Warning: take the warnings about SSRI with teens seriously

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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/

+1,000,000
My father, who suffered from depression all his life, committed suicide when he was 60. He had never been treated for depression and was taking no medicine. I started taking Prozac in my 20's, after recognizing depression in myself. It literally has changed my life. I will happily take it for the rest of my life, and only wish I had been diagnosed with depression as a teen so I could have taken it earlier.

Both of my children are now on Prozac - diagnosed with depression in their teens. Depression is a real disease and can be successfully treated with SSRIs. I only wish my dad had taken them. His life might have been so different.

DH had pretty severe depression in his teens and he’s not and never was on SSRI’s. He did talk therapy for years and it helped him.
Nowadays everyone pops a pill. Sure, people who did not improve should have the option of meds and maybe multiple meds but the immediate medication is not appropriate for everyone.
There are actually life changing side effects on a lot of these drugs too.

Yes, and there are actually life changing effects to waiting to start an SSRI while you experiment with "talk therapy." Many (most) people who are clinically depressed don't need to talk it out. They have a serious serotonin imbalance that needs to be corrected. When I was depressed, I didn't need to talk it over with someone. I needed medication to correct my brain chemistry, and fast. After three weeks of taking Prozac, I felt like a normal person again. It probably saved my life.

So I would say to you that talk therapy is not appropriate for everyone. Many clinically depressed people simply need to up their serotonin. Just as a diabetic needs insulin, the depressed brain needs serotonin. Talking about it does nothing to correct the imbalance within the brain. I'll stick to my Prozac, thanks.

You are wrong on the science of depression. It is not fully understood. Some depressed people actually have an excess of serotonin.

SSRIs work barely better than placebos. A sugar pill might have had the same effect that you think Prozac had on you.

Personally, I was on an SSRI for 10 years, starting at age 18. I, too, was convinced that it saved my life. Around year 8 or 9, the side effects became unbearable. It was then that I stated to look into SSRIs more deeply. They’re not the miracle drugs many people think. They’re actually a fairly ineffective treatment for depression.

Look, this is your experience. It is not at all mine or that of the many other people I know who have taken SSRIs longterm. I've been taking it for 20 years and have *never* had side effects or found it to be less effective than it once was. I was just talking to a friend of mine this past week about how Prozac has changed our lives - she's also been on it for decades. It didn't work for you. It works for MANY other people. I'm very grateful for it and the members of my family who also suffer from depression are as well. But you go ahead and liken it to a "sugar pill" because it didn't work for you. How utterly absurd.

[Anonymous]

Anonymous wrote: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.

Plenty of risks with ketamine - funny, you didn't mention any of them:
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00392-2/fulltext

[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

Exactly. But you're far too rational for this thread. Some people desperately want to believe the worst about antidepressants, even those which have been around for years and years. I'm eternally grateful I found a medication which has helped me overcome my depression. I only wish I had started it sooner.

[Anonymous]

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

You mean Accutane? It was a life-saver for all three of my teens.

[Anonymous]

Anonymous wrote: 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.

+1,000

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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/

+1,000,000
My father, who suffered from depression all his life, committed suicide when he was 60. He had never been treated for depression and was taking no medicine. I started taking Prozac in my 20's, after recognizing depression in myself. It literally has changed my life. I will happily take it for the rest of my life, and only wish I had been diagnosed with depression as a teen so I could have taken it earlier.

Both of my children are now on Prozac - diagnosed with depression in their teens. Depression is a real disease and can be successfully treated with SSRIs. I only wish my dad had taken them. His life might have been so different.

A sample size of 3 doesn't allow drawing this conclusion. The FDA didn't ask around the neighborhood before putting on these warnings. They halp many people. They also cause suicidal behavior in others. Both are true. Your experience is great, but cannot be used to gloss over these problems, which are real. By dismissing these concerns you are doing people a disservice.

Look up Study 329. It was the original Paxil study and a reanalysis was performed in the original data. They found serious errors. Remember Paxil was marketed as being especially suited for teens -- found it was not safe and not effective for teens. Think about that: it was literally found to be not safe and to have no measurable benefit. But it is still on the market.

I will go by the dramatic effect SSRIs have had in myself and in family members. Just as I would go by real life experiences with a drug like Accutane, which all three of my kids have successfully taken. Are there side effects? Yes, among some people. However, the vast majority of people who take SSRIs (and Accutane) have life-changing results.

By dismissing these real success stories, you are doing people a disservice - people who could very well benefit greatly from medication.

Inaccurate on the SSRI claim.

Nope. It's actually quite accurate. And it's a shame that you and others are probably going to discourage those who could really benefit from SSRIs from taking them.

[Anonymous]

Anonymous wrote:My child has been on SSRIs for several years. He has seen 3 different psychiatrists. All 3 of them are absolutely certain that SSRIs do not cause suicidal ideation/suicide. I don't know what t believe.

