Warning: take the warnings about SSRI with teens seriously

[Anonymous]

Wow, peoples are really desperate defenders of SSRI's despite documented risk of suicide. Not all people with depression get suicidal symptoms. It takes a LOT to get the FDA to put this kind of warning on a medication.

I really wish people would look at the actual studies on SSRIs and see that they are only marginally effective for most people, and not effective at all for a lot of others. I thought Prozac was a miracle cecause it made me feel substantially better pretty quickly. Like an amazing honeymoon of non-depressed. But then it didn't feel as effective and doubling, quadrupling, and adding another led to the dose did nothing except cause me to gain 80 pounds in 2 years. But because the SSRI's blunted all my feelings, I didn't really even care. I barely remember my SSRI years. I wasn't depressed. I wasn't anything.

After finally getting of SSRI's, I did a lot more research on them and I'm so angry that something with such marginal effectiveness but with so many catastrophic side effects is so commonplace.

My depression is in complete remission now for the first time in 30 years (I'm in my mid 40's) thanks to monthly IV infusions of ketamine. I'm not on meds other than that, though I've recently adopted a ketogenic diet and that has improved my baseline mood as well. Ketamine is dramatically more effective for most people than SSRI's and the event is felt the next day, not weeks after starting. And aside from feeling dissociation during the infusion, there are no systemic side effects beyond the day of the infusion itself. It's has been used in much higher doses as an anesthetic for kids for decades, so it has a great safety profile. But most p-docs don't even know about it. Why? No big pharma involvement. No sales reps giving them trips for
Prescribing it. No big ad campaigns. And essentially no big profit to be had, since its generic.

Big pharma is catching up now and developing 3 for profit meds that are derivatives of ketamine. The FDA has given fast track approval for 1 because it is so promising. But the original is more effective and has less side effects.

[Anonymous]

PP, can you recommend a doctor for ketamine? I have a young adult at home who perhaps could benefit and would like to look into further.

[Anonymous]

I have heard that about Zoloft a lot. Terrifying.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. Let me clarify a few things. First and foremost, I have been on an SSRI for 20 years. I am not against them. I am saying the warning is there for a reason.

My understanding is depression / anxiety is complex. In DD's case, I am betting that what we saw with the higher dose was a reduction of anxiety. She was much calmer. But, apparently, it did not help the depression. She was not fearful of the results, but she felt bad. And she hit a very short term deeper depression -- she wanted the pain to stop. So, she tried to stop it.

I thought the zoloft was working, because we were not seeing the anxiety outbursts. But it just took care of the anxiety, and not the depression.

She is down to a minor dose of zoloft, and will probably be off it within a week. Something will replace it. She is also on Ability (very low dose) to help those really short term deep depressions.

And she is in an IOP multiple days a week, to try do get her better coping strategies.

I could have lost my daughter because of a documented side effect. I wish I knew how it was manifesting in her before it got critical.

What "side effect" are you claiming lead to this?

Side effect may not be the right word. But SSRI increases the risk of suicide.

The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. Careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition.

The highest risk of suicidal thinking and behavior occurs:

During the first few months of treatment with an antidepressant
When the dosage is increased or decreased

From: https://www.mayoclinic.org/diseases-conditions/teen-depression/in-depth/antidepressants/art-20047502?pg=2

[Anonymous]

Anonymous wrote:I know you mean well and I'm very sorry for what you've been through with your DD but I hate it when people like you post these anecdotal stories. You don't know that it was the SSRI that worsened your DDs depression and led her to attempt suicide. As you stated, your DD was on an SSRI for a reason and she already had a history of self-harming. Every person with anxiety/depression, especially one like your DD, is at increased risk for suicide and the risk increases if not treated. All your 'warning' is doing is reinforcing the idea that SSRIs are too dangerous and make people less likely to accept that medication is an effective treatment for anxiety/depression.

Nothing is without risk including ibuprofen (heart attack/stroke), acetaminophen (liver damage/kidney disease/heart attack/stroke) and every other thing that enters the body. Whether your DD was on an SSRI or not, she was at increased risk of suicide and you should have been watching her. While shocking, this should not have been a surprise.

I say this as someone whose father and two brothers killed themselves and they were not on SSRIs. I also have 2 boys that have been on SSRIs since ES and my DH has taken them for 20 years.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799109/

Mean we’ll? I think op is providing valuable information that I would like to know even if the risk is tiny . And yes this is a real risk . It is in the drug label.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I know you mean well and I'm very sorry for what you've been through with your DD but I hate it when people like you post these anecdotal stories. You don't know that it was the SSRI that worsened your DDs depression and led her to attempt suicide. As you stated, your DD was on an SSRI for a reason and she already had a history of self-harming. Every person with anxiety/depression, especially one like your DD, is at increased risk for suicide and the risk increases if not treated. All your 'warning' is doing is reinforcing the idea that SSRIs are too dangerous and make people less likely to accept that medication is an effective treatment for anxiety/depression.

Nothing is without risk including ibuprofen (heart attack/stroke), acetaminophen (liver damage/kidney disease/heart attack/stroke) and every other thing that enters the body. Whether your DD was on an SSRI or not, she was at increased risk of suicide and you should have been watching her. While shocking, this should not have been a surprise.

I say this as someone whose father and two brothers killed themselves and they were not on SSRIs. I also have 2 boys that have been on SSRIs since ES and my DH has taken them for 20 years.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799109/

Mean we’ll? I think op is providing valuable information that I would like to know even if the risk is tiny . And yes this is a real risk . It is in the drug label.

