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Dr. Bob is Robert Hsiung, MD,
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Posted by notfred on February 8, 2007, at 5:17:34
In reply to Teen Suicide Spike Linked to SSRI Black Box, posted by halcyondaze on February 7, 2007, at 21:09:11
WE have already discussed this here:
http://www.dr-bob.org/babble/20070201/msgs/730301.html
and here:
http://www.dr-bob.org/babble/20070207/msgs/730793.html
But the short of it is the teen suicide rate was higher in 1990 than was in 2004.
The teen sucide rate was higher prior to black box warnings.
"The statistics are certainly believable. The controversy is in their interpretation.
In 1990, the adolescent (ages 15-19) suicide rate was about 11 per 100,000, falling to 7.3 in 2003. In 2004 (the year these recent statistics summarize), the rate rose to 8.2/100,000.
Why is controversial.
Lar"
Posted by notfred on February 8, 2007, at 6:05:33
In reply to Teen Suicide Spike Linked to SSRI Black Box, posted by halcyondaze on February 7, 2007, at 21:09:11
Ah, the black box warnings caused a decrease in the number of kids taking SSRI's and that caused the increase in teen suicide.
"The warnings created a barrier to treatment "by scaring young people and parents away from care" that may be linked to the rise in suicide, Dr. Shern said in a statement.
Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine here told reporters he has no doubt that the warning contributed to the suicide increase.
"The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates," Dr. Nemeroff said.
Noting that the adolescent suicide rate had been falling, David Fassler, M.D., of the University of Vermont in Burlington, Vt., called the new data "very disturbing."
"The sudden increase in the adolescent suicide rate," Dr. Fassler told reporters, "corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group."
He said there are no data showing that SSRIs increase the risk of suicide and "the current data suggest that the decreased use of these medications is, in fact, associated with an increase in actual deaths attributable to suicide.""
Posted by Squiggles on February 8, 2007, at 17:02:22
In reply to Re: Teen Suicide Spike Linked reduced SSRI use, posted by notfred on February 8, 2007, at 6:05:33
Excuse me for being cynical, but it does
sound like a spin to me, even though I
do not believe that SSRIs are more likely
to cause suicide in any age than other ADs
during loading a psychotic or manic or anxious
state.Oh what a tangled web.....
Squiggles
Posted by MIke Lynch on February 8, 2007, at 17:43:08
In reply to Re: Teen Suicide Spike Linked reduced SSRI use, posted by notfred on February 8, 2007, at 6:05:33
So why would people be scared by a black box warning, if they were already experiencing suicidal thoughts?? What complete conjecture, the only way to find out is to talk to the families. There have been suicides and homicides linked to the usage of ssri's.. so it's a catch 22
Posted by Squiggles on February 8, 2007, at 18:03:26
In reply to Re: Teen Suicide Spike Linked reduced SSRI use, posted by MIke Lynch on February 8, 2007, at 17:43:08
> So why would people be scared by a black box warning, if they were already experiencing suicidal thoughts?? What complete conjecture, the only way to find out is to talk to the families. There have been suicides and homicides linked to the usage of ssri's.. so it's a catch 22
I'm not sure what your point is.
In the article, these statements:
"According to figures compiled by the CDC there were 1,985 suicides among those ages 10 through 19 in 2004, compared with 1,737 in 2003.
That's a rate of 2.6 per 100,000, up from 2.2 per 100,000 the year before, according to the Annual Summary of Vital Statistics, published in the February issue of Pediatrics.
Overall, the death rate from suicide increased by 18.2% -- a change that was deemed "unacceptable" by David Shern, Ph.D., president of Mental Health America.
Dr. Shern said it's premature to draw conclusions about the cause of the increase, but noted that it coincided with the FDA's warning that selective serotonin reuptake inhibitors (SSRIs) had been linked to suicidal thoughts in young people."
would make me wonder exactly what increase is
statistically significant compared to other years of spikes and lows in suicide rates; and whether there is any way to legitimately link this to the Black Box.. yeah, maybe talk to the families is a good idea. But jumping to the Black Box Warning does not mean that these or other drugs were not taken.Yes, of course 18.2% is unacceptable. 1% is unacceptable.
Squiggles
Posted by munificentexegete on February 8, 2007, at 21:52:28
In reply to Re: Teen Suicide Spike Linked reduced SSRI use, posted by Squiggles on February 8, 2007, at 18:03:26
theoretically, the therapeutic effect of an AD should increase up to a particular point based on increasing receptor activity, beyond which there would be an increase in side effects without further antidepressant effect. doses above such a level could be said to be toxic or even induce suicidal behaviour depending on the s/e profile.
