results of 2003 antidepressant warnings

From Psychiatric News: Diagnosis, Treatment of Youth for Depression Fell After FDA Alert

It’s not just that children and adolescents are less likely to be prescribed SSRIs following the alert – it’s that they’re now less likely to be diagnosed and less likely to be treated at all (there has been no corresponding increase in psychotherapy, atypical antipsychotics, or anxiolytics).

You can view the original journal article here.

In the article they suggest it’s possible that in the wake of the recommendation families may not be fully disclosing symptoms, or filling prescriptions written for them.

They also note that the rates of diagnosis are lower than the published incidence rates (i.e. how many people get diagnosed if you go and look and see, instead of only diagnosing people who come to you). So it’s unlikely that we used to be overdiagnosing and overprescribing, and likely that we are now even further underdiagnosing and undertreating.

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4 Responses to results of 2003 antidepressant warnings

  1. Michael says:

    The warning on antidepressants is about as useful as the homeland security color system, and about as prone to cause panic. Here’s what we really need to know:

    * How long is the window in which there’s a heightened risk of suicide?
    * Who becomes suicidal? Is it people who were already on the edge of being suicidal, or does it come out of the blue?
    * Is it like normal suicidality, with all the suicidal thoughts a person can report, and all the warning signs? Or do people just up and kill themselves?

    And most critically:

    * How does the risk of suicide from starting antidepressants compare to the reduction in risk from successful medication? Is the overall suicide rate increased or decreased?

    Of course, it’s a very strong human tendency to favor sins of omission over sins of commission, so it would be an uphill battle to get parents and kids to accept the idea of taking a drug that might cause suicide, even if the probability-weighted outcome is that it would _prevent_ suicide. But it’s a start.

  2. Michael says:

    You know what would be another start? Finding the motherfuckers who decided to originally cover up these findings, giving them a long perp walk by a crowd of parents whose kids died because they didn’t have warning that SSRIs can increase suicidality, and locking them up long enough not just to account for those deaths, but for all the deaths and suffering caused by the loss of public trust in antidepressants and psychiatry.

  3. Meredith says:

    I completely agree with Michael’s points and questions. Also, I’d add, does this take into consideration bipolar adolescents and young adults who were misdiagnosed, placed on SSRIs, and subsequently became suicidal, as happens quite commonly under those circumstances? I’d say that it probably does, as many of those misdiagnosed patients either successfully kill themselves, or their doctors don’t ask the right questions afterward. I say that because I was one, a little over three months ago. I’m lucky to be sitting here blogging about it. I was diagnosed with severe depression, placed on Zoloft, and let go. No questions about mania or hypomania. Within a week, I was on the psych ward after I’d attempted suicide. Turns out I’m bipolar II. According to one of my bipolar books (I think it’s in The Bipolar Handbook), over half of all bipolar patients were similarly misdiagnosed, and since bipolar disorder tends to onset around adolescence/early adulthood, there could be a lot of young people with similar problems. So, I definitely think another point should be added to the list of questions: Are we even sure we’re diagnosing the correct disorder?

  4. resonance says:

    Michael:

    Yeah. An “oh my god this might kill people but we don’t know who when or how” warning isn’t very useful. And absolutely agreed that we need comparisons between negative results of antidepressants and negative results of depression (and positive results of antidepressants ought to weigh in there too).
    And yeah, kick the drug company employees who make decisions about cover-ups in the nuts. Hard.

    Meredith:

    I’ve wondered that myself. Despite the controversy surrounding antidepressants and youth, and the controversy surrounding pediatric bipolar diagnoses, they don’t seem to get connected much! I think I saw it mentioned once in a NY Times article, but I’m unaware of it receiving any other popular attention.

    I’m a mod over at crazyboards and I think well over half the new people with bipolar that we get have a similar story…

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