FDA Issues Warning on Antidepressants: Possible Suicide, Severe Depression, Anxiety, Panic Attacks in Children and Adults

"We specifically decided not to tell people not to use these drugs," said Katz. "We don't think that is necessary at this point."

Thats uhh... curious wording...

It's like pointing out a statistical correlation between marriage counseling and divorce. Just because it's true doesn't mean it's right.

xpost

I do wonder what led to such a high-profile announcement at this point
I think the studies have been known for awhile, but only recently the FDA made it an official release.

i've been on almost all of the major anti-depressants and many other crazy drugs and the only ones that have caused me any problems were paxil and zoloft. the former for physical and the latter b/c it made me too manic.

everyone's different and these are tricky chemicals to be messing with so I'm sure it some people it can have this effect (the increase of depressive syptoms). But for many people (including myself) life without ADs is very scary and it's worth the risk to see if it will help.

A few times I have decided to chuck the meds b/c I'm sick of everything that goes along with them but everytime I've done that I have nearly died. It's just not an option for me.

But is the adverse / extreme effect these drugs have on children that surprising? Kids seem to me emotionally and physiologically vulnerable (since they're, y'know, not yet fully grown), and any sort of drug that messes with chemical equilibrium is bound to have extreme results on subjects who are still in flux. Or is that a base assumption? Either way, I'd be curious to see the results of such a test on people 25 and over.

These warnings absolutely need to be on this medication. I have no doubt that they probably work great for some people but they have to be monitored far more than they have been; non-psychiatrists dole them out to kids in colleges like fucking aspirin. Honestly now I think people in late adolescence/early adulthood would probably benefit more from regular taking of st. john's wort and exercise.

OTM. When I tried quitting in January, i only got through early march before i broke down and got back on 'em. Totally impossible/crushing depression/horrible anxiety/lack of appetite... getting off that shit is dangerous, man.

one thing that most people can't seem to understand is that regulated dosage is crucial. especially with kids, who are usually somewhat ambivalent about being on them to begin with -- if you get going on them, then go off them for 5-6 days (forget them on a vacation & decide not to worry about it, etc.), you are going to be subject to some absolutely staggering mood shifts. likewise, if for a while you only take one every other day... or, take an extra one when you're feeling _particularly sad_ (which I've heard about people doing)...

I've been taking klonopin since, and it has been great, but unfortunately, it seems like its effectiveness is starting to die off (which I've been warned could happen) and the past week or so has been the worst I've had since before treatment, so I might be back on another SSRI pretty soon. I'm hoping the Tylenol and Advil I've been taking for my aching wisdom tooth and subsequent removal since the beginning of the year is the cause of the lack of klonopin effectiveness, and hopefully stopping the painkillers will make me better again.

Two successful trials out of how many trials? Answer: there are no limits, no current standards. To illustrate the problem, if you're a pharmaceutical company, let's say you do your first study and your drug does better than placebo. Then in your attempts to replicate, your next 6 studies produce zilch: you find absolutely no difference between drug or placebo (or who knows, maybe even a negative difference in favor of the placebo). Then, on the 8th try you luck out and your drug once again does better than placebo. BINGO! You've got your 'evidence' for FDA approval.

See also:

http://www.spiked-online.com/Printable/00000006DF68.htm

http://www.ahrp.org/risks/SSRIsuicide0204.html

http://www.journals.apa.org/prevention/volume5/pre0050023a.html

Kirsch is, obviously, a pretty controversial figure in the clin. psychology field. Saw him give a talk recently--great speaker, his talks are very provocative for debate and thinking about a complex issue

As more children pop pills for attention deficit and other behavior disorders, new figures show spending on those drugs has for the first time edged out the cost of antibiotics and asthma medications for kids.

A 49 percent rise in the use of attention deficit/hyperactivity disorder drugs by children under 5 in the last three years contributed to a 23 percent increase in usage for all children, according to an annual analysis of drug use trends by Medco Health Solutions Inc.

.....

The most startling change was a 369 percent increase in spending on attention deficit drugs for children under five. That's in part because of the popularity of newer, long-acting medicines under patent, compared with twice-a-day Ritalin and generic versions available for years.