I hate to be pick on this, but as a scientist, risk of suicide in a group of depressed individuals is a well-known risk/characteristic of that diagnosis. The meta analysis that lead to the black box warning was very flawed - it is not considered a reliable way to conduct a "study," but the FDA likes to be overly cautious. Drug labeling has to do with things patients experienced during the clinical trial and isn't evidence / admission that the drug causes the 'side effect.'

Based on OP's story line the drug didn't cause the suicide attempt. The drug was well tolerated for a long time. An adverse event is more like, you get on a drug and immediately attempt suicide. Even then, it would be a case-by-case basis to determine whether the suicidal thoughts were there before treatment.

https://www.ncbi.nlm.nih.gov/pubmed/28445632

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I know you mean well and I'm very sorry for what you've been through with your DD but I hate it when people like you post these anecdotal stories. You don't know that it was the SSRI that worsened your DDs depression and led her to attempt suicide. As you stated, your DD was on an SSRI for a reason and she already had a history of self-harming. Every person with anxiety/depression, especially one like your DD, is at increased risk for suicide and the risk increases if not treated. All your 'warning' is doing is reinforcing the idea that SSRIs are too dangerous and make people less likely to accept that medication is an effective treatment for anxiety/depression.

Nothing is without risk including ibuprofen (heart attack/stroke), acetaminophen (liver damage/kidney disease/heart attack/stroke) and every other thing that enters the body. Whether your DD was on an SSRI or not, she was at increased risk of suicide and you should have been watching her. While shocking, this should not have been a surprise.

I say this as someone whose father and two brothers killed themselves and they were not on SSRIs. I also have 2 boys that have been on SSRIs since ES and my DH has taken them for 20 years.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799109/

Mean we’ll? I think op is providing valuable information that I would like to know even if the risk is tiny . And yes this is a real risk . It is in the drug label.

I hate to be pick on this, but as a scientist, risk of suicide in a group of depressed individuals is a well-known risk/characteristic of that diagnosis. The meta analysis that lead to the black box warning was very flawed - it is not considered a reliable way to conduct a "study," but the FDA likes to be overly cautious. Drug labeling has to do with things patients experienced during the clinical trial and isn't evidence / admission that the drug causes the 'side effect.'

Based on OP's story line the drug didn't cause the suicide attempt. The drug was well tolerated for a long time. An adverse event is more like, you get on a drug and immediately attempt suicide. Even then, it would be a case-by-case basis to determine whether the suicidal thoughts were there before treatment.

https://www.ncbi.nlm.nih.gov/pubmed/28445632

I am an OP. I am also a scientist. In hindsight I see the causality in the change in her attitude. I missed it in realtime. I think the SSRI can take away the fear of action (anxiety) without taking away the root depression. Given the impulsive nature of teens, they do not realize the down cycle is not permanent and they are more inclined to take action.

[Anonymous]

In med school on my psych rotation, one of the psychiatrists thought that the reason some people attempt suicide on SSRIs is because after they have been depressed for so long they finally have a little bit of energy, enough to be able to carry out a suicide plan. He believed that oftentimes severely depressed people don't even have the energy to try to kill themselves and then the SSRI helps them feel slightly better so then they can try. Obviously that was just one person's opinion, but I found it very interesting.

[Anonymous]

Anonymous wrote:In med school on my psych rotation, one of the psychiatrists thought that the reason some people attempt suicide on SSRIs is because after they have been depressed for so long they finally have a little bit of energy, enough to be able to carry out a suicide plan. He believed that oftentimes severely depressed people don't even have the energy to try to kill themselves and then the SSRI helps them feel slightly better so then they can try. Obviously that was just one person's opinion, but I found it very interesting.

OP here. Makes sense.

[Anonymous]

It's very possible your daughter is Bi-Polar. Take away the depression and all you leave is manic. I would look into it.

[Anonymous]

OP I understand why you posted, understand that it's not some blanket indictment of SSRI's, and I appreciate it. I'm glad your daughter is doing better.

All OP is doing is reminding people to be aware of and on the look out for this type of situation. I'm not sure how anyone can argue against that.

[Anonymous]

Anonymous wrote:PP, can you recommend a doctor for ketamine? I have a young adult at home who perhaps could benefit and would like to look into further.

I did some searching on the internet and found there is a place in Baltimore and another in Potomac. Also found out it seems to help OCD, which my young adult also has. Thank you PP for mentioning this--this is a treatment he might actually agree to try.

If you have any further information on Potomac vs Baltimore I'd be very interested.

[Anonymous]

Accurate did a number on my teenage nephew’s mental state.

[Anonymous]

I am an OP. I am also a scientist. In hindsight I see the causality in the change in her attitude. I missed it in realtime. I think the SSRI can take away the fear of action (anxiety) without taking away the root depression. Given the impulsive nature of teens, they do not realize the down cycle is not permanent and they are more inclined to take action.

You claim to be a scientist but your conclusions are based on what you 'see' and 'think'. Not very 'scientific'. While I'm sorry for what happened to your DD and I believe a very small subset of people may be more susecptible to suicide after taking medication, the black box label has done far more harm than good. It is well documented that since the black box label was applied in 2004, rates of treatment for depression have decreased and suicide rates increased. The FDA threw the baby out with the bath water.

From your posts, it's clear that your DD's attempt at suicide was because her depression was not well controlled and not because of the SSRI.

[Anonymous]

Anonymous wrote:

Anonymous wrote:In med school on my psych rotation, one of the psychiatrists thought that the reason some people attempt suicide on SSRIs is because after they have been depressed for so long they finally have a little bit of energy, enough to be able to carry out a suicide plan. He believed that oftentimes severely depressed people don't even have the energy to try to kill themselves and then the SSRI helps them feel slightly better so then they can try. Obviously that was just one person's opinion, but I found it very interesting.

OP here. Makes sense.

So people shouldn't treat their depression with SSRIs. Got it.