could be predicted in the US, as the FDA does >not regulate off label use by doctors for almost >all substances except investigational ones that >must have a license, but for numerous people >they gave the first hope for a lessening of >their symptoms.
Thats *if* you have any faith in the validity of clinical trials.
>One has to remember that biochemical disorders >come with the psychodynamics and psychological >components of ideation of suicide. It is no >surprise that they occur.
Yes, but I restate again. When a clinical trial compares both the active drug and placebo in terms of propensity to induce suicidal thoughts and behaviors, one becomes capable of filtering out the possable suicidogenic effect of the active drug. Remember, the people taking the placebo are just as sick.
>And that is my point of argument -- for the >largest part, suicides of people, even >those "protected" in part by medication, occur >anyway, because if one is determined to do >oneself in, there really is no way for a doctor >to prevent it other than to restrict the amount >of medication available to the patient.
Why is it so inconcievable that such powerful mind altering medications might actually provoke such sucidial reactions? Not everbody starts off with the same biochemistry.
Check this study out!
Apparently the issue of antidepressant induced suicidal behaviors is geniune and meaningful enough that top researchers are trying to pinpoint biological predictors of sucidal responces to certain antidepressants!
http://www.ncbi.nlm.nih.gov/pubmed/17548750
If antidepressants have not been proven to actually reduce suicide *and* (as some data suggests) they may actually inhibit natural recovery (making the disease more chronic), then it may be time for a critical reevaluation of their usage.
Linkadge
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.