Suicidality from antidepressants

The real chilling experiment has been the drugging of millions of America s children with toxic so-called antidepressants, with no proven efficacy and with proven adverse effects, including mania and suicidality. Of course, it should be hoped that the change in label reduces the number of children exposed to these drugs. As for the empirical question concerning any potential increase in youth suicide from a reduction in antidepressant use, it is hard enough to draw conclusions from... 

Damluji and Ferguson (1988) reviewed paradoxical worsening of depressive symptomatology caused by antidepressants in an article of the same title and reported four cases of their own caused by the older antidepressants amoxapine, desipramine, nortriptyline, and trazodone. The APA National Task Force on Women and Depression (1990) report on benzodiazepines also cited the problem of depression and suicide from tricyclic antidepressants. 

The full spectrum of depressive symptoms including depressed mood, anhedonia, lack of energy, and even suicidal thoughts may strike as many as 25% of patients who experience a TBL Depression in these patients not only exacts a tremendous psychosocial toll but also interferes with their participation in physical and occupational rehabilitation. As a result, long-term functional recovery from TBl can be sorely compromised by depression. Potential treatments for post-TBl depression include conventional antidepressants and stimulants (see Table 12.1). 

Apart from symptomatic, general measures (gastric lavage, cooling with ice water), therapy of severe atropine intoxication includes the administration of the indirect parasympathomimetic physostigmine (p. 102). The most common instances of atropine" intoxication are observed after ingestion of the berry-like fruits of belladonna (children) or intentional overdosage with tricyclic antidepressants in attempted suicide. 

Imipramine (Tofranil) [Antidepressant/TCA] WARNING Close observation for suicidal thinking or unusual changes in behavior Uses Depres-sion, enuresis, panic attack, chronic pain Action TCA t CNS synaptic serotonin or norepinephrine Dose Adults. Hospitalized Initial 100 mg/24 h PO in doses T over several wk 300 mg/d max Output Maint 50-150 mg PO hs, 300 mg/24 h max Peds. Antidepressant 1.5-5 mg/kg/24 h daUy-qid Enuresis >6 y 10-25 mg PO qhs T by 10-25 mg at 1-2-wk int vals (max 50 mg for 6-12 y, 75 mg for >12 y) Rx for 2-3 mo, then tap Caution [D, /-] Contra Use w/ MAOIs, NAG, acute recovery from MI, PRG, CHF, angina, CVD, arrhythmias Disp Tabs, caps SE CV Sxs, dizziness, xerostomia, discolored urine Interactions t Effects W/ amiodarone, anticholinergics, BBs, cimetidine, diltiazem, Li, OCPs, quinidine, phenothiazines, ritonavir, verapamil, EtOH, evening primrose oil t effects OF CNS depressants, hypoglycemics, warfarin T risk of serotonin synd W/MAOIs 4-... 

Stone M, Jones L. Clinical review relationship between antidepressant drugs and adult suicidality. Avaible from URL http //www.fda.gov/ohrms/dockets/ac/06/ brieflng/2006-4272bl-index.htm, 2006. p. 31. 

In patients receiving antidepressants for acute major depression, the initial therapeutic response is often delayed by several weeks. Patients with severe anxiety or insomnia may benefit from the concurrent, time-limited use of a benzodiazepine or short-acting hypnotic (Chapter 3). A patient may initially experience a return of energy and motivation while still having feelings of hopelessness and excessive guilt. Such patients may be at an increased risk for suicide because a return of energy in an extremely dysphoric individual may provide the impetus and means for an act of self-destruction. 

The best-known products come from the amphetamine group (see Table 1.12) Dexedrine1 1 (generic name d-amphetamine) and Pervitin 1 (methamphetamine) were particularly used in the 1950s and 1960s as stimulants and also as appetite suppressants, but today play hardly any role in medical practice. Ritalin (methylphenidate) has some relevance its psychostimulant action is said to be weaker than that of amphetamines and it is apparent ) less abused than the latter. Because methylphenidate also possesses mild antidepressant activity, in some countries it is used to combat not only narcolepsy and ADHD but also mild depressions without suicide risk (Satel and Nelson, 1989). 

Isacsson, G., Boethius, G., Bergman, U. Low kvel of antidepressant prescription for people who later commit suicide 15 years of experience from a population-based drug database in Sweden. Acta Psychiatr. Scand. 85, 444-448, 1992. 

Coppen et al. (191) evaluated the status of 104 bipolar or unipolar recurrent patients after 10 years of lithium maintenance to assess mortality rate, in part because of reports indicating unusually high rates, with many deaths attributed to suicide. Compliance was very high, with only 6% discontinuing lithium therapy, and patients also received adjunctive antipsychotic and/or antidepressants when clinically indicated. No patient died of suicide during this period, in contrast to the results in lithium noncompliant patients. The authors concluded that the absence of suicide resulted from the significant reduction in morbidity achieved by the careful administration of lithium. 

A serious complication of PD is the abuse of sedatives and alcohol through attempts at self-medication. In several studies, those who did well on antidepressants did not return to alcohol or drug abuse, but those in the control groups, not maintained on medication, often returned to a level of drug abuse that eventually necessitated rehospitalization. Another complication is the risk of suicide, which may be as high in patients with PD as in those suffering from a major depressive disorder (3, 4, 5 and 6). 

Note that this conclusion concerning antidepressants in general ignored the Paxil data published in May 2006 by GlaxoSmithKline indicating an increase in suicidality in all ages for adults suffering from Major Depressive Disorder. 

In general, the pattern of adverse reactions is similar among all the SSRIs and some of the other new antidepressants that block the reuptake of serotonin, especially venlafaxine. As a result, the FDA has required class label warnings for them in regard to suicidality and to the array of stimulant adverse reactions, from agitation and hostility to mania. 

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