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Antidepressants and Suicide: The Rant

[Content Note: This is 618 words about suicide. If that’s triggering, there’s nothing you could enjoy in this post. Take care of yourself.]

Antidepressants do not cause suicide.
Antidepressants do not cause suicide.
Antidepressants do not cause suicide.

There’s plenty of reasons that people with depression don’t take anti-depressants (AD’s have uses for other psychiatric illnesses, but we’ll focus on depression here). For one thing, they’re only effective for about two-thirds of those who try them. The side-effects aren’t always fun either.

So what I’m saying is, not everyone takes or is helped by antidepressants. But, there’s also a dangerous trope that continues to circulate–that taking psychiatric drugs can cause you to commit suicide. Mercola (of course) is perpetuating it. Psychiatrist–sputter–Dr. Peter Breggin is saying it. And saying it again–this time to Congress.

Except…it’s not true.

So why this type of warning?

Prozac-black-box1

Here’s what we know. During the first few weeks of anti-depressant use, teens and children experience a slightly higher risk of attempting suicide. As of this time, no study has ever found antidepressants responsible for suicide, nor has any participant in studies of antidepressants ‘successfully’ completed an attempt. (FDA)

Why? Why just a brief risk period?

First, The Background. Suicidality comes in a few levels of risk:

-Ideation: This comes in a spectrum from not wanting to be alive to wanting yourself dead. It can vary from the occasional passing thought to invasive, pressing, and overwhelming.
-Planning: The thoughts have are specific. Varies from having a preferred method to  saving medications or buying a weapon. (Women tend to pick less successful methods, such as pills, men, more lethal. Women are far more likely to attempt, men are more likely to succeed.)
-Attempting: Some suicidal action is intentionally taken. This can range from making an intentionally unsuccessful attempts–such as taking too few pills to be lethal–to making every effort to die. Attempts do no occur in a vacuum;  one attempt makes a second all the more likely.

Okay. Back to depression. (This is not a cheerful post.)
People suffering from depression often find themselves without motivation–unable to muster the energy for friends, work, etc. Ally of Hyperbole and a Half has a long description and illustrations that cover it perfectly.

This gets really interesting when you look at the ways antidepressants begin to work in children and adolescents. Often, they experience heightened levels of activity and drive…while still feelings the emotions of depression. Then, more slowly, antidepressants decrease depression.

Which leads to a little bit of a common theory about why suicide risk go up in the first few weeks of teen AD use. Take Theoretical Jane:

TJ has been depressed for a few months. She can’t always bear to get out of bed in the morning, and feels like she’s sleepwalking through class. She’s had some thoughts about suicide, and considers it at least once a day. TJ starts taking Prozac. For the first couple of weeks, it’s just starting to get working. She still has suicidal ideation–but she also doesn’t have trouble with exhaustion or lack of motivation. So we have someone who doesn’t want to be alive, but suddenly has all the energy and drive to be able to do something about it. I think we can see where this would be a problem, yes? Luckily, Prozac starts to help with the depression fairly quickly, and our Theoretical Jane starts to feel better.

——-

So. There’s what we know, what we think causes it, and then blanket misinformation about a link between antidepressants and suicide. Antidepressants do not cause suicide. Yes, sometimes people who take antidepressants commit suicide. That might have to do more with why they’re taking them in the first place. Let’s stop making it harder for people to take them in the first place.

Comments

  1. says

    Hooray for all of this. I’ve often said over the years—and only partially jokingly—that some days my depression is the only thing that’s keeping me alive. And that’s exactly because of what you’re describing here: I have vivid ideas of suicide, but I’m just too fucking lazy to get up and do it. One of Dorothy Parker’s more well-known poems, “Résumé,” describes it concisely and with her typical dry wit:

    Razors pain you;
    Rivers are damp;
    Acids stain you;
    And pills cause cramp.
    Guns aren’t lawful;
    Nooses give;
    Gas smells awful;
    You might as well live.

  2. Kate Donovan says

    And I’ll say, again, I guess, since I haven’t here recently enough, that I do read these sorts of books. Kinda all the time. In fact, I grew up hearing with these ideas, and many others about alternative practice. I also don’t always agree with the medical/disease model of mental illness. I’m not the type of skeptic you’re railing at here. I spend my time, both personal and academic, immersed in the literature from both sides. So, please, provide more evidence than a pop anti-psychiatry book.

  3. says

    And I’ll say, again, I guess, since I haven’t here recently enough, that I do read these sorts of books. Kinda all the time.

    Claiming to have read them and actually fairly and publicly engaging with their arguments and evidence are two very different things.

    I also don’t always agree with the medical/disease model of mental illness.

    You shouldn’t ever agree with the brain disease model in the case of depression; it’s well known to be false, and it’s quite a harmful belief.

    I’m not the type of skeptic you’re railing at here.

    “Sigh” is railing now? You’re exactly the type of skeptic that convinces me that the community is just not ready to have this discussion, though it’s our moral responsibility to do so.

    I spend my time, both personal and academic, immersed in the literature from both sides. So, please, provide more evidence than a pop anti-psychiatry book.

