The View from Hell

Just another WordPress.com site

Suicide Trends: Antidepressants, They Do Nothing

with 6 comments

Suicide trends in the United States: this is what they look like, in case you’re confused.

One question often asked, in reference to whether antidepressants are effective, is whether suicide rates have declined in response to widespread antidepressant use. Many authors have attempted to answer this question. One study attempted to demonstrate a time correlation between antidepressant use and declining suicides. Why did these authors cut off the data for the 1950s, and begin their analysis with data for the 1960s? Including the suicide rate data (very low, especially among women) for the 1950s would reduce confidence in the authors’ conclusion that antidepressant use is time-correlated with a drop in suicides. (The 1950 data occurred long before SSRIs were available, but undercut the authors’ claim that the 1960-1988 data represented the baseline condition from which suicide rates dropped.)

More importantly, given the data that antidepressant use is not associated with a drop in suicidal behavior, such as suicidal ideation and suicide attempts, even if time correlation were properly demonstrated, the effectiveness of antidepressants is not supported. It is difficult to imagine any way in which antidepressant medications could reduce suicides while having no effect on suicidal ideation, behavior, and attempts, especially given that the JAMA study found that “cry for help” insincere suicide gestures decreased slightly between the 1990-1992 and 2001-2003 studies.

Actually, there is a way that antidepressants could reduce completed suicides but not suicidal behavior or ideation: if they interfere with cognitive ability in general, rendering suicides clumsier or more poorly planned.

But the more likely explanation, given all the data, including the February study that the commonly prescribed antidepressants don’t work better than placebo, is that some factor other than antidepressant use is responsible for any drop in suicides. The obvious answer is that, to the extent that there has been a drop in suicide rates, it’s due to the drop in gun ownership over the past few decades. (Here’s a graphic.) As I have previously noted, gun ownership is highly correlated with suicide. Reduction in gun ownership, in addition to reduction in availability of other reliably lethal methods of suicide, such as lethal pesticides (frequently used for suicide by men and women in poor countries) and barbiturate sleeping pills, is much more likely to be responsible for the drop in suicides than increased antidepressant use. These factors – what might be termed coercive suicide prevention methods – would easily explain a drop in suicide not associated with a drop in suicidal ideation or behavior.

Thanks to Overcoming Bias poster Peter McCluskey for the pointer to the PLoS article.

Edit: Cognitive behavioral therapy (CBT), much hyped for depression, apparently doesn’t work either. From the study:

Stravynski and Greenberg suggested that all models of psychotherapy, including cognitive behavior therapy, may be “equally unsound scientifically but they energize the therapists and provide useful fictions to activate the patients to lead somewhat more satisfactory lives.” [Citations omitted.]

Advertisements

Written by Sister Y

June 12, 2008 at 11:30 pm

6 Responses

Subscribe to comments with RSS.

  1. Do you know if the trends differ by region in a way that correlates with geographic differences in rates of gun ownership?

    Chip

    June 13, 2008 at 3:57 pm

  2. That’s what the < HREF="http://injuryprevention.bmj.com/cgi/content/full/12/3/178" REL="nofollow">Miller study<> is about, dividing the country into four regions:Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership.

    Sister Y

    June 13, 2008 at 8:41 pm

  3. Is this Sister Y? The folks at BB miss you, if it is!If not, just letting you know you have a new reader, as this post was rather well written.

    Anonymous

    June 14, 2008 at 7:31 am

  4. Why yes it is, and thank you – I miss BB too!

    Sister Y

    June 14, 2008 at 7:43 am

  5. Curator,Thanks. My link is gated, but I was able to read the abstract. I would be more convinced if the study also looked at regions where gun ownership rates had remained constant and perhaps where gun ownership rates had increased. But still, a quick glance at suicide rates by state seems to lend credence to the Miller study and to your hunch, though there appear to be some outliers (relatively low rates in presumably gun-dense states like Texas and Georgia).Makes me wonder how the Japanese manage to off themselves so often with so few guns at their disposal.

    Chip

    June 14, 2008 at 6:08 pm

  6. The Japanese have access to news reports of successful suicides – see my piece on < HREF="http://theviewfromhell.blogspot.com/2008/04/suicide-contagion-impulsive-suicides.html" REL="nofollow">suicide contagion<> – and, as my boyfriend points out, a background of cultural approval of honorable suicide. I’m not sure how much culture really matters, but it’s a possibility.

    Sister Y

    June 24, 2008 at 7:43 am


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: