Antidepressants and psychotherapy show similar adolescent suicide risk

[HuckleB]

http://www.psychiatrysource.com/psychsource/News/article1978.htm

"Preliminary study findings suggest that emergent suicide is as likely to occur in depressed adolescents receiving psychotherapy as it is in those taking antidepressants.

Concerns over increased suicidal behavior in children and adolescents taking antidepressants has led to the US Food and Drug Administration (FDA) issuing a public health advisory ordering manufacturers of such drugs to issue warnings to alert doctors to this risk.

...

Among the 88 depressed adolescents, 11 (12.5%) developed suicidal behavior during treatment. Ten showed emergent suicidality in that they had ideation without a plan and one made a suicide attempt. There were no completed suicides during the study period. In eight of the 11 cases, suicidality occurred within 3 weeks of beginning treatment.

The researchers note in the American Journal of Psychiatry that this rate is similar to that previously reported in trials of antidepressants.

..."

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Related:

ACNP Issues Final Report on SSRIs and Suicidal Behavior in Youth -- Task Force Finds Urgent Need for Effective Treatment for Depression in Children and Adolescents
http://sev.prnewswire.com/health-care-hospitals/20051123/DCW00223112005-1.html

[depakid]

1. Skeptical

Several of the statements make me question the objectivity of this report. It seems to be suporting an agenda- at least, that's how the PR wire reads- and that's how the media and their PhArMA advertisers are going to pick it up.

One would need to read the full report to see how it differed from Mossholder's and Healy's interpretations in their mata-analyses.

I agree wholeheartedly with this statement, though:

"The report also noted the need for clinical trials and other research studies to include better measures for evaluating suicidal behavior, including asking study participants about suicidal thoughts and behavior, and not excluding patients at high risk for suicidal behavior.

"Adverse event reports of antidepressants are a poor way to determine suicide risk," explained Dr. Mann, "We need studies using other, better systematically collected measures."

[HuckleB]

5. I remain skeptical, too.

But this matches my anecdotal experience in the field, so I do believe that it cannot be discounted. I have yet to meet a psychiatrist or nurse practitioner who has been able to match the increase in suicidal ideation associated with SSRIs to their experience in practice. Something isn't making sense, and research is needed to bring things into perspective.

[mzteris]

2. Check your sources.......

The "owner" of psychiatricsource is:

"AstraZeneca is one of the world's leading pharmaceutical companies which provides innovative, effective products to fight disease in important areas of medical need. It is striving to make diseases of the Central Nervous System treatable.

The company's investments in research are aimed towards developing solutions - medicines with greater effectiveness and fewer side effects. Our aim is clear - to create hand-in-hand partnerships with psychiatrists and all care-providers to help their patients enjoy a better life.

PsychiatrySource.com is dedicated to providing you with unbiased, unfiltered clinical psychiatry news, resources, and internet tools. Tools to help psychiatry health professionals stay up to date and research information on the internet faster, easier and better."

http://www.psychiatrysource.com/psychsource/About_Us/

nuff said.


PS - ANYTHING on PRWIRE is automatically suspect. It's a "vanity press" site.

[depakid]

3. I agree, but the PR Wire does refer to peer reviewed research

This is the Report referred to:

http://www.nature.com/npp/journal/vaop/ncurrent/full/1300958a.html

You'd have to read through it pretty carefully to make any sort of reasonable judgment on its conclusions. Like I mentioned, having both read Healy and Mossholder's report (and another meta-analysis from Australia, I think) I'm skeptical of this, since all three seemed to come to the same conclusions- and they didn't have access to some of the the unpublished material that presumably wan't favorable to the phamaceutical companies.

Each of them found that there was a increased incidence of suicidal behavior and ideation (without any corresponding efficacy) associated with the SSRI interventions (except with Prozac, where there were slight, but significant improvements on the relevant psychological inventories).

The other study cited was in the American Journal of Psychiatry. Again, you'd have to read through the thing to make any determination as to whether the findings can be broadly applied.

Pretty small sample size- we don't know who they are or how they were chosen, we don't know from the abstract how representative the therapy was and we don't know whether the therapy brought out self disclosure of symptomatology that was actually present at intake.

Emergent Suicidality in a Clinical Psychotherapy Trial for Adolescent Depression

OBJECTIVE: The authors’ goal was to examine the incidence and predictors of emergent suicidality that occurred during a clinical trial of psychotherapy for adolescent depression.

METHOD: The rates and predictors of emergent suicidality in 88 medication-free depressed adolescent outpatients who reported no current suicidality during an intake interview were assessed over 12 to 16 weeks of psychotherapy treatment.

RESULTS: The incidence of emergent suicidality was 12.5% (11 of 88 subjects). Self-reported suicidal thoughts at intake were a significant predictor of emergent suicidality, even when suicidality was denied at intake interview.

CONCLUSIONS: Emergent suicidality is a common occurrence in psychosocial treatment of adolescent depression, with rates similar to those reported recently in antidepressant trials. To evaluate accurately the role of treatment in emergent suicidality, it is important to assess self-reported suicidality at intake and to balance treatment groups on this key predictor of emergent suicidality.

http://ajp.psychiatryonline.org/cgi/content/abstract/162/11/2173

[HuckleB]

4. Not enough said.

I know the sponsor. I pay attention to that.

However, the web site has yet to show any reason to doubt its validity.

The actual source of this piece is The American Journal of Psychiatry. Most pieces that appear on this source come from peer reviewed journals. Suspicion is one thing. Reality can often be another.