Depressed About Antidepressent Warnings

For a while now I've heard about how certain anti-depressents, the SSRIs I believe in particular, are said to "increase the risk" of suicidal thoughts and/or suicide itself in teenagers and children. I've been quite skeptical of any studies that are reported as supporting these contentions. Now today the news is announced that the FDA is expanding this warning for anti-depressents to include "young adults" as well -- those 18-24 -- during the first month or two of treatment.

Now, granted I'm not a doctor. Nor a scientist involved in such medical studies. Nor someone who is otherwise an expert in this area.

Having said that, I think I have good reason to be suspicious. First of all, I think we should all be pretty skeptical of much of what the FDA says: as a large government bureaucracy, and one that causes (or are at least morally responsible for) a great deal of harm and death by holding back helpful drugs for years and years, they don't inspire confidence generally speaking.

But even if you do hold the FDA in high regard... I must ask: have you yet heard reports on this issue that make any sense? They always speak in very vague terms about "increased risk" and so on. When you read further or dig into the underlying data, you find out that the "risks" are still very low.

More importantly, the word "risk" is tossed around as implying that some sort of actual causation has been shown -- of if not proven (which it hasn't been at all), then at least a strong statistical effect has been determined. But I am highly skeptical of this, and here is why. How would studies be done on this in a rigorous scientific way? From what I understand of SSRIs, they are slow acting -- meanings days and weeks, not hours. An increasinly depressed person, who actually gets to a point where they visit their doctor and are prescribed an SSRI, are likely going to continue to get worse before they get better -- caused by the depression itself, not from the drugs they've been prescribed!

Another reason to be skeptical here is that many times I've read of extreme cases of actual suicide or violence for new patients on SSRIs, but often when you dig into those you find out the person didn't follow the prescribed amount. With SSRIs you are supposed to slowly ramp up your dosage (and then slowly ramp it down when you are coming off of it). If you take five times the amount prescribed, then it is easy to see how that could cause problems.

And lastly, the FDA is the organization behind regulating and demanding all those ridiculously long listings of supposed "side effects" for every drug ad you see on TV or in magazines (if you can even read them, as they are often filled with legalese and printed in 2-pt font). Some instances of this are better than others, but I think their definition of "side effect" is likely wrong-headed, their ability to interpret statistics dubious, and their understanding of real, scientifically valid causation nearly non-existent. Its gotten to the point where comedians now are making fun of such side-effect listings for the jokes they often are. And then there are the high-profile court cases where people sue for heart attacks from this or that medication, many of which quietly get decided later in favor of the pharma company because the person was obese pounds and had every other actual heart disease risk known to man.

Prescription drugs can do harm, no doubt. And I consider it logically possible that SSRIs are actually causing increased suicidal thoughts in young people during their initial weeks or months taking them. But I am not at all convinced that we have any actual evidence of this at all, and I find it much more plausible that what is really happening is that people who are increasingly depressed and start taking the medications continue to get worse -- from their depression -- before the positive benefits of the drugs kick in.

So the next time you read or hear a news item speaking vaguely of studies that indicate "side effects" or "increased risks", and especially if the FDA is touting it, dig a little deeper, and ask if there is evidence of actual, proven causation -- or just some fairly weak, and perhaps grossly misunderstood statistics?