There was a front page article in the Boston Globe yesterday about a teenager who had committed suicide four days after having been released from a short psychiatric hospitilization. The doctors had increased her dose of Zoloft to near the maximum over a short period, and according to the article, she had reported side effects of irritability and anxiety that had been ignored. In addition, apparently unbeknownst to her parents, she had talked about suicide while hospitalized. The suicide occurred about a month before the FDA issued its warning about the dangers of giving adolescents antidepressants.

Many times I have seen people on this board recommend to BS's and occasionally WS's, "Ask your doctor about antidepressants." Although clearly it is becoming recognized that antidepressants can be dangerous for teenagers, that does not mean that they are necessarily safe for adults either. Doctors should be cautious about prescibing antidepressants and monitoring their patients, but obviously not all of them are, and I think that there is sometimes a cavalier attitude toward these medications, on this board and in real life, that can be very dangerous.

If you look at hormone-replacement therapy for women of menopausal or post-menopausal ages, it seemed that short-term results indicated lots of benefits. Now all these women are going off them.

With anti-depressents, it seems like it is the same thing. People feel better in the short term, but what is the long term effect? I've looked at information on anti-depressents, and the articles state that they simply don't know.

Also, the articles state that, if there is a chemical imbalance, then the A-Ds will work, and if there isn't, there is no effect. I find that hard to believe. Does coffee only work on a person who is sleepy? No -- it has a different effect.

For me, it was clear to me that my depression could be caused by the situation I was in. I was dealing with an abusive husband who broke my arm when I tried to call a woman with whom, in fact, he was having an affair. A-Ds might have helped me to live in the situation better, but what I needed to do was get out of it.
Cherished

<small>[ June 28, 2004, 07:56 AM: Message edited by: Cherished ]</small>

While I’m aware that some doctors prescribe anti-depressant too easily; that many anti-depressants have bad side affects and many of them can potentially be dangerous to use, I also know that these drugs can be “life savers” in certain circumstances and with certain conditions.

i'm personally scared of A-Ds.

many years ago there was a co-worker with whom i knew to be a very smart and nice guy. i had worked directly with him previously but was not at the time it happened. he killed himself, his wife found that he cut his wrists in their house. they had a young son. at the time i was actually working closely with his wife. it was so sad. she told me about how he was recently put on A-Ds and they were constantly "adjusting" his dose. she believed that played a role in his suicide.

my only personal experience with them is when I was on them for a short time back in 2001 when my dad died and when i was in a day program for mental health. i did not feel i was monitored appropriately by the doctor, especially after i left the day program in went back to work.

Nellie,

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial">Many times I have seen people on this board recommend to BS's and occasionally WS's, "Ask your doctor about antidepressants." Although clearly it is becoming recognized that antidepressants can be dangerous for teenagers, that does not mean that they are necessarily safe for adults either. Doctors should be cautious about prescibing antidepressants and monitoring their patients, but obviously not all of them are, and I think that there is sometimes a cavalier attitude toward these medications, on this board and in real life, that can be very dangerous. </font><hr /></blockquote><font size="2" face="Verdana, Arial">Antidepressants CAN be dangerous, and one side effect is suicidal/homicidal thoughts and tendencies. It is critical that if someone begins antidepressant therapy that they be aware of this potential side effect, and get themselves back to the doctor immediately.

However, the incidents of these severe side effects is statistically extremely low, and I don't think feel that suggesting that someone dealing with the turmoil of an affair be evaluated and consider antidepressants is cavalier whatsoever. These medications can be very appropriate in these and other circumstances, and have demonstrated great benefit for millions of people who have taken them.

Aspirin and penicillin are two "safe" drugs that have saved or helped countless millions of lives. They've also killed a number of people. Whenever you ingest ANYTHING, be it pharmaceutical, herbal, food, alcohol, etc---it comes with a risk. It's good to know that there IS a risk and what that risk is, but many times that risk is perfectly acceptable.

As someone who was spent several years on Zoloft, and has tried about every other Selective-Serotonin Reuptake Inhibitor (SSRI), i.e. Prozac, Paxil, Effexor, etc., there is a lot of myth and hysteria out there amongst the facts.

Consider for a moment that the people who are getting these drugs are ALREADY depressed...some of the are suffering a major depressive episode. So that means that some of them are already suicidal; whether they've expressed it or not. Now consider that SSRI's take 4-6 WEEKS to become effective in the bloodstream. The first few weeks, and I don't care what the ads say, the first few weeks some people feel like sh*t. The drugs, as your body adjusts to them, has side effects. Shakiness, diarhea, upset stomach, headache, etc. So, on top of not feeling well mentally, you start feeling badly physically as well. THAT could have a lot to do with pushing someone who is standing on the edge over it, IMO.

