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eden2eve's avatar

Do you believe that SSRI's (antidepressants) can be implicated in suicide and murder cases?

Asked by eden2eve (3693 points ) May 25th, 2010

Over the years, there has been much discussion in the media about the prevalence of murder or suicide cases where the perpetrator was on prescription antidepressants. Many of those were young people.

Here is an article which points the reader to a site listing numerous instances of crime related acts linked to the use of SSRI medications.

This web site explores some specific cases, even some who have been proven legally to implicated antidepressants, It states: “In (July 2003, the FDA has advised that no one under age 18 should be prescribed Paxil for depression, owing to the risk of suicide.”

In 2004, and again in 2006, Dr. Ann Blake Tracy testified to the FDA regarding her research on the correlation between drugs and violence, and the conclusions she has drawn.

What is your opinion on this? Do you believe that there is cause for caution, or even some sort of change in the prescription of these very powerful medications? And do you believe that the FDA has been sufficiently responsible in responding to these concerns?

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25 Answers

dpworkin's avatar

What a load of crap. You can twist certain statistics to make anything seem plausible.

Seaofclouds's avatar

There should be caution with every medication we take. I think the FDA has done what they can by saying that certain medications shouldn’t be used with those age groups where there has been a link in increased suicidal ideations and actual suicides. There are several medications that carry the warning and they should only be used as an absolute last effort with that age group.

The increase in suicidal ideation is a side effect of those medications. The good of those medications is still prevalent, so I don’t see the FDA pushing for more control at this point. Especially since there is no real way to tell who will react this way to those medications.

CyanoticWasp's avatar

Maybe so… maybe so. But you’ll never take ‘em alive! And besides, at trial they’d point the finger of blame at mothers’ milk, anti-perspirants and public education and thereby raise reasonable doubt.

Case dismissed.

eden2eve's avatar

@dpworkin

You concluded that without even reading the links. Amazing!

Dr_Dredd's avatar

It’s not true that the FDA “advised that no one under age 18 should be prescribed Paxil for depression, owing to the risk of suicide.” The FDA issued a warning that suicidal thoughts may be increased by SSRIs, so the risk must be balanced with the “clinical need.” It’s not the same thing at all.

And, hell, you can say that about any medication! It’s always a risk vs. benefit analysis.

dpworkin's avatar

@eden2eve I conclude that based upon the last 12 years of research on SSRIs. We already know that the concept of peer-reviewed research is foreign to you – you prefer scary anecdotes

le_inferno's avatar

This is pretty stupid. Correlation does not imply causation. Just because people happened to be on SSRIs when they committed crimes doesn’t make them the culprit. I read the article you linked, there is no convincing evidence for the claims at all. Perhaps if someone found evidence that the actual brain changes that SSRIs produce are directly traceable to parts of the brain responsible for violence, kleptomania, etc., there would be some credibility. But until then, all they’re doing is pointing a finger at a vague, undetermined cause. These cases haven’t been explored enough.

SSRIs prevent the reuptake, or absorption, of serotonin into the neuron, keeping more of it in the synapse. This is to stabilize moods. There is currently no scientific reason why these drugs would cause violence.

dpworkin's avatar

@le_inferno Bingo. Thanks for the reasoned response.

evandad's avatar

Ridiculous

Facade's avatar

I’m not sure, but they should definitely need to be integrated somehow.

nikipedia's avatar

Well, I just spent fifteen minutes trying to find a single peer-reviewed scientific article by Ann Blake Tracy to no avail. So when she talks about her “research,” it seems pretty clear that she means “opinions.”

I actually find it really frustrating when people try to dismiss scientific findings, especially with the argument “correlation is not causation.” The people who make these statements almost universally do not understand statistics and do not understand the literature they criticize, if they even bothered to read it.

That said, I think what you have here is a brilliant, shining, perfect example of a situation in which correlation is not causation. I would be hard-pressed to find a better real-life example of two things that are highly correlated that almost certainly do not have the causal relationship suggested.

Here’s why: suppose you have a random group of people who are suicidal, and a random group of people who are not suicidal. If you then survey those two groups of people to see how many are taking antidepressants, which group of people do you think has a higher rate of antidepressant use?

The suicidal people, obviously. The suicidal people are taking antidepressants because they are suicidal. They are not suicidal because they are taking antidepressants.

So you might be asking, well, nikipedia, how do you know the directionality of the causation? There’s a simple answer: science! If you properly design your experiment, you can actually begin to draw conclusions based on data and statistics rather than… opinions!

One way to properly control for this might be to survey rates of suicidality in people with depression who are taking a placebo versus antidepressants. That study was performed in 2000 by Khan et al. and published in the Archives of General Psychiatry, and again in 2003 in the American Journal of Psychiatry. Another way to study this might be to see if, over time, as more people take antidepressants, rates of suicide go down. That study was performed in 2003 by Olfson et al. and was also published in the Archives of General Psychiatry, and again by a different group in Australia that published their findings in BMJ.

