Furious Seasons

January 22, 2008

Suicide And Anti-Depressants Connected In Sweden

There is a surprising report just out, claiming that over half of the women who committed suicide in Sweden in 2006 had filled a prescription for an anti-depressant within 180 days prior to their deaths. That works out to 52 percent among women who had committed suicide. Among men 33 percent had filled a prescription for anti-depressants 180 days prior to their deaths.

That's not particularly good news for defenders of the faith in psychiatry, who claim that anti-depressants are a suicide prevention technology. Such a claim is often the basis for pharmaceutical advertising and for the exhortations of advocacy groups.

There are, of course, weaknesses in the data. Filling a prescription for an anti-depressant within 180 days before a suicide does not mean that the anti-depressant caused the suicide, and it does not mean that a particular person was taking a drug at the time they committed suicide. They might have stopped taking a drug 179 days before their death.

What's more, the common response in the US on the anti-depressant/suicide question that "these are troubled people, so of course they were on an anti-depressant when they killed themselves" could no doubt be used in this case.

But, still, these Swedish numbers are perhaps the best population-based entre we've got into the ticklish question of whether anti-depressants induce suicidality. Taking these numbers at face value, you'd have to say that there is an unsettling connection of some kind. But, keep in mind, that 48 percent of women who committed suicide didn't have a prescription for an anti-depressant either. Is that the more telling metric? I simply don't know.

What I do know is that anti-depressants sure aren't the rock solid anti-suicide technology we've been told they are. Some people with depression respond very powerfully to the drugs, others see little effect, still others appear to worsen and others seem to have tragic responses to the drugs themselves. While the evidence on suicide and anti-depressant use in the US is mixed (some studies say yes, others say no), it's certainly eye-opening to see this Swedish data, courtesy of that country's unique reporting methods (ones that don't exist in the US nationwide).

My own thinking is that there is a definite problem here, but one that doesn't offer simple answers. If you can assert that untreated depression is linked to suicide and can assert at the same time that anti-depressant use is linked to some suicides, then what do you do about treating depression? Do you treat it or not? And, what do you treat it with?

The mystery deepens.

Posted by Philip Dawdy at January 22, 2008 11:00 AM

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Comments

I can't find the data, but I read an article in the New York Times last year about a study indicating that most suicides are caused by events in a person's life, not "a chemical imbalance" in the brain but loss of a job, being trapped in an unhappy relationship, loss of home, death of loved one, horrific war experience....so what seems to happen is this, you are in a life situation that makes you unhappy be it a relationship or a financial problem or suffering a loss (death of loved one) so your doctor prescribs anti depressants. The anti depressants don't change your life, but either in most people due to placebo or due to intoxication, the antiD's brighten your mood. So you hate your life still but you're no longer unhappy about hating your life, in fact you are so optomistic that you end it, sort of like someone high on lsd thinking they can fly and jumping off of a building.

These are drugs folks. Giving people mood altering drugs in times of crisis has been commonplace since the first caveman came across a naturally fermented piece of fruit. I don't think it's always wrong, but it's never, on it's own a solution. Going out for a night drinking with the girls after your boyfriend dumps you works. Staying at home drinking, doesn't. AntiD's are the same. If that makes any sense...

Posted by: Sally at January 22, 2008 11:35 AM

Do you treat it or not? And, what do you treat it with?

I think the question is "how do you treat it?", not "do you treat it?"

There are many many options besides drugs.

Posted by: Gianna at January 22, 2008 12:00 PM

Also, what tends to happen in the States (don't know about Sweden) is that people are given drugs and sent on their merry (or not) way. There is very little follow-up and very limited availability of follow-up even if sought, at least on a timely basis. Giving someone a pill and no support network is of very limited effect, even for those the pills do help.

Posted by: anne at January 22, 2008 02:49 PM

My personal experience using Prozac brought me to a place I've never been in my mind. It was propelled into suicidal ideation, and it didn't have any control in my thoughts. I will never use an anti depressant again, because that was something bad, not a depression or idea of my own.

I also have witnessed the only suicidal ideation/behaviors with my daughter on anti depressants; to the point where her behavior and words are directly connected to anti depressant use: and I never see, hear or witness this unless she is on one. [such as Prozac, Zoloft and even BuSpar].

Let's face the facts here: these are brain altering chemicals.

Posted by: Stephany at January 22, 2008 05:39 PM

Whatever this study really demonstrates I am beside myself with glee that someone is finally making a stab at tracking the pharmaceutical history of suicide victims. Tracking such information was one of my recommendations in my first FDA testimony in 2004. There is a lot to be learned from knowing exactly what suicide victims were taking in the weeks and months, if not even years, before they died. I think one of the most important ways to "treat depression" is with the "empathic alliance" either from friends, family or counselors -- somehow to get through to the depressed person to let them know they are not alone and that they are loved. And to get them to reframe their "story". There are lots of other more holistic and healthy ways to deal with depression than throwing antidepressants at it.

Posted by: Sara at January 23, 2008 08:48 AM

Well, I certainly never understood what the black hole of depression really looked like, what real anxiety is, massive insomnia, hypomania, akathesia, mania, suicidal ideations, and a whole slew of physical problems. No, I never understood any of this until I shook hands with Paxil. Seven years of an increasing nightmare on and 20 months of hell in my post-Paxil life. In fact, if it weren't for PaxilProgress I would not be alive today. I would not have known what the hell was happening to me when the akathesia started 7 months post-Paxil. This drug destroyed my life physically, emotionally and financially. My behavior on this drug was unbelievable, and now that I'm off it I still can't believe it was me that was doing all these awful things. It's going to take a long time to heal from this, that I know. It's nothing short of a brain injury. And it's sad that the only support you can get is online because doctors don't believe that this stuff happens.

Posted by: Cathy at January 28, 2008 07:07 PM