Duffbert's Random Musings

1 - It is not just SSRIs that present a dangerous transition
between severe depression and sudden recovery. The
gap can be short, as in other ADs, anti-psychotics,
benzos, and mood stabilizers. In the interim the fatigue
and desperation which dampened the volitional energy
to commit suicide gives way to a sudden but not complete
recovery to do so -- until stabilization takes place.

Unfortunately, we no longer have hospitals in which
this kind of treatment should be monitored; particularly
during this dangerous phase.

Squiggles

2 - My wife, she of the MD after the name, has pointed out to me in the past that the problem isn't that the SSRI makes people suicidal, the problem is that the SSRI gives severely depressed people enough energy to actually do something about their suicidal tendencies. It is not uncommon for one to be too depressed to commit suicide. SSRIs, ironically, can improve a person's outlook just enough to allow them to kill themselves. The tragedy is that the depressed person is clearly responding to the medicine and would benefit from it in the long run, but they first need to get past that "not quite better but well enough to do something suicidal" hump, if you will, and into the "feeling reasonably good" stage.

3 - Right on, Captain Husband. You listen quite well while I rant.
I haven't read the book so I can't comment on the content. But I can say that the FDA black box warning was very politically motivated.

Any doctor worth their salt knew of these risks before the FDA rubbed our (and patients) faces into it.

I recently went to a conference where a psychopharmacologist discussed the FDA warning and treatment of major depression and dysthymia in children and adolescence. There is some so far limited data out there but it seems to point towards a significant benefit of early medical treatment of the first episode of a mood disorder. It might keep the mood disorder from recurring over one's lifetime or worsening from dysthymia to major depression. With that info, I worry that the FDA may have made it more difficult for me to convince a family that an SSRI is the right plan of attack. A doctor friend told me today a family recently refused meds for their child b/c of the black box warning.

Just after the black box warning came out a family called worried that I would have to stop prescribing the Zoloft that has made their incredibly anxious child able to go to school without throwing up every morning. She can go to the mall with friends, go sledding with her sister and can ride the bus to school - all things she couldn't do before "better living through chemicals".