Actually, 'pass' is vague...I meant to register a drug with the FDA

Withdrawal symptoms: Crying. Sweating. Physical pain. Crying. (i sat on a screned porch and wept for three days - when i wasn't gripped by physical pain.)

result: I am probably better off having gone to hell and back - but i still feel depressed. I know the triggers, i know the symptoms, and I know the results, so i get to make choices every day.

Conclusion: Don't take the pills without a second or third opinion! I almost died because of prozac - for me, it triggered very bad reactions. Don't ever let kids take drugs that are licensed for a developed brain - even Timothy Leary was old enough to give consent, and we still do not know the long range effects of these panaceas.
Post Script: Isn't it weird how a generation of American's were villified for taking drugs, only to insist their own children take drugs?.

http://health.yahoo.com/search/healthnews?lb=s&p=id%3A58200

Anytime I've tried not to take pyschotropic medications I've become dangerously ill so no longer think of ways to get off of them.

oh the irony

everyone should be on seroxat, then with all those violent urges the world would be like Streets of Rage

Do people really take SSRIs as a post-rave one-off? This is kind of weird to me given that every time I've been put on them I've just felt hell of sick and headachey and distant for the first two days, and I haven't felt any mood benefits for several weeks. Doesn't seem much fun as a one-off.

Is that report Kate posted upthread saying it's genetic the same report? The BBC television news went with the "they're all useless" tack, so I hope that is what the report said, or it'd be kind of irresponsible. I mean, I have no axe to grind for them (I'm pretty suspicious of them myself), but even if they are all useless, coming off that stuff cold turkey hurts; I'd hate to think of anyone chucking them in the bin because the TV said to or anything.

max and v4h1d - yes perhaps pills are a better treatment than being "opened and cut up"!!

by the way, euripides pants, i breaka you face

Sorry, I got that off the standard NHS news digest thing that gets posted around, so I don't know the source beyond what is quoted.

I think that the genetic link thing is important, and it seems bad science to me that it's not been as widely reported (if it is from the same study.)

Yes, I agree that anti-depressants are over prescribed. This isn't just the fault of pharmabusiness, it is also the fault of both the medical profession and people at large in not understanding that depression is not a one size fits all disorder. It can have many causes, and be a symptom of many other things, some physical, some situational, and often mixed. One patient's depression is not always anything like another patient's depression, and cannot be cured by the same thing.

This is one of the problems with having GPs prescribing anti-depressants rather than mental health professionals. (That said, even for the best of mental health professionals, it's still largely guesswork.)

My own personal experience that is that many of the psychopharmeceuticals I have formerly been on were useless to downright harmful. SSRIs have been one of the few drugs which have a noticable and almost immediate effect. They've been nothing short of a lifesaver for me. This does not appear to be a placebo effect, or the other anti-depressants would have had the same effect!

The two studies or reports together say a lot more about either by itself. Some mental illnesses are known to have a strong genetic component, including mine. It would make sense that certain medications would have effects on people with those genetic tendencies.

But it is ridiculous to assume that any medication will have a one size fits all effect on a condition as variable as depression. That's like expecting a single medication to have a blanket effect on a dripping nose, ignoring the fact that the symptoms of dripping noses can be caused by anything from colds to sinus infections to allergies to pneumonia to even just having come in from the cold.

Ben Goldacre sez: it's not a study on just SSRIs and it doesn't say they're no better than placebo.
http://www.badscience.net/?p=619 (mostly about general shenanigans w.r.t. scientific studies)

"general shenanigans" = drug companies burying internal studies that reflect poorly on their products

this is basically the type of thing that "the insider" was about

Yeah I didn't mean to downplay it, it's pretty dodgy stuff - just slightly OT.

"A paper in the New England Journal of Medicine dug out a list of all trials on SSRIs which had ever been registered with the Food and Drug Administration, and then went to look for those same trials in the academic literature. There were 37 studies which were assessed by the FDA as positive and, with a single exception, every one of those positive trials was written up, proudly, and published in full. But there were also 33 studies which had negative or iffy results and, of those, 22 were simply not published at all — they were buried — while 11 were written up and published in a way that portrayed them as having a positive outcome."

SSRIs have been one of the few drugs which have a noticable and almost immediate effect. They've been nothing short of a lifesaver for me. This does not appear to be a placebo effect, or the other anti-depressants would have had the same effect!

