Thursday 14 August 2014

The epidemic of 'antidepressant'/ SSRI-triggered suicides by hanging: hidden in plain sight


The suicide by hanging of Robin Williams while (reportedly) being treated for depression brings this to mind, Williams apparently following the similar and very rare suicide method used by Mick Jagger's girlfriend, L'Wren Scott.


The overall suicide rate is going down, but the rate of suicide by hanging is going-up

There is a stereotypical pattern of SSRI triggered suicides - which used to be rare but is now becoming much more common:

On March 17th L’Wren Scott hung herself in her Manhattan apartment. She hung herself from a door handle. Hanging with your feet or body on the ground is a classic antidepressant MO when it comes to suicide. Hanging in this way led Pfizer to claim that Matt Miller, a 13 year old boy, hadn’t committed suicide but had died from auto-erotic asphyxiation gone wrong. It has led people in Bridgend and Wales to speculate on the influence of Satanic cults to explain the rash of bizarre suicides there. What happens is this. Antidepressants trigger thoughts of self-harm. These thoughts can vary from the mild to the malignant. The drugs can trigger thoughts like this in perfectly normal people, who have rarely if ever thought of harming themselves. Partly because these are such unfamiliar thoughts, someone like Matt Miller, Yvonne Woodley or L’Wren Scott can play with them by attaching a noose around their neck and leaning forward to see what it would be like. But leaning forward like this can put pressure on the carotid bodies, cause a person to lose consciousness, slip forward and asphyxiate.


The rate of prescription of drugs as a whole is going down, but the rate of prescription of antidepressants (SSRIs and similar) is going up, and probably faster than any other  major group of drugs - despite its being three decades since their introduction.

This is almost-certainly due to drug dependence.

It is difficult to stop taking SSRIs after taking a significant dose for several months to due withdrawal effects - which may be severe.

Therefore, once people have been on SSRIs for a while, they tend to stay on them forever.

Prescriptions for SSRIs therefore accumulate: each new antidepressant user tending to become a permanent user, each new prescription for antidepressant tending to become a permanent prescription.


(To summarize a lot of literature) SSRIs overall cause, and do not prevent, suicide.

Suicide rates are known to be high in people with moderate to severe melancholia/ endogenous depression - but these severely depressed people are very rare (less than one percent prevalence) and almost always treated as hospital inpatients; and SSRIs are ineffective (they do not work) in inpatient, endogenous depression.


In practice SSRIs are given to a large group of about 15 percent of the population outside of hospital, in general practice and outpatient psychiatry - people who suffer unpleasant symptoms such as anxiety, worry, severe and unpleasant mood swings, chronic unhappiness, guilt and so on - people in distress but people who continue to live at home, continue to look after themselves, often continue to work.

This group of SSRI-users do not intrinsically have a raised suicide rate - if they were not taking drugs, they would be no more likely to kill themselves than normal controls.


It is thoroughly established that SSRIs increase suicide rates.

This was known during their pre-marketing trials. It is officially acknowledged that SSRIs should not be given to children and young people due to increased suicide risk

There are plausible pharmacological and psychological reasons to explain why SSRIs can trigger suicide, and these symptoms have also been found when healthy volunteers take the drugs as well as among patients with psychological symptoms.


So, SSRIs do not prevent suicide, and they are only useful in a group of people who do not have a raised risk of suicide; but SSRIs are dependence-producing and prescriptions are growing faster than any other major drug, and they do increase the risk of suicide and the suicide is often of a violent, unusual, impulsive nature (most stereotypically casing death by asphyxiation by hanging from a kneeling position) and the suicide may be out-of character for that person, and indeed comes out-of-the-blue.


In conclusion there is a very high visibility epidemic of what look-like SSRI-triggered suicides, now becoming visible among the rich and famous who are reportedly being treated for depression, and who kill themselves violently and unexpectedly; and yet this epidemic is hidden in plain sight.

It as if we cannot believe that a drug prescribed officially and with good intentions cannot do harm!

It is as if we assume that powerful, mind-altering, dependence-producing chemicals are necessarily innocent until proven guilty - merely because they are prescribed by a doctor!

Indeed these antidepressant-triggered suicides are generally spun into indicating the need for even-more antidepressant treatment - more treatment to 'prevent' the suicides which were actually triggered by antidepressant treatment.

The situation is Kafka-esque: the more treatment-triggered suicides, the more demand for treatment - the more suicides... 