As for the no effect/coffee comparison, that's not a good comparison. You have a specific number of neuro-receptors, that need Serotonin in order to make a "contact", or to function. The nerve synapse releases Serotonin, and then, in a physiologically conservationist way, reabsorbs any Serotonin that is not required. SSRI keep the synapse from "re-uptaking" the Serotonin, because it is believed that in some people with depression that the synapse is actually sucking the serotonin back up BEFORE it ever has a chance to make it to the neuro-receptors. So by not allowing the synapse to re-absorb the serotonin, it increase the probability that the contacts will be made. While much still has to be learned, I haven't read much that indicates that the excess serotonin floating around by the synapse can cause any major problems.

My other point is this: Why do we, as Americans, because it is largely an American phenomena, expect perfection from all of these drugs? There has always been, and will always be, a certain number of cases that are "anomolies"...and cause, in some cases, extreme reactions like death. We should aim to keep this to a minimum, but we should never expect that any drug will be perfect. Is it the rise of our Tort system? Is it the attitude of the 40's and 50's when we were taught that soon we would be able to live forever and eliminate disease completely from the planet? As an example of what I consider over-reaction, I point to PPA, or PhenylPropanolamine. It was withdrawn from the market a couple of years ago, after having been used for DECADES as an effective anti-histamine. As I understand it, a little over 100 cases had been documented where women had had heart attacks after taking Contac or some other PPA containing drug. Probably not Contac, because it was an over the counter med. Much higher doses of PPA were available by prescription. But, anyway, how many BILLIONS of doses of PPA have been taken over the last 50 years, successfully? And why, after about 100 deaths out of probably a billion (and that's not an exageration) doses, do we completely remove an effective drug from the marketplace. Because of market hysteria, and bad news reporting, that's why.

A/D's, like most other drugs, are good when used for THOSE WHO NEED THEM. The problem isn't usually with the drugs...it's usually with either a) the doctors who overprescribe drugs, or b) the patients, who after hearing a TV ad for some drug, decide they need it, and go in and basically FORCE their doctor to write them a scrip. Doctors are business people too, and they know if their patient goes somewhere else, and get their prescription, then they might stay with the other doctor.

So drugs have been shown to be bad, even when used as directed. Thalidomide, for one. But in recent years, Thalidomide has regained popularity as one of the most effective drugs for Leprosy (I think). Now, is a woman is being treated for Leprosy with Thalidomide, and becomes pregnant, and then bears an awfully disfigured child, should the entire drug be banned because of it?

I guess my point is this: the brain of a young person does not complete it's maturation process until sometime in the mid twenties. I agree that more studies should be done on giving "adult" med's to young adults with developing brains. But don't completely discount the effectiveness of the drugs, for ALL people, when doing your research.

Off my soapbox now.

Bob

Editing to add: I just remembered about the PPA cases...the women who were dying WEREN'T EVEN USING THE DRUG FOR IT'S DESIGNED PURPOSE! Someone discovered, as they gave this drug out for allergies, that it caused weight loss. So they started marketing it as a Weight Loss supplement, and people were taking WAY TOO MUCH of it. That is another big problem...using drugs for things other than what they were developed. Dr's are prescribing Prozac for weight loss, Birth Control Pills for Acne, and Antibiotics for viral diseases. What do we expect is going to happen when this starts to occur?

<small>[ June 28, 2004, 11:23 AM: Message edited by: Plumb Bob ]</small>

Plumb Bob,
As the parent of a high-energy boy, I find it repulsive that 5% of pre-school boys are being given Ritalin. Yes, he did have difficulty in kindergarten and first grade -- I don't think God designed boys to sit still at that age -- but he bloomed in second grade.

As for A-Ds, my concern is that it seems to be readily prescribed without an understanding of what is going on. Situational depression treated with drugs? Does that make sense? If a situation depresses a person, the situation needs to be changed if at all possible.

I compare the rise of A-D use to the "magic pill" approach of hormone replacement therapy for older women. It was assumed you'd get it to help you, and it ended up having a long term negative effect. Even more frightening is phen-fhen or whatever that diet drug was that caused people to lose weight. Thousands were on it before the heart problems were linked to the drug.

Are we going to have an epidemic of people with problems like kidney disease or brain cancer in 25 years that is linked to long-term A-D use? You may think that is the notion of someone who is paranoid and I must say my father as a chemist has taught me to be very skeptical of drug use unless it is very clearly necessary (ie. to get over pneumonia). The fact is, and in reading the articles you will see, scientists just plain don't know the long-term effects of ADs.