Um, not really.

ledge how is that off-topic? it's the whole point of this study! they managed to get access to the full range of experimental data that's been denied to others for years!

You present a convincing argument.

One of the more interesting topics that is popping up in the psychiatric literature are studies examining the engineering of randomized clinical trials used to compare drugs and placebo...drug companies and other experimenters are taking into account, when designing their drug trials, variables in the design of the study that may be associated with greater drug-placebo separation (e.g., the number of treatment conditions being compared, fixed dosing vs. variable dosing of medications), to bolster as much as possible the chances of finding a statistically significant effect in favor of the drug.

This isn't just the fault of pharmabusiness, it is also the fault of both the medical profession and people at large in not understanding that depression is not a one size fits all disorder. It can have many causes, and be a symptom of many other things, some physical, some situational, and often mixed. One patient's depression is not always anything like another patient's depression, and cannot be cured by the same thing.

I think this is a really important point to remember, and I'd say not just with depression, but just about any mental disorder (though depression is probably the greatest example of it). One size does not fit all. I think the biggest mistake in view people can make, and understandable to certain degree because its can often be such a 'hot' issue emotionally for them, is that if they attribute a certain explanation for why they have a mental issue, then that must be the etiological explanation for everyone, or if they have successfully coped with a mental health issue by a certain means, then that must be the mechanism everyone else should use to cope with the same mental health issue as well.

cf. Tom Cruise and ADHD :-)

SSRIs do not provide a one-off benefit, they take weeks to be absorbed into your system and take effect, and it's actually fairly dangerous to go around taking a high dose once in a while. So any post-rave benefits are (lol) actually just a placebo effect.

Actually, there is some research emerging in the psychiatric literature challenging the 'weeks and weeks to take effect' or "downstream" notion of antidepressant efficacy (this notion was based on studies from a psychiatric research group at Columbia in NYC)--that if you are a psychiatrist prescribing antidepressants, and you don't see any effect within the first week (or two max? can't remember), then likely (not DEFINITELY--but likely) you will not be seeing an effect in the subsequent weeks (the implication being that you should be already then considering an alternative strategy).

but that still doesn't lend any credence to "oh I just take one after taking E on the weekend and it works," does it?

not trying to be condescending, my first post was just parroting what my doctors have told me so I'm not trying to claim any serious medical knowledge.

but that still doesn't lend any credence to "oh I just take one after taking E on the weekend and it works," does it?

Oh definitely not. :) No worries/no condescension taken-- the 'weeks and weeks' view is probably what is in all the psychiatry textbooks and what is currently still being taughtto med students, so your doctors are only going on what has long been passed on for years and years.

For any interested in reading more about the topic, here is the 'emerging research' I was alluding to in the above posts:

Journal of Clinical Psychiatry (2005), Volume 66 (2), pages 148-158.
(there is a critique/response about this article in a later volume)

Archives of General Psychiatry (2006), Volume 63 (11), pages 1217-1223.

link to an australian broadcast about this, interviewing a guy from the black dog institute: http://www.abc.net.au/newsradio/audio/mp3/20080227-depress.mp3

it's about seven minutes. a summary:
He feels this latest bit of research is flawed.

The flaw: the research studies that find no difference to placebo are randomised control trials and for ethical reasons, randomised control trials are more inclined to rule people out than in: in other words, no one is included if they are suicidal, if they ill enough to be an inpatient, if they have anxiety, other personality or psych. issues. And people are paid for their participation. So they aren't representative of people suffering depression. They represent only a portion of people suffering fairly mild depression with zero complications.

He likens it to testing a drug for pneumonia on people suffering from a cold.

sadly for many of us the withdrawal symptoms are widely effective in making you feel worse than you've ever felt

yep. it sucks. i have never gone much more than 24 hours and that alone is so terrible.

That's fucked-up. I'm sure the vast majority of people working on the ground floor developing these drugs and psychiatrists trying to help their patients, etc. all mean well (big pharma marketing, OTOH, I feel fairly cynical about), but, geez, so many of the side effects and withdrawal symptoms are positively alarming. I'm glad that many people report finding relief through these types of drugs, but man...there is such a hubris centered around western medical science, and how it represents THE BEST WAY for dealing with all of humanity's ills.

