Posted by Larry Hoover on August 28, 2004, at 8:08:12
In reply to Re: pediatric suicidality and SSRIs » Larry Hoover, posted by jay on August 27, 2004, at 18:01:47
> Hey Lar....
>
> Good points...but I really have to wonder as there are numerous cases that have shown up over the past few years, where so-called 'normal' or 'non-clinically depressed' people have taken the meds (SSRI') and reported suicidal ideation and rumination. These number of reports came from clinicians in France and England, and some had even taken the drug themselves. (They used other co-workers to double blind the studies.) I'll see what I can find. I really *don't* think this is limited to kids. Most a.d.'s cause some pretty hefty chemical shifts at first when taken..and it seems that it is during this begining phase when most of the reports (including the many with kids)indicate there was suicidal rumination or behaviour.I certainly agree with you that there is a treatment-emergent risk of suicidal rumination and actions. In fact, I think the effect is more pronounced when the drugs are given to non-depressed subjects. I've been following the subject closely, as there is far too much hyperbole and too little critical thinking, for my taste.
> There is a *very* simple sollution to this. First off, doctors should monitor new patients say weekly if not sooner, and start on as low a dose as possible. If that means liquid meds...or cutting into fours...whatever it takes! If agitation seems to be a possible problem, a heavy dose of a good benzo and a few days away from work/school may help. It's just using common sense, and I don't see why doctors shouldn't be held somewhat responsible, especially in the early care, for this. My old pdoc saw me every week for a year, then every two for the next.
>
> Anyhow...just IMHO .02 (CAN) cents. ;-)
>
> JayI agree with you, absolutely, Jay. I'll add my own .02 Canadian to your two, and maybe we'll have .02 U.S. between us?
The SSRIs are serious meds. They have been prescribed fairly loosely, and have been very poorly managed by the prescribing physicians. This is a drug management issue, IMHO, not a drug issue. Recent comparisons with e.g. TCAs have shown that the incidence of suicidal induction during the early treatment phase is about the same for both classes of drugs. In fact, one of the prime motives for developing the SSRIs was to find an antidepressant which was not lethal in overdose. It was a bit ironic to prescibe a drug (e.g. a tricyclic) which was to treat major depression, which simultaneously gave the patient the tool to end their misery.
The European Union has recently brought down restrictive prescribing guidelines for the SSRIs, and strongly suggested monitoring protocols. It is also recommended that the risk of suicidality is overtly discussed, and that family and associates (as appropriate) are made aware of the risk, as well.
I don't know how we came to believe these drugs were so benign, and I'm not laying that on the drug companies. We've all been willfully blind to what is going on around us.
Lar
poster:Larry Hoover
thread:382578
URL: http://www.dr-bob.org/babble/20040825/msgs/383252.html