A new study has found that children and adolescents taking a high
dose of antipsychotics are almost twice as likely to die of any cause
than children on other types of medications. Perhaps even more striking,
children taking high doses of antipsychotics were more than four times
as likely to die of cardiovascular or metabolic causes than children on
other medications.
The study, published online in JAMA Psychiatry, was led by
Wayne A. Ray, PhD, at the Vanderbilt University School of Medicine. The
data was captured between 1999 and 2014. The researchers included youths
between the ages of 5 and 24 years old, who were recipients of Medicaid
insurance in Tennessee. This allowed the researchers to examine their
medical records. In total, there were about 250,000 individuals in the
study. The researchers excluded children with severe physical illness
diagnoses, tic disorders, and schizophrenia. The most common included
diagnosis was ADHD. Photo Credit: Public DomainThe study was composed of three groups: a control group who were on
medications such as stimulants or antidepressants; a group who were
prescribed a low dose of an antipsychotic, and a group prescribed a high
dose of an antipsychotic.
The group taking a low dose of antipsychotics did not have a
significantly increased risk of death when compared to the group taking
other medications. However, children taking a high dose of
antipsychotics were 1.8 times more likely to die of any cause, 3.5 times
more likely to die of unexpected causes (not including overdose), and
4.29 times more likely to die of cardiovascular or metabolic problems.
Deaths from suicide were no different between groups.
In total, there were 40 deaths out of the 27,354 in the higher-dose
group (0.15%), compared to 67 deaths out of the 123,005 in the control
group (0.05%).
Of course, there could be other confounding factors that led to this
effect—something present in the higher-dose group that was not present
in the control group. However, the researchers controlled for the most
obvious explanations (diagnosis, medical illness, and any medication
use). Additionally, after the researchers ran a sensitivity analysis,
they concluded that “to explain the risk of unexpected death in the
higher-dose group, the confounder would have to increase risk by 5-fold,
have a 75% prevalence in the higher-dose antipsychotic treatment group,
and not be present in control patients.”
The potentially deadly cardiovascular and metabolic adverse effects
of antipsychotic medications are well-documented, but according to the
researchers, this is one of the first large studies to examine whether
children are at a greater risk of death due to these causes. The
researchers write that after the second generation of antipsychotic
medications was invented, these drugs began to be prescribed in younger
patients for all variety of indications, such as ADHD, depression, and
behavioral control—indications for which other, safer therapies might be
a better option. According to the authors,
“The study findings appear to reinforce existing
guidelines for improving the outcomes of antipsychotic therapy in
children and youths. These guidelines include restriction to indications
for which there is good evidence of efficacy, an adequate trial of
alternatives including psychosocial interventions when possible,
cardiometabolic assessment before treatment and monitoring after
treatment, and limiting therapy to the lowest dose and shortest duration
possible.”
****
Ray, W. A., Stein, M., Murray, K. T., Fuchs, C., Patrick, S. W.,
Daugherty, J. . . . Cooper, W. O. (2018). Association of antipsychotic
treatment with risk of unexpected death among children and youths. JAMA Psychiatry. Published online ahead of print Dec. 12, 2018. doi:10.1001/jamapsychiatry.2018.3421 (Link)
MIA-UMB News Team: Peter
Simons comes from a background in the humanities where he studied
English, philosophy, and art. Now working on his PhD in Counseling
Psychology, his recent research has focused on conflicts of interest in
the psychopharmaceutical research literature, the use of antipsychotic
medications in the treatment of depression, and the general
philosophical and sociopolitical implications of psychiatric taxonomy in
diagnosis and treatment.
According to new research, between 2013 and 2014, 38.4% of adults took a medication that lists depression as a potential side effect, and 9.5% received three or more such medications. About 23.5% took a drug that listed increased suicidality as a side effect. The researchers found that the use of these drugs was associated with people developing depression and suicidality.
“Use of prescription medications that have depression as a potential adverse effect was common and associated with greater likelihood of concurrent depression,” the researchers write.
The research, published in the Journal of the American Medical Association (JAMA), was led by Dima M. Qato, PharmD, MPH, PhD, at the Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, and also included Katherine Ozenberger, from that same institution, as well as Mark Olfson, a psychiatrist and public health specialist from Columbia University, New York.
Numerous medications include depression and suicidality as a potential side effect, including hormonal contraceptives, beta-blockers, proton pump inhibitors, anti-anxiety medications, and, paradoxically, “antidepressants” themselves.
The researchers found that rates of depression were higher in those taking medications that listed depression as a side effect. They controlled for numerous other factors, including gender, race, age, education level, socioeconomic status, marital status, employment, and multiple medical conditions (e.g., hypertension, cancer, diabetes, and many others).
The authors also controlled for potential confounds and reverse causality by using a statistical method called sensitivity analyses. For instance, the researchers conducted additional analyses to test if removing those who used psychotropic medications would alter the outcome, or if removing those who had hypertension (which is also associated with depression) would alter the outcome. In all of these cases, the association between medication use and depression continued to be statistically significant.
These results indicate that even when removing potential confounding cases (such as other psychotropic drugs, or people with illnesses linked to depression), there was still a link between medication use and the development of depression.
The connection between these drugs and depression were even more powerful for people who took three or more medications that had depression as a side effect. In fact, according to the researchers, about three times as many people who took three or more of these drugs developed depression when compared to those who were not on such medications:
“The estimated prevalence of depression was 15% for those reporting use of 3 or more medications with depression as an adverse effect vs 4.7% for those not using such medications.”
Their finding was not merely due to medication use in general—there was no difference in depression symptoms between those who took no medication and those who took even three medicines that did not have depression as a side effect. Thus, only drugs with depression listed as a side effect were associated with the development of depression.
