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SSRI’s and the Black Box Warning: Patient Advocacy or Alarmist Propaganda?. Master’s Project Presentation Lucas Kennedy April 3, 2008. Adolescent Depression: the basics. Major Depressive Disorder is defined by the DSM as follows:
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Master’s Project Presentation
April 3, 2008
“Either depressed /irritable mood or loss of pleasure along with at least three other symptoms present over the same 2 – week period”
Number of office visits where
children and adolescents 1.44 million 3.22 million
Percentage prescribed 47% 52%
Percentage of patients who 76% 81%
were prescribed SSRI’s
Proportion of patients who
received psychotherapy of 83% 68%
mental health counseling
Australia, New Zealand and Canada soon followed suit with restrictions of varying degrees on antidepressant usage in children and adolescents.
Let me repeat…………….
Another valid concern is the lack of any defining characteristics for many of the phrases that get tossed about concerning suicidal behavior.
“In the Americanstudies, the concept of suicidality was no more clearly
demarcated than what constituted a child. Terms used to define
suicidality included – though not in any uniform way across studies –
behavioral activation (itself a vague concept), disinhibition, impulsivity
emotional lability, self-inflicted harm, suicide ideation, suicide attempts
and completed suicide. In one study, a child who slapped herself was
considered to be suicidal, as was another child, who in a fit of anger
banged his head into a wall. An event involving a child frustrated
by his school performance who stabbed himself in the neck with a
pencil was labeled merely an accident.” John Bostwick: Mayo Clinic
What is the relative danger of suicidality?
Vitiello and Swede noted: “suicidal ideation is not an accurate predictor of suicide since most persons with such ideation do not attempt to die by suicide.”
Gibbons et al noted: “by design, the randomized controlled trials analyzed by the FDA systematically excluded patients who were actively suicidal, and thus the FDA lacks data on those who are at highest risk for suicide.”
Time Magazine published an article in February of 2004 titled: Prescription for Suicide? At the beginning of the article the following narrative was included:
Kara Jaye-Anne Otter, 12, had been on the antidepressant Paxil for
seven months when she committed suicide. “I was told the worst side
effects would be flulike symptoms,” recalls her mother, Shannon Baker.
“But after three weeks she had begun to cop an attitude. Her grades
started falling. Then she didn’t care what she looked like, and she
was fighting with everybody.” Baker says her daughter developed
rashes and dark circles under her eyes and had trouble sleeping. Then,
on June 3, 2001, Kara pinned a note to her chest reading, “By the time
you find me I’ll be dead. I love you with all my heart. Don’t worry, Jesus
is with me.” She hooked a bungee cord onto a plate hanger on the wall,
wrapped the cord around her neck and pulled against it until she passed
out. Within minutes she was dead. (Lemonick, 2004)
The article does go on to present a simplified but accurate summation of the controversy over prescription of SSRI’s in youth including arguments by physicians who support the continued use of these medications in the treatment of depression, however, the damage has been done.
Most people reading this article are not going to come away with the message that many practitioners still believe that SSRI’s are an important pharmaceutical option for depressed youth. The majority of the people who read this article are going to remember the vivid description of Kara Jaye-Anne Otter’s suicide, and furthermore that this tragic sequence of events was triggered by an antidepressant.