Posted by notfred on February 9, 2007, at 0:19:51
In reply to Re: Teen Suicide Spike Linked reduced SSRI use, posted by Squiggles on February 8, 2007, at 18:03:26
"So why would people be scared by a black box warning, if they were already experiencing suicidal thoughts?? What complete conjecture, the only way to find out is to talk to the families."
I think in some cases the black box warnings cause doc's to be less willing to suggest these meds to patients. That has to be a hard sell to parents,
"I want to put your depressed kid on a med that has a warning about increased suicide risk".
Posted by Squiggles on February 9, 2007, at 8:20:02
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by notfred on February 9, 2007, at 0:19:51
I guess i really am an unrepentant cynic;
you know-- i think that most of the drs.
don't even read about the black box warning.
I have a friend who was prescribed an arthritis
drug two years after a Black Box warning, with
no awareness of that at all.Squiggles
Posted by notfred on February 9, 2007, at 10:51:29
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by Squiggles on February 9, 2007, at 8:20:02
> I guess i really am an unrepentant cynic;
> you know-- i think that most of the drs.
> don't even read about the black box warning.
> I have a friend who was prescribed an arthritis
> drug two years after a Black Box warning, with
> no awareness of that at all.
>
> Squiggles
I wonder how a family would know about the black box warnings, most either never get PI sheets or if they do, never read them.I have always be advised of black box warnings by my docs.
Posted by Sebastian on February 11, 2007, at 14:12:50
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by notfred on February 8, 2007, at 5:17:34
here's a theory, black box warning, everyone stopes taking there AD, and becomes suicidal?
Posted by notfred on February 11, 2007, at 14:49:50
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by Sebastian on February 11, 2007, at 14:12:50
> here's a theory, black box warning, everyone stopes taking there AD, and becomes suicidal?
Right, that is what the study is indicating.
Posted by linkadge on February 11, 2007, at 15:21:52
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by notfred on February 11, 2007, at 14:49:50
I think it is just a trend. If it is to mean anything the trend will continue.
It could just be the reverse placebo effect too. Ie, the notion of having less treatment options will inherantly make somebody feel more deparate. This would occur independantly of the actual effect of drug absence, just as placebo effect occurs independnantly of theraputic effect.
Linkage
Posted by FredPotter on February 12, 2007, at 13:48:29
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by linkadge on February 11, 2007, at 15:21:52
Another explanation could be that the black box advertises to a desperate person that the medication can be used for suicide. Just a thought. Here in New Zealand we have one of the highest rates of teen suicide. No-one knows why. Some think it's because we don't eat enough fish. It's quite expensive here surprisingly and sad because our seas are beautifully clean and our fish unpolluted
Fred
Posted by Squiggles on February 12, 2007, at 14:11:02
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by FredPotter on February 12, 2007, at 13:48:29
> Another explanation could be that the black box advertises to a desperate person that the medication can be used for suicide. Just a thought. Here in New Zealand we have one of the highest rates of teen suicide. No-one knows why. Some think it's because we don't eat enough fish. It's quite expensive here surprisingly and sad because our seas are beautifully clean and our fish unpolluted
> Fred
I just read an article in a weekend paper regarding suicide rates in Canada. And the Province of Quebec is the highest of all. The author sites the relatively very high poverty rate, illiteracy, linguistic and cultural divisions, medical inaccessibility and political and social insecurity. Suicide rates are highest in the poor districts of the province.Squiggles
Posted by munificentexegete on February 12, 2007, at 15:00:21
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by Squiggles on February 12, 2007, at 14:11:02
> > Another explanation could be that the black box advertises to a desperate person that the medication can be used for suicide. Just a thought. Here in New Zealand we have one of the highest rates of teen suicide. No-one knows why. Some think it's because we don't eat enough fish. It's quite expensive here surprisingly and sad because our seas are beautifully clean and our fish unpolluted
> > Fred
>
>
> I just read an article in a weekend paper regarding suicide rates in Canada. And the Province of Quebec is the highest of all. The author sites the relatively very high poverty rate, illiteracy, linguistic and cultural divisions, medical inaccessibility and political and social insecurity. Suicide rates are highest in the poor districts of the province.
>
> Squiggles
>
>
>most people in distress will tell you why they are feeling that way.
farmers suffering from drought
too much pain from terminal cancer
partner cheating on them
parent or sibling dying
loss of jobpeople don't just commit suicide without a reason.
Posted by Squiggles on February 12, 2007, at 15:05:35
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by munificentexegete on February 12, 2007, at 15:00:21
most people in distress will tell you why they are feeling that way.