I read in the WSJ that there were 143 million prescriptions for ADs last year. Wow! In a country of aboutr 300 million, that's a lot.

Cherished

I have been on Effexor for a month, D day was April 15. I was so depressed and hurt I could not function, I could not sleep. I know that it takes 4 to 6 weeks to work completely, but after 1 week I was starting to sleep again. I still get depressed when I think about what my WW did to me and my D, but I can deal with it much better. I did not experience any side effects. I am glad the doctor put me on them and I hope I can get off of them soon but I am soooo hurt that I need it now otherwise I could not cope. I still tear up when we talk about things, but I don't break down.

Tellmewhy

Cherished,

I'll be the first to admit, in fact I even addressed over-prescription or careless prescription in my first post, that TOO many people are on A/D's.

But does that mean they shouldn't be used, or that they are BAD for EVERYONE? No.

You said:

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial"> Situational depression treated with drugs? Does that make sense? If a situation depresses a person, the situation needs to be changed if at all possible. </font><hr /></blockquote><font size="2" face="Verdana, Arial">In some cases, yes, it does make sense. Depression can result from any number of things from serious injury or illness, to severe mental disorders. Where A/D's help, is that, in conjunction with therapy, they can accelerate the rate for recovery. Some people can be physically ready for recovery, but their body chemisty is stil out of whack. That is why in many cases a six month regimen of A/D's will often be enough to help these people. On every A/D I have ever taken it says clearly, and in big letters, "The effects of long term use of this drug have not been evaluated".

So, if you are like me, someone who has had 3 major depressive episodes, what do you do? Do you wait 15-20 years for our FDA to "thoroughly" test these meds for long term use, or do you weigh the risks and make your own decision on whether or not to use them. Without these drugs the people who are seriously depressed wouldn't survive long enough to hear the results of a long term study.

I agree with your concern about over-medication. But NO-medication is not the answer, and waiting for our inept, grossly over-politicized FDA to approve certain drugs is not an option, either.

As to Ritalin, I agree that too many parents want a babysitter in a pill. Schools do, too. I have read many reports about diet modification being very beneficial to MOST children who are given this drug. But that doesn't mean that it should be banned, because there are SOME kids out there who really do need it. We, as adults and caretakers of these children, need to be more careful about administration of the drugs.

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial"> Are we going to have an epidemic of people with problems like kidney disease or brain cancer in 25 years that is linked to long-term A-D use? </font><hr /></blockquote><font size="2" face="Verdana, Arial">I think that is a reasonable question. The way I view it, though, as a sufferer of depression is this...what percentage of people might end up with some "serious" long term damage vs. how many would be dead within the next 5 years without these drugs. Or vs. how many were effectively treated with these drugs over the long term.

If the "kidney disease or brain cancer" that you worry about was to effect say 5% of the people treated long term with A/D's, would you consider that a failure or a success for the long term use of A/D's? I would have to consider it a success, as it would have effectively treated 95% of the people treated, without long term injury. It's horrible if you're in that 5%, but it's all probabilities.

Take vaccinations for example. There are people who are unwilling to get their children immunized for fear of the risk of the side effects. Even though the side effect rates are in the 1 per 100,000 or greater range. Then consider that if the un-vaccinated child was to get the disease the vaccination is for, that the long term health effects could be as bad, or worse, than the side effects of the vaccination. And the odds, if stricken with the disease are far greater for serious long term health concerns.

I'm just saying that the risk of bad effects has to be weighed honestly against the risks of positive effects. And when people start talking about banning certain drugs, let's keep in mind the ratio of people helped vs. people suffering side effects.

Bob

It is quite possible that antidepressants are appropriate for adults suffering from clinical depression. However, situational depression is another matter, and most of those who become depressed after discovering their spouses are having an affair are suffering from situational depression. I believe it is inappropriate and very risky to recommend antidepressants when you are neither a medical professional nor in a position to evaluate whether someone is suffering from clinical depression, situational depression, or something else entirely.

Nellie,

Was this quote directed towards anyone in particular?

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial"> I believe it is inappropriate and very risky to recommend antidepressants when you are neither a medical professional nor in a position to evaluate whether someone is suffering from clinical depression, situational depression, or something else entirely. </font><hr /></blockquote><font size="2" face="Verdana, Arial">If it was directed to me, please paste the comments you believe I made that recommend A/D's to anyone in particular? I have only argued that they have their use, in proper situations. If you feel I have spoken otherwise, please show me.