The bad news is that suicidality is also a probable side effect of some other types of antidepressant as well as the SSRIs; and also of the antipsychotic/ neuroleptic/ 'mood stabilizer' group of drugs - which are heavily and increasingly prescribed(in multiple combinations - often five drugs together!) for the vaguely-defined pseudo-diagnosis of 'Bipolar Disorder'.


The take-home-message is that all powerful drugs have serious possible risks as well as bad inevitable side effects - and all psychoactive drugs create dependence.

Therefore they should only be used carefully (prepared to stop at signs of trouble, or when not clearly effective), at as low a dose and for as short a time as possible; and when the hoped-for benefits outweigh the certain risks - which, in practice, means only when the psychological illness is severe, debilitating, incapacitating.

And (in general) drugs which cause severe definite present side effects and have dangerous risks and cause dependence - should not be used on the excuse of 'trying to prevent future problems'.



Valkea said...

Why bipolar disorder is a 'pseudo-diagnosis'? Aren't depression-manic cycles real?

Bruce Charlton said...

@V - True manic depressive disorder is very rare and very severe (used only to be diagnosed in people who had been hospitalized for both depression and for mania) - it affects about 0.1 percent (one per thousand) or less of the population.

By contrast 'Bipolar Disorder' is nowadays being diagnosed in about 5% (one in twenty) or more of the population.

They are not the same thing. People being diagnosed with Bipolar Disorder are probably mostly a mixed bag of people who would have been diagnosed as neurotic depression (which includes mood swings), anxiety disorders, and drug side effects/ withdrawal effects (for example, SSRIs can trigger mania, and their withdrawal can trigger depression).

For example Britain's best-known 'Bipolar Disorder' Poster Boy is the actor Stephen Fry; who is possibly a psychopath (jailed for credit card fraud as a young man) and has admitted to taking cocaine daily for ten years - regular psychotropic drug use explains all possible mood swings, and means that a functional psychosis *cannot* be diagnosed.

Matthew C. said...

I think the epidemic of partial suspension suicides is more a factor of their current popularity on the internet than on SSRI drug use.

The "suicide crowd" is always looking for the next in-vogue so-called "perfect" method - last year it was helium tanks and suicide bags, this year it is partial suspension hanging.

Of course the true cause is that human beings cannot truly thrive without meaning and purpose beyond our biological fourscore and ten.

Bruce Charlton said...

@MC - Yes, but that ignores a lot of psycho-pharmacological evidence.

Anonymous said...

My gut feeling on this is that these drugs are psychologically worse for people than Steven Fry snorting coke for a decade. The effects I have seen on people I know are horrific: like watching a person become a zombie. I watched people I knew pretty well become heroin junkies; it wasn't the same thing, but it was similar.
I'm not so sure about the suicide thing though. When you introduce new drugs to, say, athletic endeavor, there are obvious changes in outcomes: you can spot when steroids, growth hormones, EPO and other such drugs became available by looking at Olympic records. You can't see that in suicide rates in the US, despite the fact that their use has gone from zero to ubiquitous: suicide rates are flat over the last 25 years (antidepressant use is up 4-500%). The data says if the drugs cause suicide, there must be something else happening to prevent it. Of course, the data also says if they prevent suicide, there must be something else there which is causing people to want to kill themselves.
The pattern is the same in other countries; flat:

That said, people in the US and the West in general must be incredibly unhappy. 11% of Americans above the age of 12 take these things. If we restrict it to white people; it's 14%; about what it is in England. 24% of middle aged women (yay Feminism!) take them. That's not lifetime use: that's "take them right now."

Huxley was an optimist. At least Soma sounded like it was fun. As far as I can tell, SSRIs are emotional numbing agents. Most of the people I know who have taken them are people who have made bad decisions in life, and can't accept the consequences of these decisions. Basically, people who get their ideas on how things should work from television.

Bruce Charlton said...

@Scott - Official figures cannot be trusted because we know they are manipulated, and are indeed not even trying to reflect reality. But I think the answer is that there is an interaction between what the drugs does, and the problem (if any) of the individual taking it.

Some people find the numbing effect of SSRIs to be welcome - at least for a while. Others are cut off from 'Life' and demotivated.

So the good versus ill effects of SSRIs depend on who they are given to (at a population level as well as at an individual level).

But it would be better overall if SSRIs were not used, and people self treated with St Johns Wort - taking as much as they felt they need for as long as they felt they needed it; in practice people tend to self-limit the usage of drugs they buy and control for themselves.

St John's Wort seems to do much the same as SSRIs but more safely and with fewer side effects (and when people feel significant side effects they stop taking it, whereas they carry on taking prescribed drugs whatever happens).

Bruce Charlton said...

Added note