Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antidepressant-suicidality FDA advisory in light of declining national suicide statistics from many countries

Department of Psychiatry, University of California, San Diego, San Diego, California, United States
Journal of Affective Disorders (Impact Factor: 3.71). 09/2006; 94(1-3):3-13. DOI: 10.1016/j.jad.2006.04.003
Source: PubMed

ABSTRACT Given that suicidality is a well-known symptom and outcome of untreated or inadequately treated depressive illness, the United States (US) Food and Drug Administration (FDA) warning of emergent suicidality in children and adolescents based on the antidepressant arm of placebo-controlled randomized trials (RCTs) has created understandable concern in clinical practice. The issues involved are of broader public health importance for all age groups. As in other branches of medicine, psychiatrists must always be vigilant of the rare risk of iatrogenesis when prescribing potent agents like antidepressants for patients with depressive disorders where the risk of suicidality is inherent. The overall evidence we review suggests that the widespread use of antidepressants in the new "SSRI-era" appear to have actually led to highly significant decline in suicide rates in most countries with traditionally high baseline suicide rates. The decline is particularly striking for women who, compared with men, seek more help for depression. Recent clinical data on large samples in the US too have revealed a protective effect of antidepressant against suicide. We argue that the discrepancy between RCTs (in children) and national and clinical suicide statistics (in adults) may reside in new provocative data documenting high rates of unrecognized pseudo-unipolar mixed states particularly in juvenile, but also in adult, clinical populations. Such an interpretation accords well with equally provocative data that bipolar II (which is often "mixed" in nature) may well represent a particularly vulnerable clinical substrate for suicidality. In this respect, the widespread (at least in the psychiatric sector) augmentation of antidepressants with benzodiazepines, atypical antipsychotics or mood stabilizers may represent one situation where current practice is superior to evidence-based medicine. We conclude that rather than being a threat, the judicious clinical use of antidepressants actually does serve to effectively treat and indeed protect depressed patients from suicidal outcome. The fact of being in treatment with regular clinical follow-up appears beneficial as well.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Only a few studies have investigated the factors associated with suicidal behavior after antidepressant treatment onset in adults. We examined the specific predictors of de novo suicidal ideas or attempts among depressed patients in the community, including subjects potentially at risk of suicidal behaviors, who initiated a new antidepressant treatment. Methods A large set of GPs and psychiatrists throughout France followed-up, for 6 weeks, 4,357 outpatients for whom an antidepressant drug was prescribed. Dimensions related with antidepressant-induced suicidal events, such as depression, anxiety or hopelessness, were assessed longitudinally using univariate and multivariate approaches among subjects with treatment-emergent suicide ideation or attempts. Results New suicidal ideas were observed in 9% of patients with no suicidal ideation at baseline (n=81), while suicidal attempts were reported for 1.7% of the sample during the 6-week observation period (n=75). The onset of suicidal ideas and attempts was associated with the initial features of the patients (baseline level of anxiety, past history of suicide attempts and alcohol misuse) and the non-improvement of depression. Worsening of depressive symptoms during the follow-up increased the onset of new suicidal ideas (OR=5.67, p<.001) and attempts (OR=2.60, p=.002), corresponding to 67.5% and 56.5% of attributable risk respectively. Conclusions When the analyses are restricted to the occurrence of suicidal ideas or attempts, the link between antidepressants and suicide risk might be more adequately explained by a poor response to antidepressant treatment rather than by a direct trigger-effect. This naturalistic study is limited by the use of non-structured diagnoses and self-report outcomes.
    European Neuropsychopharmacology 10/2014; 24(10). DOI:10.1016/j.euroneuro.2014.07.007 · 5.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This report focuses on the application of different proteomic techniques in diagnosis and treatment of psychiatric disorders such as major depression, suicidal behavior, schizophrenia, and attention deficit/hyperactivity disorder (ADHD). Firstly, we briefly describe different analytic approaches that can be applied for the discovery of specific biomarkers for diagnosing the above disorders, as well as for monitoring the effect of their treatment. Secondly, we discussed the types of biomarkers in general used in biomedicine for characterizing different disorders and diseases. Next, the potential applications of these biomarkers for diagnosing and managing major depression, suicidal behavior, schizophrenia, and ADHD are discussed in details. Forensic aspects of these biomarkers for the above disorders are also considered. Finally, we discuss the potential of specific biomarkers for distinguishing between comorbid psychiatric disorders in clinical setup as well as their potential for understanding mechanisms underlying the disorders and in discovery of new treatment strategies.
    Advances in Protein Chemistry and Structural Biology 01/2014; 95:283-315. DOI:10.1016/B978-0-12-800453-1.00009-9 · 3.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The process eγ → eZγ∗ is studied in e+e− collisions with the OPAL detector at LEP at a centre of mass energy of √s = 189 GeV. The cross-section times the branching ratio of the Zγ∗ decaying into hadrons is measured within Lorentz invariant kinematic limits to be (4.6 ± 0.9 ± 0.6) pb for hadronic masses between 5 GeV and 60 GeV and (1.5 ± 0.3 ± 0.3) pb for hadronic masses above 60 GeV. The spectra of the Mandelstam variables ŝ, t̂, and û are also measured and compared with the predictions from the Monte Carlo generators grc4f and PYTHIA.
    Nuclear Physics B - Proceedings Supplements 03/2000; 82(1). DOI:10.1016/S0920-5632(00)00188-2 · 0.88 Impact Factor


Available from