Thanks,

Bob

Editing to add:

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial"> I believe it is inappropriate and very risky to recommend antidepressants when you are neither a medical professional nor in a position to evaluate whether someone is suffering from clinical depression, situational depression, or something else entirely. </font><hr /></blockquote><font size="2" face="Verdana, Arial">That door swings BOTH ways. I understand what you're saying, but I, since I've been on the OTHER side of this discussion, feel believe that it could be inappropriate and very risky to DISCOURAGE A/D USE when you are neither a medical professional nor in a position to evaluate whether someone is suffering from clinical depression. BTW...you may want to explain the definitions of the terms you're using. "Situational Depression" is not a scientific or medical term, that I know of. If it means depression brought on by one's situation, then does Clinical Depression mean that which is brought on by being in a clinic?

ALL depression is, to some degree, a reflection of your "situation".

<small>[ June 28, 2004, 06:50 PM: Message edited by: Plumb Bob ]</small>

Nellie, I understand much of what you are saying, however, you lose me when you say it's inappropriate to suggest a person see their doctor about anti-depressants. Their doctor IS a medical professional and only he has the power to prescribe AD's. One doesn't NEED to have a medical degree to suggest that someone SEE their doctor.

a teenager who had committed suicide four days after having been released from a short psychiatric hospitilization. she had reported side effects of irritability and anxiety that had been ignored.

Sometimes, a teen presents with "depression" when in reality they are bi-polar (as yet undiscovered) .... and the anti-depressant is given to treat the depression (and it works!) ... However, suddenly the depression is gone and the teen develops mania, irritablity, and suicidal ideation.

This happends in teens. Treated for depression because that's the only side of the bi-polar that has been seen ... up to that point. Then the brain tips into full blown mania.

This particular case .... if this child was severe enough to be hospitalized... the risks of suicide are VERY high irregardless of whatever medication given.

My son was hospitalized with depression twice before it became apparent he was actually bi-polar.
It happends.


Pep

Plumb Bob --
I think your response to mine was very balanced and well thought out. I had situational depression -- major surgery for childbirth related injury that put me in the hospital for 5 days, 12 days later my H broke my arm because I was threatening to call this woman from work whom he said was calling him and he couldn't hang up because it would be rude, and 11 days after that surgery on the arm which showed 7 breaks and meant probable permanent reduction in flexibility and 50% chance of chronic pain in that arm for the rest of my life. I got through it without A-Ds. Time will tell how well our children got through it. The child who was 10 months old when I weaned her abruptly for the surgery is showing an incredible amount of independence and nastiness -- I am concerned that stress on her at such a young age may have caused permanent changes in the brain, something I read about in Science magazine.

But I'm through it now, only to look back and regret that I didn't call my parents, ask them to come out and help me through the surgeries, and boot my H out of the house until he got his anger under control.

I think A-Ds may have helped me to survive his treatment, which I remember telling myself "Not even Ted Bundy deserves to be treated like this", but what I really needed to do, in the words of my mother when I called her four months later when I exposed the affair by calling the woman's husband: "Throw the bum out."

That "bum" is working hard now to be a good husband, something I should have said was necessary in order for us to remain living together, but foolishly clinging to my Christian commitment to marriage, I tried to forgive and change myself because I was the problem. As he so poignantly put it, it was my fault my arm got broken: he was just going to punch my shoulder. I was the one who put my hands up to protect my face.

We all have our biases when it comes to medication. I think I needed therapy that said I deserved better than I was getting -- get him out of there -- not pills to help me cope with his treatment. This isn't Pakistan. A woman in this country has alternatives to getting beaten up.

Cherished

Cherished (BH&A),

</font><blockquote><font size="1" face="Verdana, Arial">quote:</font><hr /><font size="2" face="Verdana, Arial"> We all have our biases when it comes to medication. I think I needed therapy that said I deserved better than I was getting -- get him out of there -- not pills to help me cope with his treatment. This isn't Pakistan. A woman in this country has alternatives to getting beaten up. </font><hr /></blockquote><font size="2" face="Verdana, Arial">I understand your position. We just happen to both believe in personal choice. You believe people should choose not to take the med's, I believe that they should have the right, along with a doctor, to detemine that need for themselves.

Thanks for the discussion. I like it when it stays civil! <img border="0" title="" alt="[Big Grin]" src="images/icons/grin.gif" />

Bob

Plumb Bob --
I think medications can be used unwisely to get people to tolerate situations that should not be tolerated. That's not the same as thinking ADs are never appropriate. Looking back, I realize that I had post-partum depression after our second child and only boy was born. I think ADs may have been appropriate then. I just think, in facing an abusive and unfaithful husband, they may have help me to stay put whereas what I needed was to get out of the situation.