According to the researchers, some of these medications are available over-the-counter (such as proton pump inhibitors and emergency contraceptives) in the US, and their packaging is often not thorough enough to describe the association of these drugs with depression and suicidality. Thus, consumers may not be aware that the medications they are taking could be responsible for their altered emotional state.
Additionally, the researchers note that calls for screening for depression have expanded considerably—yet screening instruments do not ask about potential medication side effects. Thus, screening for depression may result in someone receiving a diagnosis of depression (and potentially receiving antidepressants) when what is happening is that they are experiencing the side effect of another medication.
****
Qato, D. M., Ozenberger, K., Olfson, M. (2018). Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States. JAMA, 319(22), 2289-2298. doi:10.1001/jama.2018.6741 (Link)
One in every two transgender adolescents who are born female but identify as male has attempted suicide in the past year, according to a new study.
The study, “Transgender Adolescent Suicide Behavior,” was published in Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics.
It raises serious questions about how families, schools, doctors, government, and the media should grapple with the increasing number of children and teens who self-identify as transgender.
In addition to the alarmingly high rate of suicide attempts among transgender boys, the study reported an attempted-suicide rate of over 40 percent for adolescents who identify as gender nonconforming (neither exclusively male or female) and nearly 30 percent for transgender girls (children and teens who were born male but identify as female).
Researchers said they did not find any evidence that transgender youth of color were at a higher risk compared with white transgender adolescents. Higher levels of education among parents and geographical location—urban or rural—did not have a significant effect on suicide attempts.
To arrive at the results, three researchers from the University of Arizona analyzed a survey filled out by more than 120,000 young Americans between the ages of 11 and 19.
By comparison, they found that 14 percent of all teenagers had attempted suicide at least once.
According to the Centers for Disease Control and Prevention, suicide is the second-leading cause of death among adolescents and young adults ages 10 to 34 in the U.S.
The study’s leading author, Russell B. Toomey, focuses his work on youth who identify as lesbian, gay, bisexual, transgender, or what they call queer—meaning that any attempts to discredit the research as “anti-LGBTQ” will likely fall flat.
“Largely, my research has examined these relationships with explicit attention to the minority-specific stressors of prejudice, stereotyping, and discrimination that contribute to the disparate rates of negative outcomes experienced by sexual and gender diverse adolescents and Latinx youth, and the protective factors (e.g., family support, acceptance) that buffer these associations.”
“Latinx” is a gender-neutral term that some use instead of Latino or Latina.
The new study comes on the heels of another alarming and controversial one examining the contagious nature of transgender ideology.
That study, published Tuesday in the journal PLOS One by Brown University’s Lisa Littman, looked at “rapid-onset gender dysphoria”—that is, gender dysphoria not present in early youth but that manifested within days or weeks in teens and young adults.
Littman found that exposure to peers who identified as transgender and transgender-positive content online may contribute to development of this rapid-onset gender dysphoria.
Within days, Brown University pulled down an article promoting Littman’s study. The university said it removed the article in order to conduct an academic review, but it’s clear the decision had more to do with political correctness and uncomfortable results.
Unlike “Transgender Adolescent Suicide Behavior,” Littman’s study wasn’t peer-reviewed. Littman herself concluded that her study “raises questions for more research.”
“One of the main conclusions is that more research needs to be done,” she said.
The study by Toomey and fellow University of Arizona researchers Amy K. Syvertsen and Maura Shramko provides further evidence that research institutions should encourage more studies in this area—not shut them down. At this point, we don’t just know that lives are at stake—we know how many lives are at stake.
And those numbers deserve repeating: One in two biological girls who identify as boys tried to kill themselves in the past year. Two in five gender-nonconforming adolescents tried to kill themselves. And three in 10 biological boys who identify as girls tried to kill themselves.
In discussing these results, Toomey described an “urgent need to understand why transgender, female to male, and nonbinary adolescents report engaging in suicide behavior at higher levels than other adolescent transgender populations.”
He’s right. But that’s just the first of many questions this study begs to be answered.
There’s no excuse. You can’t be an ally of the transgender movement and reject this research. You can challenge it. You can debate it. You can encourage more of it. But you can’t suppress it.
Doing so is harmful to the cause you claim to defend.
Every day, more and more children and teens are identifying as transgender. That’s a fact that The Atlantic captured well:
“In June 2016, the Williams Institute at the UCLA School of Law estimated that 1.4 million adults in the U.S. identify as transgender, a near-doubling of an estimate from about a decade earlier. As of 2017, according to the institute, about 150,000 teenagers ages 13 to 17 identified as trans. The number of young people seeking clinical services appears to be growing as well. A major clinic in the United Kingdom saw a more than 300 percent increase in new referrals over the past three years.”
With more teens identifying as transgender, and attempted-suicide rates for this group between 30 and 51 percent, this has become a national epidemic. The time for political correctness has passed.
Families, schools, doctors, government, and the media have an obligation to figure out how to differentiate between celebrating differences and encouraging dangerous behavior. Because if being transgender poses such a grave risk to adolescent lives, it’s hard to understand why any sane society would embrace the trend.
Kelsey Harkness is a senior news producer at The Daily Signal and co-host of "Problematic Women," a podcast and Facebook Live show. Send an email to Kelsey.
Mad In America Robert Whitaker Aug 6, 2016 In June, the Centers for Disease Control reported that the suicide rate in the United States had increased 30% from 1999 to 2016, with more Americans killing themselves “than ever before.”
The CDC has been sounding this alarm for several years now, stirring
headlines—each time it issues its annual report—of a “public health
crisis.”