>
> farmers suffering from drought
> too much pain from terminal cancer
> partner cheating on them
> parent or sibling dying
> loss of job
>
> people don't just commit suicide without a reason.
>I agree. A miserable life can only exacerbate
a depression; often alcohol is used, stress is
high, worries, etc. However, I *do* think that drugs can overpower these very real conditions of some peoples' lives. To take to extremes, if you put someone under anesthetic for an operation, it really doesn't matter what his social position is. And psychiatric drugs are very powerful. The only thing is that SSRIs may be just as jarring as other antidepressants, under certain conditions.Squiggles
Posted by notfred on February 12, 2007, at 15:21:45
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by FredPotter on February 12, 2007, at 13:48:29
> Another explanation could be that the black box advertises to a desperate person that the medication can be used for suicide.
But the black box warning is on the monograph, not on the bottle the patient receives, so I do not see how people even know about the black box warning. Nor will a whole 30 day supply taken at once cause death.
Posted by notfred on February 12, 2007, at 15:46:51
In reply to Re: Teen Suicide Spike Linked to SSRI Black Box, posted by notfred on February 12, 2007, at 15:21:45
http://www.healthfinder.gov/news/newsstory.asp?docID=535841
"I have no doubt that there is such a relationship," said Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine.
"The concerns about antidepressant use in children and adolescents has paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates."
"This is very disturbing news," said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine. "The adolescent suicide rate has been declining steadily since the early 1990s.
"The sudden increase in the adolescent suicide rate," Fassler continued, "corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group."
The nonprofit group Mental Health America has also called for a further look into the FDA's decision to strengthen warnings on SSRIs.
"As a result of the agency's activities, dramatic decreases in the use of SSRIs in the adolescent population were noted," said David Shern, president of Mental Health America in a statement issued Monday. "Other research has indicated a general relationship between the use of SSRIs and decreasing suicide rates in the general population.
"We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants have caused an increase in youth suicide."
Warning Labels May Scare Doctors, Parents
Some doctors say the additional black box warnings may have led medical professionals to be less confident in prescribing antidepressants.
"In the state of Michigan, we have found that our colleagues in pediatrics have become increasingly uncomfortable with the prescription of SSRIs following the institution of the black box warning," said Dr. Sheila Marcus of the section of child and adolescent psychiatry at the University of Michigan Hospitals.
"The past history of such FDA warnings has revealed that they create barriers to care and unnecessarily frighten families away from seeking treatment," Nemeroff said.
Posted by Squiggles on February 12, 2007, at 15:59:51
In reply to Teen Suicide Spike Linked to reduced SSRI use, posted by notfred on February 12, 2007, at 15:46:51
> http://www.healthfinder.gov/news/newsstory.asp?docID=535841
>
> "I have no doubt that there is such a relationship," said Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine.
>
He has no reason to doubt or not to doubt
such a relationship.> "The concerns about antidepressant use in children and adolescents has paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates."
What's paradoxical about it? Did the warning signal an increase in their use?
>
> "This is very disturbing news," said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine. "The adolescent suicide rate has been declining steadily since the early 1990s.
>I didn't notice the date - 1999-- if there is a spike in one yr. on account of the Black Box warning, then that is something to consider.
> "The sudden increase in the adolescent suicide rate," Fassler continued, "corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group."There was a time, not so long ago, before the 80s I would say, when antidepressants for adolescents was unheard of. Certainly, it was an odd idea in my youth, and i was am a boomer.
>
> The nonprofit group Mental Health America has also called for a further look into the FDA's decision to strengthen warnings on SSRIs.Yeah, "a further look" -- not so far methinks; pretty soon they will turn the Black Box around.
>
> "As a result of the agency's activities, dramatic decreases in the use of SSRIs in the adolescent population were noted," said David Shern, president of Mental Health America in a statement issued Monday. "Other research has indicated a general relationship between the use of SSRIs and decreasing suicide rates in the general population.I can't argue with the ivy leaguers, but personally I think that adolescence is such a tumultuous period of personal development, that it is the most difficult time to distinquish depression from passionate disposition.
>
> "We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants have caused an increase in youth suicide."Yup, we must, we must, we must;
>
> Warning Labels May Scare Doctors, Parents
>
> Some doctors say the additional black box warnings may have led medical professionals to be less confident in prescribing antidepressants.
>
> "In the state of Michigan, we have found that our colleagues in pediatrics have become increasingly uncomfortable with the prescription of SSRIs following the institution of the black box warning," said Dr. Sheila Marcus of the section of child and adolescent psychiatry at the University of Michigan Hospitals.