Everybody is different. Last summer, DS was lounging around the house, happy and lazy. Then he started moping around, then could not stop crying on night, telling us thoughts of killing himself kept floating into his brain and he did not know where they came from... He had no history of depression. The pediatrician and us had no idea what was going on. After a couple of days of wrecking our brain on what caused the sudden change, I remembered that he started taking Doxycycline for acne a week ago. Google yielded a single study with 4 cases of suicide with no history of mental health issues while on this antibiotics. He stopped the meds immediately and was back to normal in a week. It was so scary. Nobody expected some run of the mill antibiotics would have this kind of effect.

[Anonymous]

I really should post the Doxycycline separately as a PSA. DH has been fighting depression for a long time. He was prescribed Doxycycline for rosacea even after he told his doctor about what happened to DS. We thought since we only saw a few cases for such a common drug, it would not hurt to try it while be on the watch for side effects. After less than week, he said he felt more moody and stopped the med.

[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/

Having side effect and suicidal are completely different. You can never be too careful with the later, even if you are just on vitamin.

[Anonymous]

Anonymous wrote:I think the posting of this article was good as long as folks read more than just the original post. Someone mentioned that Effexor caused manic behavior. I was diagnosed with a terminal illness at 31, whose only cure was a bone marrow/stem cell transplant. I was lucky enough to have a match, and had that transplant. Two years later we had a daugher, and it was at that point that I started having massive anxiety, and panic attacks. I was put on SSRIs for the management of that instead of taking daily xanax. It took me almost 7 years to find an SSRI that didn't have unbearable side effects. For me that was viibrd. But what I learned in the process is that:
a) Those FDA warnings should be there for people of any age, not just teenagers. SSRIs are very important in the treatment of what is a very serious illness in clinical depression (my wife has this and is on Effexor for it). But all of them have side effects, and those vary significantly by person.
b) One person's Effexor, that can cause manic behavior or depressed behavior, is another person's savior. I slowly became hypo-manic and headed towards full mania from Lexapro, not from Effexor. Any of them can cause this (or the opposite - severe depression), and if they do it's important to switch to a different med. I was taken off the Lexapro and immediately put on Zoloft even though we knew Zoloft gave me other side effects I didn't like. Then we slowly tried different meds until viibryd worked for me. It still has some unpleasant side effects, but not as bad as the others.

My point is that it's not a specific brand of SSRI in my experience, or the age, that can cause sudden, severe depression, or sudden or gradual severe mania - it's any of them, and which one depends on the person. Its still pretty rare, but it does happen, and does happen to adults too (I was 37 when I became hypo-manic from Lexapro, and eventually almost manic - was lucky my psychiatrist at the time recognized what it was when I walked in one day and said "I feel better than I've ever felt before".

So SSRIs are a very necessary set of drugs for treating both clinical depression and severe general anxiety disorder, but they absolutely should be monitored regularly not just by parents, but also my a trained psychiatrist who knows what to look for in terms of early signs of severe depression beyond the regular clinical depression, or early signs of mania. If those are detected, my experience is switching to a different SSRI immediately is better than lowering the dose and adding something else. Adding something else may well be a great idea, but given how differently each of these drugs affects different people, switching is also potentially key. Most of all find a good psychiatrist - ask them what they would look for sign wise to determine if the SSRIs could be causing signs of severe depression or hypo-mania (a stage that feels great, but leads to full mania).

Thank you for your thoughtful post.

The doctors can only go on statistics. The people who are criticizing OP: are you willing to be the fatal stats, however small it might be?

[Anonymous]

Anonymous wrote:

Thank you for your thoughtful post.

The doctors can only go on statistics. The people who are criticizing OP: are you willing to be the fatal stats, however small it might be?

Go with...

Also OP did not ask anybody to stop taking SSRI, what is wrong with be extra extra careful when it comes to life and death?

[Anonymous]

Anonymous wrote:

Thank you for your thoughtful post.

The doctors can only go on statistics. The people who are criticizing OP: are you willing to be the fatal stats, however small it might be?

Go with...

Also OP did not ask anybody to stop taking SSRI, what is wrong with be extra extra careful when it comes to life and death?

[Anonymous]

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

I am the PP posted about Doxycycline. I thought we were just a freaking outlier having psychiatric reaction to an acne drug.

[Anonymous]

Anonymous wrote:

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.

You are deliberately twisting her words. Please read her posts again. If you think this could never happen to your kid, move on. I am glad to hear any antidotes so I can be extra vigilant while my family tries new drug or new dose. Heck, people can die from nuts, let along powerful drugs. It is a number's game - I just don't want my family to be the 0.001%.

[Anonymous]

Anonymous wrote:

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

You mean Accutane? It was a life-saver for all three of my teens.

Everybody is different. The medical science is not a exact science, it is still based on statistics instead of individual, hence all the warnings come with every drug.