Sunday, November 21, 2004

Antidepressants and Suicide

The New York Times Magazine has a good overview of the possible link between antidepressants and pediatric suicide:

In the first several weeks of treatment, antidepressants can cause activation and this can increase suicide risk. In general, antidepressants over the longterm decrease the risk of suicide:

"The pharmaceutical companies are clearly making a product that most psychiatrists consider critical to treating depressed adolescents. Not prescribing these drugs may very well pose a greater threat than prescribing them. Studies have shown that areas in which antidepressant use among young people is widespread have experienced a dip in teenage suicide rates; according to Dr. John Mann, a suicide expert at Columbia University, fewer than 20 percent of the 4,000 adolescents who commit suicide in America each year are taking or have ever taken antidepressants."

Each patient responds to an differently to an antidepressant, and he must be monitored closely for side effects. My adult patients often need to take benzodiazepines such as klonopin or ativan to treat the anxiety, jitteriness, and activation that can be experienced during the first 1-2 weeks of antidepressant treatment.

Child and Adolescent Psychiatry is a difficulty field (which is one of the reasons that they make about $50,000 more per year than us general psychiatrists). There is currently a shortage of Child and Adolescent Psychiatrists. The new FDA black box warning on antidepressants and suicide is going to make pediatricians and family practitioners less willing to treat behavioral problems in children:

"while many child psychiatrists are unlikely to change their attitude toward S.S.R.I.'s, most pediatricians and general practitioners, who until now have written the bulk of these prescriptions, no doubt will. This could mean a lot of untreated children. There are only 7,400 child and adolescent psychiatrists in America; even in areas with high per-capita concentrations, the average wait to see one is six weeks. There is also the matter of cost. Many child psychiatrists charge steep hourly rates that are only partly offset by health insurance providers."

Part of my job as the Consult Psychiatry director at the U of MS is performing consults on pediatric patients (we have a shortage of child psychiatrists and our few child psychiatrists are not available to perform inpatient consults). Due to the legal risk, I now limit myself to triage of pediatric patients who I am asked to see for depression- I basically determine if the child needs transfer to a psychiatric ward or if he needs outpatient treatment with a child psychiatrist (of course, just recommending outpatient child psychiatric follow up doesn't ensure that it happens- it's a broken system out there, and not every child receives the help that he needs). With the current legal climate, I would never myself initiate treatment with an SSRI on a pediatric patient.


Jersey_Lily said...

My niece (who is 30) called me not long ago to ask my advice about this topic. She, like all of the women in my family, suffers from depression and is taking Zoloft. She wanted to stop when she heard this news. I told her that all patients who are starting an antidepressant regimen (which she wasn't) must be monitored carefully because sometimes their ability to formulate and carry out a plan returns before their overall mood improves. I also told her that these studies were primarily about adolescents. I read an article about teenagers many years ago that I clipped and kept. It described how much activity goes on in the adolescent brain as it destroys and builds new neural pathways and how teenagers need as much sleep as a small child, not less. My son wasn't all that happy to be going to bed at 9:30 in high school, but the article had a lasting impact on me. When I lectured my teenage son about alcohol, I used the same ammunition - that at his stage of physical maturity it would be dangerous in more ways than one. Now that he is in college, I remind him that alcoholism runs in the family. He drinks a bit but so far it seems to be well below the level that I did. I wish that we would recognize how vulnerable teenagers are to all kinds of chemicals - whether prescribed or not. I read an incredibly sad blog today about a family whose son died when riding with a friend who had been drinking. We lose far too many children in too many senseless ways. I applaud your caution in prescribing for children. I hope others are doing the same.

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1. Stand up straight, sit up straight. When your body is in alignment your energy can flow and when your energy is flowing freely, you can flow.

2. Smile! Yes, just smile. Easy to do and effective.

3. Repeat positive affirmations. Things like "I feel good", "Positive energy flows through my body", "I see the good in all".

4. Listen to some music that you like. It doesn't have to be anything specific, just something you enjoy. Certain types of music work better than others, but experiment and see what works for you. Studies have shown that Classical music and new age music work best.

5. Take some time out for yourself, relax and read a book, do something for yourself.

6. Meditate. Meditation is an excellent habit to develop. It will serve you in all that you do. If you are one who has a hard time sitting still, then try some special meditation CDs that coax your brain into the meditative state. Just search for "Meditation music" on Google or Yahoo and explore.

Our outside work is simply a reflection of our inside world. Remember there is no reality just your perception of it. Use this truth to your advantage. Whenever you are sad, realize that it is all in your mind and you do have the power to change your perception.

These tips will lift you up when you are down, but don't just use them when you are sad or clonazepam anxiety . Try and practice them everyday, make them a habit. You will be surprised at how these simple exercises will keep the rainy days away.

On a final note, if you are in a deep depression that you can't seem to shake, please go see a doctor. This is your life and don't take any chances. clonazepam anxiety

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