Just wanted to clarify --
Cherished

A site that describes situational depression is:
http://www.ssmhealth.com/internet/home/ssmhealth.nsf/Health+Topics/E32293273459A4BE86256D2000632D42

Clinical depression is discussed at:

http://www.nmha.org/ccd/index.cfm

They are very different,though with similar symptoms. Some research has shown that antidepressants are not more effective than the passage of time at treating situational depression.

One problem with antidepressants is that they are often prescribed by primary care physicians. If you are thinking about surgery, you would see a surgeon, then get a second opinion. Before taking antidepressants, I think it is equally important to have a complete psychiatric evaluation, followed by a second opinion.

People committing suicide when starting anti-depressants is nothing new...it's just something that the media recently picked up on. Doctors have known for a long time about the relationsip between suicide and a.d's. How it works is that anti-depressants, such as Zoloft, are supposed to raise your mood and energy level. Well, it raises your energy level quickly, but takes a few weeks to raise your mood level. What it can do, IF NOT MONITORED, is give you the energy to commit suicide.

My oldest son is on Zoloft, 50mgs. once a day. (He's 14). Trust me, he's doing better with the anti depressants than without. His energy level came up and so did his mood with only 1 side effect. AND he was carefully monitored after starting it. I asked him several times a day how he was feeling and talked to him about things bothering him.

Mitzi <img border="0" title="" alt="[Smile]" src="images/icons/smile.gif" />

::::The nerve synapse releases Serotonin, and then, in a physiologically conservationist way, reabsorbs any Serotonin that is not required. SSRI keep the synapse from "re-uptaking" the Serotonin, because it is believed that in some people with depression that the synapse is actually sucking the serotonin back up BEFORE it ever has a chance to make it to the neuro-receptors. So by not allowing the synapse to re-absorb the serotonin, it increase the probability that the contacts will be made.

Bob, This explanation might be true or it might not. IMHO, as a non health professional,(in fact a non professional of any kind) I suspect we are still in the dark ages of understanding how SSRI's work. We have been "fed" the line that it increases our seretonin levels - but there have been a few major studies (one very long one I kept on my old computer for a while) that said SSRI's work about as well as placebo's. Now - before you yell at me, I'm only reporting what I've read and these results have been replicted in more than one study. Now I'm fully aware that research results can be ambigious and wrong. (I am extremely cynical about research - unless it is carried out under very rigid conditions, and even then the results can be misleading) However, I would like to know why, if SSRI's increase seretonin and make us feel happier and more able to cope, why they totally suppress the orgasm mechanism in the majority of people taking them? e.g. paxil is great for killing panic attacks - just like it kills orgasms. To me that suggests that paxil throws a blanket over our emotions, dampening them down so much that our bodies can't even get up enough revs to orgasm. So I find myself thinking that paxil is a bit like a powerful, non drowsy sedative. (I took it for two years - and found myself in a state of total inertia about life). The reason I felt so good on it was that I no longer worried a lot. Not sure that seretonin was involved at all. Not worrying is a good start to feeling better.

With regards suicide, SSRI's are given out too lightly without proper monitoring. My daughter is a doctor who suffers depression and she won't take them because she said that practically every person who comes into A & E (ER) is taking anti depressants. Why are so many people given them? Is it considered an easy way to shut patients up rather than talking to them?

I haven't read all of the responses, so this element may have already been discussed...

(I know this subject well, will explain at the bottom)...

When a person who is depressed is put on anti-depressants, there is that "period" of time when they are working towards wellness, but not there yet.

When in deep depression, many people do not even have the energy to plan a suicide, to think about suicide...they can be very lethargic in this state.

When the anti-depressants "begin" working, the patient finds mor eenergy than they've been experiencing during the recent past.

It is at this point in time that the depression PLUS the energy create a scenario that "could" lead to suicide ideation (and/or action).

In 1999 my H (also WS) was on Zoloft, first few weeks. He became suicidal, began popping pills, sat in the car with the windows up, motor running, in the garage. I called 911 for help. (That was a STUPID mistake, believe it or not. Police came in, know NOTHING about suicide tendencies, ran to the car like a swat team...H backed the car up 10-15 feet...maybe 20 tops...was arrested for driving while intoxicated. Would NOT drop charges...would NOT listen to the doctors information about his depression. They knew how to do two things, arrest and prosecute. I'm not over this, even yet. But I digress!!!!

It was during this "window of time" when he became suicidal. The Dr.'s description of him was correct, prior to the meds he was like death walking, but with zero energy and thought. After they fully kicked in, he was much better (except of course for that "pesky" and VERY expensive legal issue).

A person "newly" on anti-d's. needs to be watched a little more closely.