Reply to 30 year old DH blowing up his life

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[quote=Anonymous][quote=Anonymous][quote]Are you familiar with the concept of "confounding by indication?"[/quote]

Nope. [/quote]

Ah, then that's part of the problem.

[quote]Be clearer in making your point.[/quote]

Sure! The comment about SSRIs and suicide is both incorrect and not relevant to this case.

The black box warning about suicidal ideation in this context is limited to children and adolescents, not adults, does not show a relationship with increased likelihood of actually committing suicide (but a small increase in talking about it), and is not higher than the risk of suicidality in untreated depression.

"Systematic reviews and pooled analysis of experimental, observational, and epidemiological studies have investigated the use of SSRIs and their association with suicidality. Taking account of the methodological limitations of these studies, the current evidence fails to provide a clear relationship between their use and risk of suicidality in adults. However, in children and adolescents, there appears to be a bit of increased risk of suicidal ideations and attempts, but not of completed suicides. This risk can be anticipated and managed clinically." 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/

Many studies were rejected because they did not control well for "confounding by indication." That is, if the risk of something is increased because of having a disorder, and it is treated, then the long term effects of that disorder can erroneously be confused with a side effect or sequelae of the treatment. So, for example, people treated for depression are more likely to have depression, and people with depression are more likely to have dementia. That doesn't establish that antidepressants cause depression. Similarly, people treated for depression are more likely to have depression, and having depression itself is associated with increased suicidality.

Hope this helps!
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