    Like what, instead of several references? Anecdotes? Theoretical Janes? It’s pretty sad that these arguments are constantly met with dismissals in the form of ad homs, “ad books,” and just waving it all away. I would LOVE it if more people knowledgeable on the subject would fairly (and critically) take on these arguments. Contest the claims, debate the evidence, but don’t write on this important topic without attending to these powerful criticisms.

    Really, if skeptics can read Mad in America, The Myth of the Chemical Cure, and The Emperor’s New Drugs and not think we have to address these arguments seriously, I’ll be stunned.

  4. Kate Donovan says

    I’m sure I’ll have a discussion about Szaz/anti-psychiatry/etc at some point. This post is not it, and it’s existence doesn’t prevent me from further discussing anti-psychiatry. However, this post is specifically about the ways in which the black box warning is misperceived. Stay on topic, please, or comment on posts when I write about models of illness.

  5. says

    FFS. I won’t be commenting here in the future. If anyone is actually interested in engaging with this subject – and we all should be – they can follow my links above (they’ll note, I’m sure that none of the references are Szasz or “anti-psychiatry,” but critical psychiatry).

    So frustrating.

  6. Kate Donovan says

    Goodness. I don’t think you understood either point. Szasz wasn’t entirely wrong in all his ideas, but he is the father of the movement that spawned nearly all the of the books you cited. So yes, that’s how I would describe a post about it. Of course there’s nuance, and of course anti-psychiatry isn’t a nuanced name. But that’s what it’s colloquially described as.

    And yes, I do get to request that commenters stay on topic. This discussion is fine elsewhere, but not on this specific post. Feel free to do so on other posts, or not comment here at all.

  7. PatrickG says

    While I’ve been skeptical of the (some forms of) anti-depressant linked to suicide, I’m a bit startled to see absolutely no citation of, well, anything past the — um, what — substandard media reporting?

    I suffer from depression, I take antidepressants. I could come up with any number of initially plausible explanations for a correlation between suicide and pills, based on my own amateur knowledge of neurochemistry and psychiatric practice. Such as:

    – initial effectiveness followed by relapse, leading to increased feelings of despair/hopelessness/suicidal ideation.
    – causal misidentification, since depression is obviously linked to suicide (you note this in your post, of course).
    – depression in teenagers, already a difficult time, all that anecdotal data of extreme pressure on depressed kids (ah, those good old days) to snap out of it, do well in school, stop being dysfunctional, what have you.

    What I can’t do (because it’s not my field) is provide hard statistics and studies that actually examine propositions like that. I’m fairly sure you can, so I’m surprised you didn’t. While I’m not at all convinced that a substantial causative link exists between (some) ADs and suicide, an assertion of unevidenced fact isn’t exactly convincing either.

    But then, you identified it as a rant, so maybe I’m just being overly demanding. :) Or maybe I just missed other posts by you and my google-fu is weak?

  8. PatrickG says

    I do feel it worth pointing out that while more or less a pacifist by nature, after reading that HuffPo column I’m envisioning Dr. Breggin being staked out over a colony of fire ants with honey on various sensitive parts.

    I pity his patients, and anyone treated by someone he’s influenced.

  9. Kate Donovan says

    Ahaha,
    Okay, you get several things right. I didn’t cite mostly because I had a deadline for a second post, due every friday. I’ll add citations in a second, because you’re not the first to notice.

    However, as I tried to make clear, the theory I presented (which is not my theory–it’s fairly standard psych belief) is not particularly testable in an ethical way. We know that teens experience lots of sudden energy with the first few weeks of meds, but no depression relief until slightly after. The connection between this and the brief rise in suicidality is the theoretical part.

  10. J Lawrence says

    You realize that causation isn’t something we can’t prove one way or another without testing, but my hypothesis: Wrong. Anti-depressants can be a causative agent of suicide. I took prozac for six weeks, and ended up trying to kill myself. I have had similar experiences on other “anti-depressants.” I don’t believe my attempts or suicidal desires would have manifested themselves without these chemicals in my brain. Anti-depressants are dangerous to those depressed patients that are undiagnosed bipolar. They produce a polarity switch; the person ends up in a mixed state and are more likely to be violent to themselves or even to others.

    Since this is all probably uncommon, the much bigger question with anti-depressants is are they even effective? A study a few years back said that overall their effect size doesn’t separate well from placebo.

  11. Miche says

    Rubbish. I firmly and completely believe antidepressants, namely SSRI drugs – Zoloft, took me from being depressed & anxious, to suicidal in a matter of less than 2 weeks & climbing & falling over a balcony intentionally, which resulted in a combusted spine, near severed spinal cord, brain injury, 2 collapsed lungs & several other life threatening injuries. I DID NOT feel or experience suicidal feelings before taking Zoloft, it started immediately after, with which I experienced severe side effects, but was told by my doctor “You will feel worse before you feel better.” Yeah, I certainly did.

  12. Liv says

    I have to very firmly disagree. Antidepressants make me suicidal. Not that I am already suicidal and I suddenly have the energy to follow through. I go from being depressed and lethargic to being a depressed and suicidal and wanting to slice my skin off and cut my fingers off and stab myself, etc, etc. These are thoughts I ONLY have when taking antidepressants, and don’t go away after taking them for a few weeks, or a few months.

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