Here are just a few of the headlines that have appeared:
Although the media reports may tell of social factors that can
contribute to suicide, such as unemployment, the language in the
articles often tell of a medical crisis. “Mental health experts
say mental health screening would help people get into treatment before
their depression becomes severe,” Voice of America News wrote, in an article
on the CDC report. “Other recommendations include reducing the social
stigma associated with mental illness and making treatment more widely
available.”
The American Foundation for Suicide Prevention, which has been
promoting suicide awareness programs since the late 1980s, similarly
tells of how “ninety percent of people
who die by suicide have a mental disorder at the time of their deaths.”
The most common disorder associated with suicide, the Foundation
states, is “depression, an illness that goes undiagnosed and untreated far too often.” It advises reporters to “convey that suicidal thoughts and behaviors can be reduced with the proper mental health support and treatment.”
This rise in suicide certainly deserves societal attention. But given
that it has occurred during a time when an ever greater number of
people are getting mental health treatment, there are obvious questions
to investigate, with the thought that perhaps our societal approach to
“suicide prevention” needs to change. Specifically:
Is suicide in the United States really at an “epidemic” level? Or is there a bit of “disease mongering” present in such claims?
What do we know about societal risk factors that could account for changes in the suicide rate during the past forty years?
Are there guild and commercial interests present in “suicide prevention” campaigns?
Is there evidence that suicide prevention campaigns work? Does more
access to mental health treatment lead to a reduction in suicide?
Do antidepressants reduce the risk of suicide?
In short, we need a scientific fact-check on suicide in the Prozac
era. The hope is that doing so might help our society respond to this
suicide crisis in a more “evidence based” way.
madinamerica Martin Plöderl, PhD & Michael P. Hengartner, PhD Suicide rates decreased steadily from the mid-eighties until the new
millennium in the USA and, on average, in Organisation for Economic
Cooperation and Development (OECD) countries.1 In Europe, suicide rates decreased until around 2007 in most countries.2
Parallel to this drop of suicides, prescriptions of SSRI’s, the new
generations of “antidepressants,” gradually increased. This led to
numerous publications arguing that the negative correlations between
antidepressant prescription rates and suicide rates was evidence that
antidepressants are likely helpful in reducing suicide because they can
alleviate symptoms of depression, one of the major risk factor for
suicide. Authors of these papers often had financial or other ties to the
pharmaceutical industry (e.g., Ulrich Hegerl, Göran Isacsson, John Mann,
Zoltan Rihmer). In 2004, a kind of shock wave hit mainstream psychiatry when the FDA
released the black box warning about prescribing antidepressants to
children and youth. Not long after, Robert Gibbons and others published a
now widely cited paper, based on data from 2003 to 2005, reporting that
the black-box warning led to a reduction in the prescribing of
antidepressants which was associated with an increase of suicides among
young people.3 However, although the article was published in the high-ranked, peer-reviewed American Journal of Psychiatry,
the statistical analysis and the related conclusions by Gibbons were
quickly shown to be in error; there simply was no increase of suicides
associated with the decrease of antidepressant prescriptions (see
Jureidini, 20074 and Stone, 20145; see also Robert Whitaker’s report). From 2000 onwards, suicide rates in the USA started to rise again
(among youth around 2007). In most countries in Europe, suicide rates
stopped declining or even increased again starting around 2007. However,
antidepressant prescription rates steadily increased from the
mid-eighties until today. As a result, the association between increased
antidepressant rates and reduced suicide rates has faded with each
passing year. Even worse for mainstream psychiatry, if you look at the
past 10 years, antidepressant rates are associated with increased
suicide rates. Yet, as this has occurred, there has been, in our opinion, a strange
silence. There has been a lack of research updates on the trend of
increases in suicide rates as prescriptions of antidepressants have
risen. And what about research reports on the long-term outcomes of the
FDA black box warnings? Two papers pointed out that suicide rates did
not increase as a result of the black box warnings in the United States
and in Canada (Rhodes, Skinner, McFaull, & Katz, 20136
and Stone, 2014), but these papers were also “silenced” in psychiatry,
since they were much less cited (9 and 36 times, respectively) than the
Gibbons et al. paper that was cited 569 times (citation-frequency
assessed via Google Scholar on August 12, 2018). Other attempts to show that the FDA warnings led to increased suicides (Lu et al., 2014,7 cited 115 times) have also been debunked (see comments to the Lu article and Philip Hickey’s blog “Suicidal Behavior After FDA Warnings” here on MIA). This silence about increasing suicide and antidepressant rates, and
the silencing of studies that disproved harmful effects of the FDA
warnings, was interrupted by at least two noteworthy incidents that
demonstrate some deep-seated form of “evidence-resistance.” First,
Robert Gibbons simply kept on claiming that the black box warning led to an increase of suicides (LA Times,
Feb. 06/2012). Second, a research group around Zoltan Rihmer published a
paper in 2015 about suicide trends and antidepressant prescription
rates in Hungary, but only used data up until 2006, excluding the time
span afterwards when suicide rates increased again (Otuyelu et al., 20158).
This way, they of course could prove that increased antidepressant
prescriptions came along with reduced suicide rates. No word about the
restricted time frame or the increase of suicides in recent years in the
limitation section of the paper. They even claimed that their results
were an indirect proof of the harms of the FDA warnings (of course
citing the debunked 2007 Gibbons et al. paper). They said that, since
there was no related warning in Hungary, antidepressant prescriptions
kept on rising in young people whereas suicides kept on falling. Otuyelu
also cited another paper that “proved” the harms of the black box
warning (Katz et al., 20089), despite opposing evidence available at that time (Rhodes et al., 2013). All of this is the background to our recent research on this topic.