So no, I don’t think there is any reason to believe antidepressant medications of any kind increase the risk of suicide, and SSRIs are the very least likely culprit. The opinions of a woman whose myspace page is in her top 3 google hits are not convincing.

What convinces me that we have no real cause for concern is not the FDA’s ruling one way or another, but the decades of research performed by hundreds of scientists on thousands of research participants around the world.

perspicacious's avatar

I do know that even the manufacturers place cautionary statements in the literature of some antidepressants regarding an increased tendency of suicide. I’ve read that it really increases the possibility in teens and young adults. I haven’t studied the “why would this be?” question. One theory is that if a person is suicidal and takes antidepressants, the meds give them enough relief from despair for them to use that newly found strength to follow through with their suicidal quest. I do not know any statistics regarding suicide by a person who was not suicidal prior to taking the meds.

eden2eve's avatar

@dpworkin
True to form, oh wise person!

Two points…

Nothing in this question suggests what my position is in this matter. As usual, you jump to conclusions based upon your bias, which is arbitrary and without substance.

“We already know that the concept of peer-reviewed research is foreign to you – you prefer scary anecdotes”
To assume that I have no concept of peer-reviewed research based upon a few posts is fallacious and foolish. You have no idea what my background is. I have spent a number of years supporting various scientists in a National Laboratory, many of whom were doing medical research. Much of my support involved researching various “peer reviewed journals” in their behalf. I find your ability to jump to conclusions to be unparalleled. You are doing what you decry in others. Making assumptions based upon scant evidence.

dpworkin's avatar

Then why do you defend this crap? Especially in the face, of, say @nikipedia‘s analysis. I only know you from what you post, and you may accuse me of whatever you please, but so long as you do not explain your devotion to various unsupported idiocies such as the present speculation it is very hard to take you seriously. There is nothing i would like better than to welcome another smart, informational poster to Fluther. You don’t seem to qualify. I would love to be proven wrong. Instead, you insist on personalizing our disagreements.

@perspicacious Sucidal ideation is not the same thing as suicidal behavior. The black box warns about monitoring adolescent patients for suicidal ideation.

perspicacious's avatar

@dpworkin Suicidal feelings and SSRIs

Antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms or thoughts are most likely to occur during the first one to two months of treatment or when you change your dosage, but they can occur at any time during treatment. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when starting treatment or changing dosage, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.
http://www.mayoclinic.com/health/ssris/MH00066/NSECTIONGROUP=2

This is a 2008 article, however, this site generally keeps their information up to date.

dpworkin's avatar

@perspicacious I am speaking of the black-box warning required by the FDA. You are quoting something from a medical site. Those are not equivalent.

perspicacious's avatar

@dpworkin True dp. The question was “do you believe….” My trust leans toward the Mayo Clinic rather than the FDA.

dpworkin's avatar

So if you had a depressed adolescent you would deny the child the most effective treatment we now have (in conjunction with careful monitoring and talk therapy)? I’m glad you don’t make the rules for most people.

nikipedia's avatar

@perspicacious: If my research is correct, the Mayo Clinic is citing findings from the FDA.

perspicacious's avatar

@nikipedia One of 16 references was a 2008 article by the FDA warning about suicidal thinking and behavior in young adults on antidepressants. The references are listed at the bottom of the Mayo Clinic article. (You have to click the “References” link)

downtide's avatar

It’s always been my understanding that ssris can cause problems, including suicidal thoughts/actions, for people who have bipolar disorder.

dpworkin's avatar

SSRIs are specifically counterindicated in the treatment of BPD.

Dr_Dredd's avatar

@dpworkin Not exactly. They should certainly be used with caution, but when combined with a mood stabilizer they can be useful for depressive episodes in bipolar disorder. The doctor has to make sure there are no superimposed manic symptoms already present, though, and he/she may want to stay away from effexor, since it had a higher rate of causing switches to mania in one study.

This is something I’d definitely refer to a specialist for. Usually a primary care physician is perfectly capable of prescribing an antidepressant, but for anyone with bipolar disorder and/or psychosis, I’d want them to see a psychiatrist.

dpworkin's avatar

I was under the impression that it was pretty dangerous, and that a mood-leveler like Lithium Sulphate was far preferable.

Dr_Dredd's avatar

@dpworkin In general, yes. But lithium alone won’t have that much of an effect on the depression part of bipolar. Lithium is better at dampening the mood swings so that the highs won’t be as high and the lows won’t be as low. But if there is a depression, usually something else has to be added.

Like I said, this is not something that should be taken lightly, and a psychiatrist should definitely be involved.

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