Magazine article Clinical Psychiatry News

Show Me the Evidence

Magazine article Clinical Psychiatry News

Show Me the Evidence

Article excerpt

The idea that depressed people are particularly likely to kill themselves when they are starting to recover is widely taught and believed, and it does make sense. But I have tried in vain to find some documentation of this phenomenon or the basis on which the idea was originally put forth.

Dr. Paul J. Fink reiterated that notion in his January 2005 column ("The Black Box Warning: A Mistake?" p. 23). Is there any evidence--other than clinical intuition--in support of this notion?

I'm not an evidence-based medicine wacko, but I do wonder if this increased-energy-leading-to-suicide business is largely a myth that has become reified through time and repetition.

Walter A. Brown, M.D.

Tiverton, R.I.

Dr. Fink replies:

I shared your question with members of CLINICAL PSYCHIATRY NEWS' editorial advisory board, and clearly, it is controversial.

Dr. Cynthia Pfeffer, a specialist in child and adolescent suicide and in suicide in general, pointed out that she does not know of any empirical work with children and adolescents that indicates that "children get suicidal thoughts as a sign that they are getting better and that selective serotonin reuptake inhibitors (SSRIs) are working."

Another board member, Dr. Carl C. Bell, said it is clear to him that medication seems to be a huge part of the solution for the problem of suicidal children. He also directed me to "The Relationship Between Antidepressant Medication Use and Rate of Suicide" (Arch. Gen. Psychiatry 2005;62:165-72), a recently published study that indicated that increases in prescriptions for SSRIs and newer non-SSRIs appear to be associated with lower suicide rates. Unfortunately, I found this article to be inconclusive, but I think it would be useful for you to read.

And Dr. Thelissa A. Harris, another board member, said she suspects that the medications may act more rapidly in children, and therefore, children may be more vulnerable to having the energy to follow through with their "secret" sooner rather than later. All of this, Dr. Harris said, calls for closer evaluation and more frequent psychotherapy for children and all other patients.

My position on this issue clearly runs counter to what most people want to believe--that is, that drugs are stimulants that cause children to have suicidal ideation and perhaps, even attempts. …

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