This article is a press release from Katherine L. Cruise, Director of Communications and Marketing, Screening for Mental Health, Inc. There is more on depression [here]. Assess your risk at [www.HelpYourselfHelpOthers.org] **** There are more than 19 million adults in the United States living with depression and many more people could be suffering but are unaware that what they are feeling is depression, according to the National Institute of Mental Health.
This is a topic that gets scant attention leaving the consuming public largely in the dark. Even though I work in the field, I’ve not hear this information except from my own reading. Fortunately, SSRIs are not as susceptible to problems crossing from brands to generics or between generics. But buproprion in other forms may not be as good as Wellbutrin. Image via Wikipedia Medical News “Antidepressant and antipsychotic drugs have become blockbusters for the firms that developed them, making them hot markets for generic competition.
Image via Wikipedia Not surprisingly,the biochemical theory regarding “chemical imbalance” is under attack again. The theory has always been an oversimplification of actual research data. All the research has said is that (1) anti-depressants have worked on average slightly better than placebo and (2) anti-depressants and therapy works slightly better than one or the other alone. Key to understanding what this means are the words “on average”, “placebo” and “slightly better”.
The CDC has released a report finding a spike in successful suicides in adolescents in 2004. This increase is the largest increase since 1990. Is this the result of all the misinformation floating around anti-depressant medications causing suicide and violence in adolescents and adults? Thats about when the hullabaloo started. So that means that the increase in suicides may continue into 2007, four years of increased suicide caused by misinformation in the media.
The decision about how to treat depression has been entirely reframed by recent research. First of all, the debate about whether anti-depressant medications actually contribute to suicidal and other impulsive behavior has called to question routine, first choice prescriptions for Celexa, Lexapro, Prozac, Paxil, and Zoloft, the so-called SSRIs, for even milder forms of depression. Secondly, the STAR*D trials have documented that SSRIs are no magic pill. SSRIs have been implicated in controversial criminal trials where defendants have claimed the medication made them violent, even homicidal.
Anyone taking or contemplating anti-depressants for treatment of depression have been concerned about the blackbox warnings from the FDA. The FDA has issued blanket warnings to anyone considering or taking anti-depressants that they may actually induce suicidal thinking. The truth is that there is still very little and conflicting information about the risks. Highlighting the risks in the way the FDA did by issuing a blackbox warning has been controversial. The problem is that the risks have been assessed in only a few studies and it is not clear what is happening.
Today, I tripped over an interesting article on assessing suicide potential. Psychiatric Weekly America bears witness to 30,000 deaths by suicide per year. Although clinicians have a fairly good grasp of long-term risk factors, possible short term indicators of risk have been largely overlooked. Dr. Jan Fawcett believes that, to make real headway in combating suicide, doctors need to identify patients at acute, not just chronic, risk of suicide and treat their symptoms aggressively.
Here is a heads up for everyone taking or considering anti-depressant medication. One study has found a higher incidence of diabetes in high risk pre-diabetic persons undergoing intensive preventative treatment. What is not clear is whether anti-depressant use was associated with previous serious depression. The results could indicate depression and/or anti-depressant use increases the risk of diabetes. Further study certainly is certainly indicated. Please note, there is NO reason to consider discontinuing your medication based on this study alone.
Well if anti-depressants, in particular SSRIs work, how do they help? Contrary to the ads you see on television, we don’t really know. A recently published article outlines the issues. Although SSRIs are considered “antidepressants,” they are FDA-approved treatments for eight separate psychiatric diagnoses, ranging from social anxiety disorder to obsessive-compulsive disorder to premenstrual dysphoric disorder. Some consumer advertisements (such as the Zoloft and Paxil Web sites) promote the serotonin hypothesis, not just for depression, but also for some of these other diagnostic categories [22,23].
Sunday I found a disturbing article in a blog that has a good reputation. Dr. Peter Breggin at The Huffington Post wrote about the FDA decision to require a “black box” warning on the anti-depressant medication Paxil because of the risk of suicide in the beginning of treatment. Dr. Breggin is the author of the book Talking Back to Prozac which is highly critical of the anti-depressant medication Prozac. In his post at Huffington’s, Dr.