Recently, when we became aware of a newly published paper in the Journal of the American Academy of Child & Adolescent Psychiatry
that analyzed trends of suicidality and mental health utilization of
young people in the US, we wondered why the authors did not also include
the results for prescriptions rates, despite that data being available.10
However, since the data was in the public domain, we were able to
investigate the association of the suicide attempt rate with drug
prescriptions for mood disorders (most likely antidepressants) among
adolescents for the years 2004 to 2016. Our analysis was rejected for publication by the Journal of the American Academy of Child & Adolescent Psychiatry and by JAMA Psychiatry. We were finally able to publish the paper in Epidemiology and Psychiatric Sciences (Plöderl & Hengartner, 201811). Unfortunately, variables for years prior to 2004 could not be
compared to later years, but with the available data we could still
explore changes in the rate of prescriptions and suicide attempt rates
following the FDA warning. The data is based on the annual National
Survey on Drug Use and Health, a nationally representative survey among
the US population. Past year major depression was assessed with a
structured interview, and participants were asked if they had taken
prescribed medication for their mood problems in the past year. We used
this as a proxy for use of antidepressant medication. Prior suicide
attempts were also assessed. This suicide attempt variable seemed to be a
valid indicator of past year suicide risk, since it correlated high
with the yearly suicide rates of the same age group (r = 0.75, p <
.05). Our analysis revealed that the rates of prescriptions, suicide attempts, and suicides decreased
in the years following the FDA warning in 2004 but started to rise
again in recent years. This is also confirmed by large and statistically
significant correlation coefficients. Obviously, this contrasts with
the assumption that the FDA warning led to an increase of suicidal
behavior. On the contrary, it seems that reduced prescriptions lead to a
reduction in suicidal behavior. It also indicates that the FDA
warning had no enduring effect, since prescriptions to youth are on the
rise again. The usual interpretation by mainstream psychiatry is that our
findings are an artefact: young people attempting suicide are more
likely to receive mental health treatment, and this produces the found
association. This explanation, however, does not fit with the fact that
our findings apply both to adolescents with and without a major
depression diagnosis. Persons without major depression are rarely
suicidal; therefore, in these youths, the strong correlation between
suicide attempts and antidepressant prescriptions is hardly explained by
diagnosis alone. Also, antidepressant prescription rates increased before the suicide attempt rates did, as indicated via a statistical technique called changepoint-analysis.
Given the limitations of our study, it is important to look for
replications. Indeed, our findings are similar to that of a study by
Gupta, Gersing, Erkanli, & Burt (2016).12
By using patient data from psychiatric settings, Gupta et al. found
that antidepressant prescriptions decreased from 79 to 60% from the
period before the black box warning (2000-2003) relative to the period
afterwards (2004-2009). The relative risk for suicidality decreased
substantially by around 60-70% as well. Of note, the relative risk for homicidality and other violent events
was also reduced around 60-70%. These findings are exactly what would be
predicted by the outcomes of randomized controlled clinical trials. In
these trials, young people using antidepressants had higher rates of
both suicidality and aggression, compared to those taking placebo. With our study results, as with all such correlational data, it must
be mentioned that causality cannot be inferred, and there are other
strong arguments regarding why such data must be interpreted with
caution. However, as stated above, our findings are in line with those
from randomized controlled trials, where young people taking
antidepressants indeed had higher rates of suicide attempts and other
forms of suicidality (Healy, Le Noury, & Jureidini, 2018;13 Sharma et al., 2016;14 Stone et al., 200915). Put together, these data strongly suggest that antidepressants can cause suicides and aggressive behavior. Disturbingly, our study and others reveal that the black box warning
is now ignored in many countries, since antidepressant prescription
rates for children and youth are on the rise again (Bachmann et al.,
2016;16
Otuyelu et al., 2015). This increase is happening despite increasing
certainty that antidepressants are rather ineffective and most likely
cause suicidal behavior in young people. It seems that the current strategy in mainstream psychiatry to deal
with the problematic evidence base is to recommend fluoxetine, because
it was reported as being the most effective drug with no increase of
suicidality (Brent, Gibbons, Wilkinson, & Dubicka, 2018;17 Cipriani et al., 201618).
Again, problems with these studies and the excess of suicidal events
under fluoxetine in the trials continue to be ignored. As with other
reports critical of antidepressant prescriptions, these inconvenient
findings are not properly acknowledged. As a result, mainstream
psychiatry will continue to claim that antidepressants effectively
reduce suicide risk, despite compelling evidence to the contrary. Show 18 footnotes
1: Patients need to Be Psychiatrized to prevent them from taking their own lives.
2: This life saving system itself is rife with people who do take their own lives.
3: The system doing the 'Life Saving Psychiatrizing' should be trusted and funded by government to interfere in other people's lives when it can't forecast/diagnose, intervene in, and save the lives of people it works with day in/day out, all day?
The Hill By Dr. Vinita Parkash, opinion contributor — 05/31/18 06:30 AM EDT
As America focuses on one epidemic — the opioid crisis — another goes entirely ignored. American health-care workers are dying by suicide in unprecedented numbers. Earlier this month, a medical student and a resident at NYU medical school completed suicide less than a week apart.
My junior colleague took her life just 11 days before her 35th birthday. I had supervised her as she transitioned into practice from fellowship. She said that the way I said her name foretold if the conversation pointed to a weakness or a strength in her patient assessment. My last sight of her was as she drove off to her new job. Less than six months later, she made a life-ending choice.
A scan of her suicide note, asking that I be notified, was emailed to me. I did not show it to anyone. The news of her suicide was announced by an email in the department. We all went about our business, as if suicide by a young colleague is usual. And perhaps, in a way it is.
