The Real-Life Risk Is Much Greater Than Described

The Real-Life Risk Is Much Greater Than Described 

In real-life medical practice, the rate of drug-induced suicidality will be much higher than in the research-oriented, controlled clinical trials. 

In actual practice, many patients are already suicidal when they are started on the drug, increasing the likelihood that the drug will push them over into self-injurious behavior. Similarly, in real-life clinical practice, compared to controlled clinical trials used for research, busy doctors provide much less supervision or monitoring, the patients are almost never tested or evaluated for suicidality, multiple drugs are often given at once, and the doctors know little about looking for adverse effects on the mind. 

Given that Paxil increased the rate of suicidality by more than 6 times in the drug company s controlled clinical trials, it will be considerably increased in actual practice. We cannot determine exactly how much greater the risk will be in clinical practice, but it will be much higher than in the brief, highly selective, and closely monitored controlled clinical trials. 

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