Full disclosure: I am speaking as someone who is both a gun owner and has been diagnosed with major depressive disorder, and had the latter treated with trazodone, and later sertraline (Zoloft).
Right, well, I found the page that list originally on
http://ssristories.com/index.phpThe first obvious problem with the hypothesis that there is a causal link between SSRIs and both suicide and homicide is that anyone who has been prescribed an SSRI has presumably already been diagnosed with some psychological disorder, most likely depression. Why multiply entities beyond necessity (to paraphrase Occam's Razor) and blame the medication when the disorder itself provides an adequate explanation?
Moreover, the list relies heavily on the 2004 FDA black box warning, which itself was mostly ass-covering based largely on one study, of which the author later (see "Suicide and SSRI Medications in Children and Adolescents: An Update" in the AACAP's
DevelopMentor http://www.aacap.org/cs/root/developmentor/suicide_and_ssri_medications_in_children_and_adolescents_an_update) has this to say:
In the Summer, 2004 issue of the DevelopMentor I wrote an article on the suicide risk posed by serotonin reuptake inhibitor medications (this article is available in the DevelopMentor archive under the topic “SSRIs”). At that time I outlined in detail the issues prompting the FDA to place a black box warning on all antidepressants. It has now been almost three years since the FDA issued the black box warning for all antidepressants due to elevation of suicide ideation and behavior. The data showed a small increase in suicidal thought and behaviors, from 2% in the placebo groups to 4% in the medication groups, when data from all trials for all indications were combined. There were no completed suicides in any of the studies conducted on antidepressant medications. The FDA issued the warning despite evidence that increasing prescriptions for SSRI antidepressant medications was clearly correlated with decreasing rates of actual suicide, and use of antidepressant medications was not associated with suicide in any prior studies.
Emphasis mine. It's important to note that suicidal thoughts and behaviors ("ideation") do
not equal actual suicide attempts, let alone completed suicides.
The author also notes that exactly
one study has come out (in 2006) that associated SSIs with increased risk of suicide, against several others that found no association. In this context, it is important to understand that the term "associated with" in medical literature tends to be given a lot more weight than it deserves, because what it really means is "we found a slight statistical correlation, but we can't demonstrate a causal relationship." The phrase "linked to" is even worse, usually indicating that there were some anecdotal caes of
X happening concurrently with or shortly after
Y, but not even a statistical correlation could be established.
In other words, the evidence that SSRIs cause an increase in suicides and homicides is very, very thin; must thinner than the evidence that they cause a reduction, at least after the first month. The danger periods are the first month after going on them, and after going off them. Note that quite a number of the cases listed on ssristories.com are of people on SSRI
withdrawal.
Moreover, it should be noted that in something like 30% of cases, SSRIs simply do not work for the patient in question, which might have an exacerbating effect in that the patient's expectations of feeling better (i.e. less bad) are not met, resulting in disappointment, hopelessness, etc. Also, there is always the risk of misdiagnosis; psychological disorders are tricky, and it's possible that a number of the cases in question were sufferers of bipolar disorder who were misdiagnosed as having major depressive disorder. Major depressive disorder is also known as "unipolar disorder" to distinguish it from bipolar disorder (which used to be known as "manic depression"); the distinction is not merely academic, as the two disorders are quite different in mechanism (though they may manifest in similar ways), and antidepressants have at best limited effectiveness against bipolar disorder, which is more commonly treated with mood stabilizers like lithium carbonate and lamotrignine. In fact, SSRIs alone (without a mood stabilizer) may do more harm than good in sufferers of bipolar disorder, possibly inducing or exacerbating rapid cycling between states of mania and depression, which in turn may cause psychotic symptoms. In such a case, it's not that SSRIs aren't any good, it's just that they're the wrong tool for that particular job.
The long and short of it is that there a lot of possible explanations why someone on SSRIs might still suffer a homicidal/suicidal episode, and very little evidence that the SSRIs are the causal factor in such episodes.
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