After all, physician suicide — and more broadly health-care worker suicide — is a huge issue in the U.S. In my own experience, I have lost six colleagues to suicide — five physicians and one physician assistant. That does not include the suicides that I have heard about through the whisper network at work.
My junior colleague was among an estimated 400 physicians who took their lives in 2016. Many physicians know more doctors than patients who have taken their lives. Physicians and nurses complete suicide more often than do average Americans; rates are even higher for women in both professions. Respect, fear and love for our colleagues often leads us to list the cause of death differently on death certificates. We frequently self-medicate, so suicides may instead be listed as accidental. Phrases to describe the scope like “an entire medical school class a year” or “a doctor a day” have particularly ominous meanings for physicians.
Two former Obama administration officials suggested that America’s European allies should punish President Donald Trump for withdrawing from the Iran deal and levying additional sanctions on the Islamic republic.
The European Union and individual European countries are obligated to take aggressive steps to preserve the Iran deal, in order to avoid becoming Trump’s “doormat,” Steven Simon and Jonathan Stevenson argued in an op-ed that ran in The New York Times Thursday. Both Simon and Stevenson were directors on former President Barack Obama’s National Security Council (NSC).
“The European Union could, for instance, announce the withdrawal of member-states’ ambassadors from the United States. Isn’t this what states do when diplomatic partners breach solemn agreements, expose them to security risks and threaten to wreak havoc on their economies? That is, after all, what the administration is threatening to do by courting the risk of a Middle Eastern war and applying secondary sanctions to European companies,” they argued. “Depending on the American response, European capitals might even follow up with expulsion of American ambassadors.”
“It would be hard to fault these moves as irresponsible, given that they would not impair vital security functions like intelligence-sharing and law enforcement coordination. They would, however, symbolize a stark diplomatic breach that could extend to other areas in which the Trump administration needs allied support,” the former Obama officials wrote. “Thus, the White House would face the first hard choice in this whole process: a full-blown crisis in trans-Atlantic relations. If the administration’s next move were to impose secondary sanctions on Europe, the Europeans could slap its own penalties on American multinational corporations, which in turn would place additional pressure on the White House.”
Obama himself sharply and publicly criticized Trump’s decision to withdraw from the Iran deal — breaking with precedent that presidents refrain from criticizing their successor. The former president and former first lady Michelle Obama have publicly slammed Trump a dozen times since they left the White House.
Two of the most liberal states in the country killed off legislation that would have legalized assisted suicide.
Lawmakers in Massachusetts and Connecticut have shelved bills that would have allowed doctors to prescribe lethal medication to patients with terminal diagnoses. Activists, who prefer the term medical aid in dying, were hopeful that heavily Democratic majorities in both states would pass the bill, and Massachusetts, in particular, seemed receptive to assisted suicide after the state's top medical association withdrew its opposition to the practice and pledged neutrality on the bill.
The Massachusetts Medical Society's stance, however, inspired backlash from doctors across the state. Former society president Dr. Tom Sullivan joined physicians across the state in February to lobby lawmakers against legalization. He told the Washington Free Beacon he was "overjoyed" when he learned that lawmakers would table the bill. "The legislature agreed that it doesn't make sense to reverse a practice that's at least 2,500 years old," he said referring to the Hippocratic Oath. "I think the testimony of other doctors made them recognize that many physicians are opposed [to assisted suicide] … it's a call for us to do more and educate not only the public and legislators but our own physicians to take care of dying patients."
Mark Rollo, a primary care doctor and Air Force veteran, said doctors needed to step up to personally lobby lawmakers after the medical society's "gutless" neutrality stance. He said legislators were persuaded about the unintended consequences of legalization would have on insurance companies incentives to withhold more expensive life-extending treatments in favor of pushing suicide.
"I think the most important message in our victory is the reality that PAS would have become a cheap medical procedure that would have steered the vulnerable toward suicide and favored the white, wealthy, and well insured," Rollo said. "The poor, people of color, and people with disabilities would have received the all too familiar denial of care letters from insurance companies and from Medicaid, refusing to cover expensive care but offering to pay for suicide pills. We the people say no thanks."
Supporters of assisted suicide at Compassion and Choices were disappointed in the results. Spokesmen for the group said denying the bill would hinder the wishes of terminal patients. Marie Manis, Massachusetts campaign director for Compassion and Choices, said it would extend the suffering of the seriously ill.
"The tragedy is terminally ill Massachusetts residents with six months or less to live will not have this option to peacefully end their suffering if they need it before the legislature revisits this issue next year," she said in a statement.
Matt Valliere, executive director of anti-assisted suicide Patients Rights Action Fund, said many patients have been spared pressure to opt for suicide.
"We welcome the Massachusetts Health Committee's unanimous vote to send dangerous, regressive bills H1194/S1225 to ‘study,' effectively killing the push for legalized doctor assisted suicide for the session," he said in a statement. "Assisted suicide is not medical treatment. It is bad public policy that puts a great many at risk of deadly harm through mistakes, coercion, and abuse."
The legislative battles drew pro-life activists from across the country to pour into the states. Deanna Wallace, spokesman for Americans United for Life, visited the Connecticut statehouse with other activists to speak out against assisted suicide. She said the failure to pass the legislation in the heavily Democratic states demonstrated momentum for upholding prohibitions against the practice.
"The recent victories in Connecticut and Massachusetts continue the overwhelming trend in state legislatures against the legalization of physician-assisted suicide. In the past 23 years, there have been more than 200 failed attempts to legalize this dangerous practice, showing clearly that the momentum is on the side of the pro-life movement," Wallace said. "Americans United for Life will continue to fight to protect vulnerable people such as the elderly, ill, and disabled from this type of fatally flawed legislation."
