The use of anti-depressants, or SSRIs as they are known in the trade, has long been associated with some controversy among mental health professionals and the broader community. Mental illness advocacy groups such as Beyond Blue wisely steer a middle course on the question, noting that each case of mental illness is different and the treatment will vary accordingly.
The debate over the efficacy of anti-depressants has not been helped by the media over recent years. There is a tendency to highlight the most negative findings to create a good news story. When the ABC’s Four Corners ran a program in 2003 on a supposed link between suicide and anti-depressants, phones rang off the hook at surgeries the next morning as panicked patients called to speak with their doctor.
A new study, published in the current edition in the Canadian Medical Association Journal provides support for the use of anti-depressants to substantially reduce the incidence of suicide among adults and the elderly. The study also confirms that care needs to be taken in monitoring young people who are on anti-depressants.
What is so useful about this study, conducted by three Italian researchers from the World Health Organization Collaborative Centre and the Department of Psychiatry at the University of Verona, is that it tests the veracity and robustness of eight previous studies and samples.
This research finds that SSRI’s can decrease the risk of suicide by over 40 percent among adults and by over 50 percent among elderly people. These are significant numbers and as Carrado Barbui, Eleonora Esposito and Andrea Cipriani the study’s authors note, they provide reassurance for doctors “that prescribing SSRIs to patients with major depression is safe.”
But when it comes to adolescents and children the use of SSRI and an increased risk of suicide can be linked, the study found, although this finding is couched cautiously because the study says that while adults can be prescribed SSRIs where depression is mild and severe, when it comes to adolescents and children they are generally only used in cases where the patient has more severe depression and is therefore potentially more suicidal.
Alarmingly, because of reports about the possible increased risk of suicide among young people who are prescribed SSRI’s, some doctors may be avoiding diagnosing depressive illness and therefore avoiding the dilemma of having to decided whether or not to prescribe anti-depressants. Writing in the same edition of the CMA Journal, two American researchers, Robert Gibbons and John Mann say that “concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders,” by doctors.
Anti-depressants have saved many lives and helped millions of people around the world over the past couple of decades, as this study confirms, but we do need to ensure that young people and children can access these medications safely or that alternative effective treatments for depression are available to them and their doctors.
Disclaimer; I have been taking SSRI drugs on a daily basis since 1997.
There is a lot of good science around that shows that anti-depressants do not outperform placebos. Manipulation of clinical trials and especially the reporting by Big Pharma conceal this fact, however. No, this is not paranoid nonsense and my PhD in psych eminently suits me comment on the issue. I’d like to know a great deal more about the research cited before I’d be happy it wasn’t another PR/marketing exercise by researchers ‘helped out’ with Big Pharma money.
Very good article Greg. The point you highlighted about the use of SSRI’s in adolescents is a very important one. I have known two adult people who took SSRI’s, both recovered from their depressive bouts.
What you need to understand is the background and interests of the researchers. SSRIs are the by product of a huge global research project on brain chemistry in the 1980s. Over 80% of participants displayed imbalances between amino acids. A common factor was Serotonin. The pharmaceutical industry charged ahead with this bit of the research and produced the SSRIs. Some decent researchers continued and – not susprisingly – discovered that the key was getting ALL the aminos back in balance. You can now do this through simple urine testing and amino acid supplementation. The ongoing problem with SSRIs is that they result in continuing imbalances.
Well said, Greg. My wife has been taking SSRI’s since they came on the market. Previous to that , she was on MAOIs and tricyclics. There were several hospital admissions over the years, but only one since she was on SSRI’s, which was a bad reaction to a particular tablet. She now has 2 degrees, some post-graduate qualifications and a responsible, rewarding career.
It sounds like a cliche, but I believe it is possible to be too depressed to commit suicide and in the early stages of treatment, the mood may be lifted enough to go through with the act.
Cheers.
Hi Greg, good article. The link to the reference for the Canadian Medical Association Journal is not operational – I’d appreciate it if you could re-post the link.
Thanks,
Graham