>
> "The past history of such FDA warnings has revealed that they create barriers to care and unnecessarily frighten families away from seeking treatment," Nemeroff said.Well, if I am bipolar, I can tell you that my childhood and adolescence reads like a textbook survival course, traversing the gamut of emotions from alpha to omega. But, I did not get hit with clinical depression until my late 20s. Hmmmm....
As I said, I think that agitating ADs like SSRIs when given to anyone at any age, may prevent an already suicidal disposition, by giving the drugs in conjunction with benzos, and within a clinical setting-- a much more demanding and expensive idea than just prescribing the drug like aspirin, and giving cab fare.
Squiggles
Posted by notfred on February 12, 2007, at 16:25:54
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by Squiggles on February 12, 2007, at 15:59:51
>
> What's paradoxical about it?A drug that should reduce sucide rates carries a warning that in some cases it might increase sucide rates (something of a paradox itself). Then these warnings cause doc's to use them less and the sucide rate rises. The paradox here is that the warnings seem to cause increases of the very thing they attempt to protect the patient from.
Posted by Squiggles on February 12, 2007, at 16:36:54
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by notfred on February 12, 2007, at 16:25:54
>
> >
> > What's paradoxical about it?
>
> A drug that should reduce sucide rates carries a warning that in some cases it might increase sucide rates (something of a paradox itself). Then these warnings cause doc's to use them less and the sucide rate rises. The paradox here is that the warnings seem to cause increases of the very thing they attempt to protect the patient from.
>
>
I may have lost you here. The SSRIs were not introduced with the promise of reducing suicide. Rather, they were the new class of antidepressants that had minimal side effects in comparison to the older ADs and had a faster remission rate on depression.That they caused suicide was one the statistical reports from Dr. David Healy.
>
As for the effect of the warnings, I think you yourself said that the BLACK BOX does not appear on the prescription bottle but rather on the pharmaceutical blurb. Perhaps a further study on how often doctors and patients read such warnings, let alone take them very seriously may corroberate this reported increase in suicides.Squiggles
>
>
>
Posted by notfred on February 12, 2007, at 16:49:40
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by Squiggles on February 12, 2007, at 16:36:54
> >
> > >
> > > What's paradoxical about it?
> >
> > A drug that should reduce sucide rates carries a warning that in some cases it might increase sucide rates (something of a paradox itself). Then these warnings cause doc's to use them less and the sucide rate rises. The paradox here is that the warnings seem to cause increases of the very thing they attempt to protect the patient from.
> >
> >
> I may have lost you here. The SSRIs were not introduced with the promise of reducing suicide. Rather, they were the new class of antidepressants that had minimal side effects in comparison to the older ADs and had a faster remission rate on depression.You asked me what was ment by the quote. I did not say AD's were indroduced with the promise of reducing suicide. They treat depression which is very related to sucide.
Posted by munificentexegete on February 12, 2007, at 17:09:08
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by notfred on February 12, 2007, at 16:49:40
> > >
> > > >
> > > > What's paradoxical about it?
> > >
> > > A drug that should reduce sucide rates carries a warning that in some cases it might increase sucide rates (something of a paradox itself). Then these warnings cause doc's to use them less and the sucide rate rises. The paradox here is that the warnings seem to cause increases of the very thing they attempt to protect the patient from.
> > >
> > >
> > I may have lost you here. The SSRIs were not introduced with the promise of reducing suicide. Rather, they were the new class of antidepressants that had minimal side effects in comparison to the older ADs and had a faster remission rate on depression.
>
>
>
> You asked me what was ment by the quote. I did not say AD's were indroduced with the promise of reducing suicide. They treat depression which is very related to sucide.is depression a medical condition *confused*?
but ssris can cause suicide which means they cause depression, that is they can be the source of a organic form of depression.
that is to say that ssris can be the biological cause of depression and suicide, as opposed to the depression which is a feeling and is not biological at all.
Posted by Squiggles on February 12, 2007, at 17:13:20
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by munificentexegete on February 12, 2007, at 17:09:08
I think there's some equivocation going
on here between depression and suicide;
but i better not post anymore after the warning
that just appeared on consecutive posts of
the same topic or the same poster.tx
Squiggles
Posted by notfred on February 12, 2007, at 18:21:04
In reply to Re: Teen Suicide Spike Linked to reduced SSRI use, posted by Squiggles on February 12, 2007, at 17:13:20
Cool. And I think that I have beaten this one to death so I am going to stop.
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Dr. Bob is Robert Hsiung, MD,
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