Assisted suicide is legal in six states and Washington, D.C. While the groups celebrated their victories in Connecticut and Massachusetts, the Hawaii house passed assisted suicide and the Democratic governor has indicated he would sign it. Tim Appleton, Compassion and Choices' Connecticut campaign manager, said the group has not given up hope of returning to states that have rejected assisted suicide.
"The fight for medical aid in dying will continue, but for some terminally ill Connecticut residents, next year will be too late," Appleton said in a statement. "There's too much at stake to stop the fight, and we're confident that Connecticut residents will one day join the 1 in 5 American adults who have access to this compassionate option."
Dr. Sullivan, the former Massachusetts Medical Society president, said he is prepared to wage the battle again and plans on visiting the Rhode Island statehouse in the coming weeks as it weighs legalization. He said more must be done to ensure patients have access to palliative care and hospice care to ease suffering in a person's final months.
"I know this is going to be a never-ending battle," Sullivan said. "This isn't just a medical issue it's a moral, cultural, and social issue … We know this is another alarm call that we need to do more for people who are suffering and depressed that has led them to desire to end their own lives."
The more of it you create the more 'Mental Illness' you create. The two go hand in hand. When you grant special people special rights you deprive other, non-special people of their rights, and Bingo, the unhappiness/depression index skyrockets.
Or, as the old German maxim would have it:
The more laws, the less justice. This is the State empowering Godless Narcissists (which makes them as Diagnosably NUTZ as any of the people they work over) who've bought a State Approved Work License to peddle made up Labels for Diseases which aren't Diseases, Drugs, Real Diseases, Violence and Death.
And scads of billable hours of collectivist bait and switch bullshit from 'roid warming 'Therapists' who sit scribbling down ideations into folders to make sure their billing paperwork doesn't bounce. Most of America, when it pays attention at all, focuses on the criminal drug cartels in Mexico, instead of the global Drug Cartels underwriting the above.
From OZY: The suicide rate for former psychiatric inpatients is 44 times higher than that of the general population. According to Australian psychiatrist and professor Christopher Ryan, some suicides may be caused by the traumatic experience of hospitalization.
“Since a majority of patients admitted to psychiatric hospitals show signs of harming themselves, some experts say it’s logical to expect those patients to remain at a higher risk of killing themselves after they are discharged. But that assumes psych wards are not helping inpatients with suicidal tendencies. Ryan has an even more damning theory: ‘It’s a distinct possibility that a percentage of those deaths are caused by the hospitalization itself.’ He suggests that some patients, especially ones who have been hospitalized against their wishes, wouldn’t have killed themselves if they hadn’t been institutionalized in the first place.”
By Peter Breggin, MD May 24, 2017 Doctors often tell patients that antidepressants can only cause suicidal behavior in children and not in adults. Many publications also make the same claim. The false claim is based on the FDA-approved Black Box Warning for antidepressants that warns about an increased rate of suicidality in children, youth and young adults taking antidepressants, but not in adults over age 24. The Black Box Warning specifically summarizes, “Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24.”
The studies that the FDA relied upon for adults over age 24 were dismally flawed and untrustworthy compared to the ones used for children. According to the FDA at the 2006 hearings:
“Due to the large number of subjects in the adult analysis, almost 100,000 patients, the adjudication process was left as the responsibility of the sponsors [the drug companies] and was not overseen or otherwise verified by the FDA. This is in contrast to the pediatric suicidality analysis in which the FDA was actively involved in the adjudication (p. 14).”
In addition, the FDA also announced at the 2006 hearings on antidepressant-induced adult suicidality that it did not require a uniform method of analysis by each drug company and an independent evaluator as required with the pediatric sample.
Thus, the FDA was comparing somewhat good apples (the pediatric studies) to rotten apples (the adult studies), while making them seem comparable. The child studies showed that antidepressants can cause suicidality — the adult studies (after age 24) showed nothing other than FDA collusion with the self-serving drug companies. As I have described in my books and scientific articles, drug companies routinely manipulate their data on suicide to avoid any causal connection to their drug (see for example my 2006 paper about GSK and Paxil).
In the case of Eli Lilly, here are two memos by employee Claude Bouchey (pages 2 & 3 of document) written to the hierarchy of the company in which he expresses guilt and shame about changing official investigator reports of Prozac-induced suicide attempt to misleading terms like “overdose” or “depression.”
Ironically, the FDA controlled and monitored the original pediatric studies precisely because the drug companies on their own failed to find any risk of antidepressant-induced suicidality in any age group. Why would the FDA assume these same self-serving drug companies, left on their own again, would spontaneously begin for the first time to conduct honest studies on the capacity of their products to cause adult suicidality?
Furthermore, even in the rotten-apple adult studies, despite the drug company’s manipulations, Paxil (paroxetine) turned out to be causally associated with increased suicidality in depressed adults in an internal FDA review of the data. As a result, in 2006 the FDA then forced the maker of Paxil, GlaxoSmithKline (GSK), to write a “Dear Doctor” letter to all healthcare providers confirming the Paxil/suicidality causal link in adults.
In April 2006, the FDA also made the drug company put a warning in its Full Prescribing Information (label or package insert) about the risk of Paxil causing suicidality in adults with depression; but GSK convinced them to drop it in subsequent years. The warning appeared in the Physician’s Desk Reference (PDR) only once in 2007.
Meanwhile, there are many studies showing that antidepressants do cause suicidality and suicide in adults.
Next time you hear someone say that the FDA studies only showed increased suicidality in children and young adults as opposed to adults, remember that the adult studies, unlike the pediatric studies, were not controlled, monitored or validated by the FDA. This is one more example of the extremes the FDA will go to in order to protect drug companies and their often lethal products.