Yes, the Western medical tradition does fantastic, amazing stuff in certain contexts, but, in the realm of the psyche, esp. with stuff like "depression", I sometimes get the impression that they zero in on a different target neurotransmitter or combination thereof every few years, and then try to hammer away at having either more or less of it pass over the synapses.

I dunno...

It just seems so clumsy and one-sided and reductionistic.

the withdrawal is one of the only things keeping me on them. i feel like i would need to take a month off of work because i am definitely not functional in this state, or pleasant to be around. and possibly do it in a medical facility. i have been on the same ssri for almost 10 years though. i will do it if it's ever the right time, i guess, but it never has been. and it's not like it makes me happy all the time, it just cuts out the low-end of depression, so maybe i really do need to be on it?

i just worry that i will end up pregnant or something and have to go off them immediately, and that is pretty scary. not that that is anything i plan to do anytime soon but it's weird to think about.

just let me know when happiness itself is recognized as the pathological condition and not the other way round

Friend of mine on them for two years only cut his dose by a quarter and had really bad withdrawal symptoms, it's crazy.

xposts

Well, I hope you have a cool enough psychiatrist to be able to talk honestly about your concerns as far as all of that goes. If not, then shop around.

Ten years is a long time. I don't know if you've tried this, but maybe tapering off in minor increments, unhurriedly, would help with the process?

Do you need to be on it? Of course no one knows likely but you, but if you could taper off all slow-like, then maybe you could meanwhile further investigate whatever things/patterns help you avoid languishing in the depression zone.

just let me know when happiness itself is recognized as the pathological condition and not the other way round

Tombot!!

http://en.wikipedia.org/wiki/Brain_shivers

ugh why do i keep reading about this stuff? sounds more and more dire. people report the withdrawal symptoms lasting a YEAR.

That's gotta be crazy rare, though. Talk to your doctor about titrating down. Also, here is lots of advice w/links to medical journals et al on the subject (SSRIs and anticonvulsants, both of which I take ever morning).

http://data.tumblr.com/fSymsOGXO5o1jh6juGmTLLOv_500.jpg

vs.

http://www.joshreads.com/images/07/06/i070627popeye.jpg

CLANK!

also why is jon having chopped cock for dinner

(hint: it's his own cock.)

http://content.ytmnd.com/content/4/9/1/491e9e5c95c75d411b69509f70ebe874.gif

NOOOOOOO, why did you post that????? I've seen it before, but, agh, so heartbreaking

i ran out of my scrip for Lexapro at the end of january, and have been too lazy to go to psychiatrist or gp to get a new one, so i just stopped taking it. other than brain zaps and shit like that, i feel perfectly fine-- any depressive runs have been due to unfortunate circumstances, not the lack of pills.

this is just me, though. luckily, i'd been weaning myself by cutting my pills in half, mostly because on the full dose i could not ejaculate during sex...or i could, but it would take a lot of fucking work down there to reach climax.

that said, i think i should start taking Lexapro again. just a hunch.

never had any weird fatty issues, though. i've pretty much stayed the same weight since i was 15, though.

though though though

sorry.

when i tried to stop taking lexapro i became immensely tired, had near-constant stomach cramps/pangs of nausea, and almost zero appetite.
i've migrated to celexa now, and will sometimes take half pills if i want to put off refilling for a while, and that doesn't seem to affect me toooo much, but if i miss more than, say, three days, things start to get nutty.

i'm on fluvoxamine. i seem to do ok on it. i don't want to mess with it. if i miss a day or two i get really mean.

citalopram is horrible shit

seroxat is also awful

I'm on prozac and it's helped my mood a lot. However it hasn't really helped my level of motivation, so I'm still doing just as poorly in school as I was when I was depressed. Feels great though!

i don't think i have any side effects from effexor and it does seem to help. but my only point of comparison is to when i was 16 since i've been on various drugs for so long, so i barely remember what it feels like to go without it.

every time i've talked about going off it with my doctor, he just suggests going straight on to something else.

complaining about this makes me feel sad-sacky but i do really wish someone had told me at 16 what i was getting in to.

at 16, everyone and their brother was telling me how antidepressants could bring out "the real me" and totally change my life. fuck you, people.

