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Surprise! Antidepressants Really Do Reduce Suicidality

A new study suggests that all the hubbub about drugs like Prozac "causing" suicide -- which led to the FDA's "black box" warning on them -- led physicians to be more conservativew about prescribing the meds. And that appears to have caused the suicide rate to go up in children and teens.

Now, the first caution is that this is correlational data. That means we know that as the emphasis on the "dangerousness" of antidepressants went up, so did the suicide rate. That doesn't necessarily mean that one caused the other. It just looks pretty darn suspicious.

But there's a bigger problem here, and that is that we're still focusing on the wrong thing: the drugs.

Healthy, psychologically sound people who feel like there's hope don't commit suicide. People who feel there is no other option commit suicide, and teens tend to be more impulsive, so their suicide rate is a little higher than average. (The teen suicide rate is not the highest, by any means. The elderly population, especially elderly white males, are far more likely than any other group to commit suicide.)

Research shows that most antidepressant prescriptions are written by general practitioners, not psychiatrists. Now, GPs are writing them because they want to help, and that's what they can do to help -- they see people briefly, write a prescription or provide some other specific advice, and send the person out the door. In some cases they recommend therapy, but with a scrip in hand, the average person ignores the therapist's name.

And the average person doesn't realize that each antidepressant works differently (that's why there are so many of them -- gasp!) and that figuring out which is the best can be a trial-and-error process that may involve different dosages and different combinations of drugs.

So people go home, pop their Prozac, and by day 2 or 3 they feel great! They don't realize, of course, that it takes 2-6 weeks for Prozac to start working, and that they're getting a placebo effect. So at the end of week 1 they're not feeling so great and by the end of week 2 they quit taking the med becuase it's "stopped working." And they feel hopeless.

Or they feel a little better, but not a lot better, but they assume Zoloft is like penicillin -- it works or it doesn't, and there's not a lot of in between. They begin to think that feeling this bad is normal, and they're just not handling it well. Nor do they want to. And they feel hopeless.

Or the drug causes side effects they don't like, so they figure that the whole drug class is useless to them. And they feel hopeless.

See how this works?

Plus, in a lot of cases, even if the drug works great, it can't rout out the cause of the problem like an antibiotic. An antibiotic kills the infection and gets rid of the symptoms, too. With mental illness you may eliminate the symptoms and even get the brain chemistry working better, but if the psychological problem, or the bad living situation, or the learning disability, or whatever is still there, you haven't dealt with the true "infection," and you're still going to struggle with depression. That's exhausting. So you feel hopeless.

My point is, it's not as simple as a drug causing or not causing suicide rates. It has a lot to do with understanding that a drug is a tool, and an important tool, but only a tool. We shouldn't put it on a pedestal or blame it for the world's ills.

SSRIs (the class of antidepressants that includes Prozac, Zoloft, Wellbutrin, etc.) were one of the most important chemical revolutions in psychiatry. They help a lot of people who couldn't otherwise live normal lives live very normal lives. But they're drugs, not magic in a bottle.

You know how they say, "Guns don't kill people, people kill people"? Well, antidepressants don't cause suicide, but they also don't usually cause miracles. It's not that simple, and until we stop trying to make it that simple, we're not using the tools as effectively as we should be.

1 Comment:

  1. Bob said...
    Tom Cruise should read this....

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