It was bad enough to find out that antidepressants cause suicidality in children. The drug companies and their minions complained mightily. The FDA and the drug companies were not going to allow a repetition of sufficiently unbiased studies that might conclude that adults are also vulnerable to antidepressant-induced suicide.
On December 25, 2016, the Baltimore Sun published an excellent article titled Drug companies prey on children, by Patrick D. Hahn, PhD. Dr. Hahn is an affiliate professor of biology at Loyola University, Maryland. Here are some quotes:
“I recently attended Youth Mental Health First Aid Training at a local public school. It was an eye-opening experience.”
“Youth Mental Health First Aid Training,
sponsored by the National Council for Behavioral Health, is intended to
enable teachers, parents and others in contact with young people to
identify potential ‘mental illnesses’ in order to facilitate early
detection and treatment by our mental health care system. My fellow
attendees were surprisingly open about their own experiences with that
system. One mentioned that her son became manic after being diagnosed
for ADHD. Another said that both she and her roommate became bipolar
after being diagnosed for depression. Neither our facilitators nor
anyone else present pointed out that mania and bipolar disorder are
toxic effects of medications commonly prescribed for ADHD and
depression.”
“Our training manual didn’t say anything
about this either, although it did claim that depression is caused by a
deficiency of serotonin — a fable that by now has become as discredited
as the phlogiston theory of chemistry. It also stated that mental health
interventions are ‘evidence-based’ and ‘scientifically tested’ —
neglecting to mention that much of that evidence is put forth by drug
companies who have a fiduciary duty to do everything they can to
maximize sales of their products.”
“So is all this a scheme to push more drugs to more kids? The 2013/2014 annual report
for the National Council for Behavioral Health, titled ‘A Legacy of
Excellence and Impact,’ gives us a hint. It lists the organization’s
supporters as including the Pharmaceutical Research and Manufacturers of
America (PhRMA) along with no fewer than 12 different drug companies.
Would these folks be ponying up the cash if they weren’t confident this
program would increase sales? And do the parents and teachers who attend
the council’s training program — no doubt with the best intentions in
the world — realize that they are essentially sitting through an
eight-hour infomercial bought and paid for by the drugmakers?”
“One out of 13 American children between the ages of 6 and 17 has taken a psychotropic medication within the last six months, according to the Centers for Disease Control. Meanwhile, youth suicide rates are at their peak
going back at least as far back as 1999, while the number of children
receiving disability benefits for mental illness is at an all-time high.”
Please take a look at Dr. Hahn’s article, and pass it on. Mental
Health First Aid is not a good thing. Rather, it is just another
psychiatric expansionist tool.
Drug agencies warn against using antidepressants in children and adolescents because they increase the risk of suicide. It is more difficult to know what the risk is in adults, as there has been massive underreporting and even fraud in the reporting of suicides, suicide attempts and suicidal thoughts in the placebo-controlled trials(1,2). The US Food and Drug Administration (FDA) has contributed to the obscurity by downplaying the problems, by choosing to trust the drug companies, by suppressing important information, and by other means(2).
In a meta-analysis of the placebo-controlled trials from 2006, the FDA reported only five suicides in 52,960 patients on SSRIs (one per 10,000 patients)(3), but there were many more suicides in these trials(2). Five years earlier, in 2001, Thomas Laughren, who was responsible for the FDA’s meta-analysis, published a paper using FDA data where he reported 22 suicides in 22,062 patients randomised to antidepressants(4), which is 10 per 10,000, or 10 times as many as he reported in 2006. In Laughren’s 2001 paper, there were four times as many suicides on antidepressants as on placebo, which was statistically significant (P = 0.03, my calculation). However, Laughren did not tell his readers about this but wrote: “There is obviously no suggestion of an excess suicide risk in placebo-treated patients.” No, but there surely was in the drug-treated patients!
In its meta-analysis, the FDA found that paroxetine increased suicide attempts significantly in adults with psychiatric disorders, odds ratio 2.76 (95% confidence interval 1.16 to 6.60)(3). GlaxoSmithKline also found an increase in suicide attempts in adults and in 2006, GSK USA sent a “Dear Doctor” letter that pointed out that the risk of suicidal behaviour was increased also above age 24(2).
The FDA was inconsistent. The agency claimed in 2009 that it is only in those below 24 years of age that these drugs are risky(5). But in 2007, the agency admitted, at least indirectly, that SSRIs can cause suicide at all ages(6): “All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants.” The FDA also noted that, “Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt.” It seems that the FDA finally admitted that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed. Such daily monitoring is, however, a fake fix. People cannot be monitored every minute and many have committed SSRI-induced suicide within a few hours after everyone thought they were perfectly okay.
Since there is pervasive scientific misconduct in the published trial literature related to suicidality and aggression on antidepressants, we decided to look elsewhere. We obtained 64,381 pages of clinical study reports from the European Medicines Agency, which proved to be very revealing(7). In January 2016 we showed, for the first time, that SSRIs in comparison with placebo increase aggression in children and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81). This is an important finding considering the many school shootings where the killers were on SSRIs.
In October, we showed in a systematic review of placebo-controlled trials in adult healthy volunteers that antidepressants double the occurrence of events that can lead to suicide and violence, odds ratio 1.85 (95% CI 1.11 to 3.08)(8). The number needed to treat to harm one healthy adult person was only 16 (95% CI 8 to 100).
