E-drug: Increased Antidepressant Use and falling Suicide Rates (cont'd)
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Dear e-druggers,
I forgot to add a very important comment to the following statement in
the message I sent earlier today:
'...A recent change in the drug [paroxetine] label also says the risk of
suicide can be higher in the early days of therapy....'
It is well known by psychiatrists, as well as by well informed patients
with unipolar major depression or major depression in the contest of a
bipolar disorder that risk of suicide is high in the first few weeks of
treatment. Untreated major depression, whether in the unipolar or
bipolar contest, leads not only to suicidal ideation but also to loss of
energy and extreme anxiety which often reaches 'paralyzing levels'.
The person affected becomes so ill that they become unable to make
any decisions, even the most trivial ones, can hardly get up in the
morning, let alone carry out an active life. Antidepressants (of any
pharmacological type) start having an effect about two weeks after
treatment is initiated. Energy levels often start picking up earlier than
mood, so that the person may become active again but still retain the
suicidal ideation which accompanies and is diagnostic of major
depression. It is at this stage that severely ill patients, having become
active again and capable of decisions, can take their own life. That's
why intensive psychiatric follow-up is essentially for the most ill
patients until mood, and not only energy, has recovered.
The fact that the above statement is now included in the paroxetine
information sheet only reflects that paroxetine is the most widely sold
antidepressant, certainly in UK, and I suppose in many other
countries. It should be included in the patient information leaflet of
ALL ANTIDEPRESSANTS, including tryciclics. This would be
extremely important now that treatment not only of mild depression
but also of suicidal, major depression is getting more and more out of
the hands of psychiatrists and more in those of general practiotiners.
Obviously generalists, because of the requirements of knowing a bit
about everything are not sufficiently informed about this danger and
do not routinely keep their depressed patients under intense follow-up
in the initial stages of treatment.
I am not sure how many of you will believe me as I am an endocrino-
logist and diabetologist by training rather than a psychiatrist.
However, I do have a many years interest and experience in
psychiatry, especially in mood disorders, although this has never led
to any formal qualification.
Valeria
Dr Valeria Frighi
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
UK
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