The flaw: the research studies that find no difference to placebo are randomised control trials and for ethical reasons, randomised control trials are more inclined to rule people out than in: in other words, no one is included if they are suicidal, if they ill enough to be an inpatient, if they have anxiety, other personality or psych. issues. And people are paid for their participation. So they aren't representative of people suffering depression. They represent only a portion of people suffering fairly mild depression with zero complications.

He likens it to testing a drug for pneumonia on people suffering from a cold.

It is very much true that the generalizability of RCT findings due to the people enrolled is a big concern--these trials tend to obtain 'cleaner' depression than one might see in the real world, due to these studies' exclusion criteria as mentioned.

To be fair, though, I think it's overstating to say that the typical RCT for depression only ends up getting mildly depressed people. I'd say the average participant is 'moderately' depressed (as defined by depression scales), and a portion are severely depressed but without suicidal ideation, or are severely depressed with suicidal ideation but not at imminent risk for acting on it.

As an aside, re: the pneumonia/a cold analogy, I recognize the person is using that as a metaphor, but I think partly the reason psychiatry has not made the progress it needs to make in studying and treating depression, as well as some other mental health disorders, is its stubborn (see "hubris of Western Medicine" above) attempts to shoehorn the phenomenon to fit into the standard medical/disease model, as if it was a condition that is directly translatable (conceptually) to other physical illnesses like the flu or high cholesterol or diabetes.

every time i've talked about going off it with my doctor, he just suggests going straight on to something else.

well of course, psychiatrists don't get to go on junkets at the expense of representatives from trader joe's, liquor companies, etc

I'm sure if ben & jerry's would provide loads of free pens and notepads and deep sea fishing opportunities you'd find many new flavors of therapy available

I'm sorry, I'm being a prick on this thread, I'm out

I'm feeling equally pissed at and cynical about the medication- and non-medication-based psychotherapy industries this week.

joe, i didn't see it that way at all. mental illness is in no way simple, and the comparison to physical illnesses was trying to address the severity of the average sufferer as opposed to the mild(er) cases being studied. the results do very little for anyone as a result, if the researchers aren't starting with a strong and accurate definition of what they're studying. i've seen the same disconnect in the research for little-understood physical illnesses--by using a broad definition that doesn't really represent the illness, scientists come up with study results that are totally irrelevant to the people that have the illness in one of its more typical (and generally, severe) incarnations.

the comparison to the flu is just making a point in a way that's easily understandable to everyone--the flu, of course, is much more simple on a physiological level than mental illness (though, hell, there's plenty they don't understand about the immune system and its interaction with viruses, either). they're aiming to study complicated and severe stuff, and the test subjects they use tend to have much simpler situations, and it fucks everything up.

i might be talking out of my ass, though. i feel strongly about this shit because i see these sort of pointless studies done time and again for my own physical illness. it seems like an oft-occuring problem for complicated and little-understood illnesses, be they mental or physical--they're trivialized because of studies that aren't studying the real thing! (i might be blathering on because of how i feel about certain medical studies and their massive glaring flaws, and how it's disturbing to see that happening with other disorders as well.)

but enough of all of that--has anyone been on wellbutrin longterm and successfully gone off of it? i wish i was still seeing the shrink who put me on it for off-label reasons--it gradually stopped working but i was afraid to go off it because of fears that maybe it was still working in tiny subtle ways. now i'm sick to death of taking pills every morning that feel essentially pointless, but when i try to decrease even in incredibly tiny increments i become scary scary levels of depressed--i'd never felt that way before being on the drug. it doesn't help that i'm ridiculously sensitive to drugs of all kinds. i haven't touched the dose for a year or so because of fear of withdrawal. it'll probably take me years to get off it, and i have no idea when my physiology/brain chemistry will be resilient enough to handle any decrease in dose. it really gets to me.

they put me on prozac during a depressive spell in my teens. it made me sleepy without changing my mood, and i went off it. therapy seemed to be helping, so i didn't go on any other drugs, since i wasn't particularly severe in my depression. i am so glad that i had a doctor who actually discerned between what was needed and not individually, rather than just throwing pills at an angsty teenager.