On November 14th, we showed that adverse effects that increase the risk of suicide and violence were 4-5 times more common with duloxetine than with placebo in trials in women with stress urinary incontinence(9). The results were similar for FDA-defined activation events, and there were also more women on duloxetine that experienced a core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81). Many women were hit by the harms of duloxetine. There were 187 who had at least one core or potential activation event on duloxetine out of 958, whereas only 42 of 955 women on placebo experienced such events, i.e. 15% more women were harmed when on active drug than on placebo, or one out of every seven treated.
Duloxetine was never approved for use in stress incontinence in the US or in Canada whereas it is approved in Europe. We performed a meta-analysis of 4 randomised placebo-controlled trials of duloxetine (involving a total of 1913 patients) submitted to the European Medicines Agency for marketing approval. We used data from the clinical study reports (totalling 6870 pages and including individual patient data). It would have been quite impossible to demonstrate how dangerous duloxetine is, if we had only had access to published research.
Our systematic review underlines that antidepressants not only increase the risk of suicide and violence in children and adolescents, but also in much older people: The women in the trials had a mean age of 52 years. In accordance with this, the FDA has previously announced that women who were treated with duloxetine for incontinence in the open-label extension phase of the clinical studies had 2.6 times more suicide attempts than other women of the same age(2).
I have no doubt that the manufacturers of antidepressants and their paid allies among the psychiatrists will argue that there is nothing to worry about because we did not find an increase in suicides or suicide attempts in adult healthy volunteers or in women with urinary incontinence, only an increase in precursors to such events. But this argumentation is faulty. Looking at precursor events to suicide is just like looking at prognostic factors for heart disease. We say that increased cholesterol, smoking and inactivity increase the risk of heart attacks and heart deaths and therefore recommend people to do something about it. Psychiatric leaders, however, routinely try to get away with untenable arguments. Many say, for example, that antidepressants can be given safely to children arguing that there were no more suicides in the trials, only more suicidal events, as if there was no relation between the two, although we all know that a suicide starts with suicidal thoughts, followed by preparations and one or more attempts.
Conclusions
Although the drug industry, our drug regulators and leading psychiatrists have done what they could to obscure these facts(2), it can no longer be doubted that antidepressants are dangerous and can cause suicide and homicide at any age(2,10,11). Antidepressants have many other important harms and their clinical benefit is doubtful(2). Therefore, my conclusion is that they shouldn’t be used at all. It is particularly absurd to use drugs for depression that increase the risk of suicide when we know that psychotherapy decreases the risk of suicide(12). The psychotherapy trials have been criticised for lack of blinding(12) but it is difficult to blind such trials. Furthermore, suicidality is a pretty hard outcome.
We should do our utmost to avoid putting people on antidepressant drugs and to help those who are already on them to stop by slowly tapering them off under close supervision. People with depression should get psychotherapy and psychosocial support, not drugs. * * * * *
References:
1. Healy D. Did regulators fail over selective serotonin reuptake inhibitors? BMJ 2006;333:92–5.
3. Laughren TP. Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). 2006 Nov 16. www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf.
4. Laughren TP. The scientific and ethical basis for placebo-controlled trials in de¬pression and schizophrenia: an FDA perspective. Eur Psychiatry 2001;16:418-23.
5. Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009;339:b2880.
6. FDA. Antidepressant use in children, adolescents, and adults. http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm096273.htm.
7. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
8. Bielefeldt AØ, Danborg PB, Gøtzsche PC. Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. J R Soc Med 2016;109:381-392.
9. Maund E, Guski LS, Freund N, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ 2016;14 November. http://www.cmaj.ca/lookup/doi/10.1503/cmaj.151104.
10. Healy D. Let them eat Prozac. New York: New York University Press; 2004.
11. Breggin P. Medication madness. New York: St. Martin’s Griffin; 2008.
12. Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2016; 5: CD012189.
The D.C. Council will take their final vote on the “Death with Dignity” bill that legalizes assisted suicide for terminally ill patients in the District.
The legislation is expected to pass and will then be sent to Mayor Muriel Bowser for final approval. The Council voted 11-2 to approve the “right to die” legislation in early November, a veto-proof margin, but Bowser already said she will not veto the measure if it passes. Many black residents in the city oppose the legislation, fearing it will be abused on racial lines, reports WJLA.
Various citizens are concerned the law may pressure low-income individuals with limited health care options into requesting the lethal medication. Critics of the bill vow to continue to fight its implementation and are prepared to take their case to the Republican-controlled House of Representatives, which could bar the law from implementation.
“We believe in life until natural death and that there is a racist component to it,” Leona Redmond, a community organizer in D.C. against the legislation, told The Washington Post in early November. “It’s eugenics being dressed up to look like it’s the best thing since gravy.”
The bill allows terminally ill patients with less than six months to live to request a prescription for lethal medication. The Death With Dignity Act of 2016, sponsored by Ward 3 Council member Mary Cheh, bars anyone younger than 18 from requesting the medication.
Critics of the legislation cite alarming statistics in places like Oregon, which legalized assisted suicide in 1994, and Washington state, which passed their own measure in 2008.
“The annual number of people taking their lives under the Oregon law is now eight times what it was in the law’s first full year of operation,” Richard Doerflinger, with the The Witherspoon Institute, wrote in a recent editorial. “In Washington state, the number has tripled in only seven years. Now this agenda is moving to D.C., where half the population is black and there are great inequities between the affluent and the urban poor.”
Council Members Brianne Nadeau and Yvette Alexander stand in opposition to the Death With Dignity Act, casting the only dissenting votes at the initial hearing.
“Those with least access to quality health care are most likely to get a late-stage terminal diagnosis,” Nadeau said at a committee hearing in October. “They’re least likely to have coverage for expensive interventions. I believe they’ll also be most likely to consider this option as their best option, even if it’s not.”
