Thursday, December 21, 2006

Do antidepressants really warrant a black box warning?

okay, here goes {something}

The increased risk of suicide with antidepressant use really is not a new phenomena, nor does it need, in my ever so humble opinion, a rash of new warnings issued but a basic understanding of depressive illness, neurochemistry, antidepressants, and the impulsive drive of suicide. Responsible psychiatrists have always known about the increased risk of suicide when they begin pharmaceutical treatment of depressed patients, that is one of the reasons they begin treatment with limited amounts of medication (the eternal conundrum being that they are putting a lethal drug into the hands of a potentially suicidal patient) and why they continue to monitor the patient.

People who understand the nature of the suicidal impulses and attempts will also tell you that it is when the patient begins to feel better that he/she is most at risk for suicidal behavior (one of the telltale signs that is often missed by friends and loved ones when they say "Oh, but they were doing so much better..." as an indication that it must have been foul play to blame rather than suicide. And for an excellent discussion of suicide please check out Night Falls Fast by Kay Redfield Jamison.

Perhaps the biggest problem we are currently facing with the antidepressant crisis is that these medications are being prescribed in greater and greater numbers, to greater and greater populations, and by physicians and other medical professionals who have not always been trained specifically in the psychiatric, psychological, or (sometimes even) neurological sciences .

There is, of course, the question of the action of these types of medication on children as opposed to adults, which much of the current news focus is on although recently it has also moved to the young adult population (18-24), and this is always a concern; but again we need to look at the nature of suicide ideation.

Suicide is almost always impulsive act. I can say with absolute certainty that is why i have never fallen prey to it. I am not an impulsive person. If i were i would be dead. If i were capable of suicide i would be dead. It is something i have considered many times in my life (much more often since the onset of the chronic migraines) and the considered contemplation of it is what keeps ME from it (individual results may vary). There are many reasons for this which i won't go into to here, i've said enough, but i've read enough and felt enough to understand the inclination (and in no way do i want to minimize Anything here including the loss and anger you feel when someone chooses to leave you in this way~i've known that as well).

I've also tried my fair share of antidepressants (though i fought it and fought it as a treatment for depression~i somehow believed it would take away that part of me that was me~antidepressants are one of the prophylactics for migraines and i'll do ANYTHING to combat those~and i do know that one type i tried as an adolescent effected me completely differently when i tried it as an adult). Some of them had me a walking zombie, some of them did give me that almost manic feeling when i began their course. Anyway, the point i was starting to make, is that children and young adults are not well known for their impulse control (and if you fall into that category don't jump all over me for judging YOU here, i'm not talking about you as an individual, YOU may very well have excellent impulse control~but as a general age group that cognitive development is still happening [and new research into the frontal lobe is discovering that judgmental skills are still developing up into the late twenties]. So what we are left with is a medical profession that really should be putting more thought, skill, experience, and follow-through into its prescribing practices as well as patient/consumer/parents putting more thought, self-education, and responsibility into their pill-popping (or not) habits rather than trying to fill up the label with warnings.

i mean i'd really like just a little less FDA in MY life

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