From a Black Box into a Black Hole
When is nine greater than 36? Hey, I'm no mathematician, but I'm pretty sure the answer is "never." But you'd never know it from reading the news coverage of a recent study on the link between antidepressant use and suicide.
The study, published in the December issue of the Archives of General Psychiatry, was conducted in Finland. For nearly three and a half years, the researchers tracked over 15,000 people who had been hospitalized for attempted suicide. The data showed that while antidepressant use reduced the risk of completed suicide by about nine percent, it also increased the risk of attempted suicide by as much as 36 percent.
Most of the news reports chose to focus on the small reduction in completed suicide risk. But I'd argue that the attempted suicide data was far more significant - and not just because 36 is greater than nine.
We've known for some time about the link between SSRIs and suicidal behavior. A few years ago, the FDA even acknowledged the risk, requiring manufacturers of SSRI antidepressants like Prozac, Celexa, Zoloft, and Paxil to add a "black box" warning to the drug's label. (SSRI stands for selective serotonin reuptake inhibitor, which describes how the drug acts on the brain's "feel-good" chemical, serotonin.)
But this new research does more than confirm the SSRI-suicide connection.
It also validates the controversial point that isn't included in the black box warning: that new SSRI users are particularly susceptible. The researchers found that the risk of attempted suicide was even higher - 39 percent among people taking antidepressants for the very first time.
Plus, the data revealed SSRIs aren't the only antidepressants with a suicide link. In fact, the strongest link was found with venlafaxine hydrochloride (Effexor), an antidepressant in another drug class entirely. (Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI), meaning it affects two brain chemicals, serotonin and norepinephrine.) In this study, subjects taking Effexor were 61 percent more likely to attempt suicide than subjects not taking any antidepressant drug. (Last time I checked, 61 is greater than nine, too.)
Sure, any reduction in completed suicide is positive. But I can't imagine any family being comforted by the fact that their loved one isn't likely to die from the suicide attempt caused by their antidepressant. There's simply no way to minimize the impact of an attempted suicide. And a 36 percent increase in risk is significant, no matter how you slice it.
Critics will argue that the subjects in this study had all attempted suicide before, so they were more predisposed to suicidal behavior than the general population. And they'll point to the millions of people whose lives have been changes for the better by SSRIs and their ilk.
Valid points both. But the data are still worthy of our attention - especially since antidepressants continue to be some of Big Pharma's best sellers.
Yes, sometimes people with major depression need prescription antidepressants. But there are millions more who are being given these drugs to treat mild to moderate depression (what I call "the blues"). This is completely unnecessary -- research and experience have shown time and time again that that type of problem can be successfully treated with far safer approaches like nutrition, exercise, mind body approaches to stress reduction such as deep breathing, meditation and biofeedback along with cognitive behavioral talk therapy (CBT). And while suicidal impulses are by far the most serious potential side effect of these drugs, it's certainly not the only one: others include depressed libido and weight gain. (Both bound to make you feel better about life, right?)
When a patient comes to me with "the blues," I tell them to cut back on sugar and caffeine, start exercising, and consider talk therapy. I also recommend trying safe, natural supplements like rhodiola, omega-3 fatty acids, folate and SAMe. In nearly every case, these changes are enough to make a difference.
If you're currently taking an SSRI for mild to moderate depression, don't stop taking them without talking to your doctor. Sudden withdrawal from these drugs can be dangerous. And again, more serious cases of depression often require these types of drugs. But if you'd like to try to address your milder mood issues in other ways, talk to your doctor about how to wean yourself off your antidepressant. Unlike with these drugs, you have nothing to lose from making some lifestyle changes - and whole lot to gain.
