Safer Antidepressants Do Not
Prevent Self-Harm, December 28, 2000
NEW YORK (Reuters Health) - For the most part,
antidepressant medications called SSRIs
[Fred A. Baughman Jr., MD:
Selective serotonin re-uptake inhibitors]
,including
Prozac, tend to be less toxic than older tricyclic
antidepressants
[Fred A. Baughman Jr., MD:
TCAs]
, making it harder to overdose on the
drugs.
[Fred A. Baughman Jr., MD:
Here, we have the SSRIs referred to as "safer'. See below, the 1994
interview of Jonathan Cole by David Healy, regarding the tendency of Prozac and other
of the SSRIs to cause suicidal thoughts]
But that does not necessarily mean that prescribing
SSRIs instead of tricyclics can prevent depressed
people from trying to kill or harm themselves,
researchers report. In a new study, people taking SSRIs
were more likely than those taking tricyclics such as
amitriptyline (Elavil) or clomipramine (Anafranil) to
try to hurt themselves, either by an overdose or some
other method.
The study included 2,776 people who were hospitalized
after attempting to hurt themselves. The most common
form of self-harm was taking an overdose of a drug,
including not only antidepressants, but also any other
prescription or over-the-counter medication. Other
methods included hanging, suffocation, guns, jumping
from high places and cutting.
Almost 17% of all self-harm attempts involved an
overdose of an antidepressant
[Fred A. Baughman Jr., MD:
SSRIs or TCAs]
, the researchers report
``The majority of (deliberate self-harm) cases who had
been prescribed an antidepressant harmed themselves
by means other than antidepressant overdose,'' the
authors write.
Recognizing whether a patient is likely to attempt
deliberate self-harm is difficult
[Fred A. Baughman Jr., MD:
Many, especially from US 'biological'
psychiatry claim to be able to test for, predict, or forecast who are suicide-prone. Here
we have British psychiatrists, much more given to the limits of their art]
so prescribing drugs that
cause less damage when too many are taken seems like
a good idea
Eli Lilly, Knoll and
SmithKline Beecham provided some funding for the
study. SOURCE: British Journal of Psychiatry
2000;177:551-556.
David Healy interview of Jonathan Cole (Director, Psychopharmacology Research
Centre, NIMH; Chair in Psychiatry, McLean Hospital), December 1994. (Excerpted by
Fred A. Baughman Jr., MD, from the book, The Psychopharmacologists, by David Healy,
Altman, Chapman & Hall.
Healy: What about a group of patients who may get worse on it (Prozac)?
Cole: Yes. I’m one of the authors of the suicide paper
I didn’t realize it would be quite
that famous
Yes, I have seen people, at least a handful, that clearly got more agitated
and got weird thoughts and suicidal drive. Tony Rothschild
found three people who
had jumped off something while on fluoxetine, who didn’t kill themselves, and agreed to
take it again. He re-created the same desperate driven quality with fluoxetine
One
patient
was so distressed by a thought telling her to kill herself over and over again,
I
told her to take some Ativan and go to sleep and she did and within 36 hours it had
passed. At the end of it she said ‘gee, I’ve been depressed for 21 years, and suicidal a lot
but that was ridiculous.’ She thought it was clearly different than anything she had ever
experienced before which is why I put her case and my name on the paper. Lilly (Eli
Lilly Corporation) doesn’t believe it
Plus about 1-2% of the people on fluoxetine
(Prozac), and none of the people on trazodone (Desyrel, a TCA), called up and said I’ve
got suicidal ideas that I haven’t had before and another 1-2% phoned up and said I’ve got
crazy ideas that I hadn’t had before
So I think it’s rare and the drug has certainly
prevented more suicides than it’s cause. I don’t think it’s a bad drug, I just think it does
funny things every once in a while.
Cole: I got so pissed about Lilly saying ‘don’t you agree that all the doctors know that
fluoxetine doesn’t cause suicide’ that I did a survey of everybody in the Mass. Psychiatric
Society, who’d answer the telephone about whether they had ever had or thought they’d
had a patient who had been made suicidal by fluoxetine, or whether they had heard of
anybody, and if they had, did they think they were prescribing less now than they were
before. You could make a case that if they had some personal experience with fluoxetine
in a patient who they thought got suicidal, they were more likely to warn patient and be a
little more gun shy.
Healy: Sometimes, ideas just get into popular consciousness and other times they don’t.
You would have thought that suicidal ideation would have killed of fluoxetine but it
hasn’t.
Cole: But the company probably did exactly the right thing which was to stone wall and
the FDA didn’t do anything. The company was publishing meta-analyses of everything
in the world – 800 patients in 6-week trials with no increase in suicidal ideation
[Fred A. Baughman Jr., MD:
perverting science and the scientific literature, with no response from the FDA, that is
supposed to be protecting us]