Suicidology update:
-------=======-------

Suicide rates in 2020 in the US are now available via @CDCgov BY AGE.

No significant change in youth groups, decreased in older ages past expected levels.

/1
By racial categories, for men there was variation but the trend of "white and Asian down, Black, Hispanic, and Indigenous" was present. Due to size of the groups the Indigenous men increase is within variance.

/2
In female suicides all groups saw a decrease, but only white women had a drop outside variance.

Women fared better than men for suicide in absolute terms (men outnumber women 4:1 this year), but also relatively (women down 8.3%, men down (2.2%)

/3
Month by month, it's visually striking how strong the drop was during the pandemic.

The drop in April-May unprecedentedly huge, not something we see in suicide epidemiology.

/4
Overall, it's validation of the notion that predicting suicide is very tricky, and so many pundits got it wrong in 2020. If you followed me, you knew that I let the data speak, and when it did, this result was predictable as early as february 2021.

/5
In the study of the epidemiology of suicide, we run behind because we do not have good active surveillance systems going. Anyone who pretends to know the future is a charlatan.

We can now await the CDC Wonder release and do all of the subgroups that we need to do.

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More from @tylerblack32

31 Oct
While the "serotonin hypothesis" of depression is no longer taught, #SSRIs delay the reuptake of serotonin @ neurotransmitters. We also now know they have a host of other effects (σ1, BDNF, CREB, cytokines, on top of a slew of differences on the various subtypes of serotonin)

/1
The key difference, is that today, we know that the brain changes seen in depression are impairing, and we know that SSRIs work. Instead of drawing a straight line between "serotonin regulation" and efficacy, the honest psychiatrist doesn't understand the current mechanism.

/2
We now suspect that there are a host of effects, second, third, & even tertiary effects, and the complex way in which the brain is interconnected plays a role.

But yes, SSRIs DO block the reuptake of serotonin. It's why we have to be careful about withdrawal and tolerance.

/3
Read 5 tweets
30 Oct
Thank you so much everyone for sharing your experiences. I have to mute notifications now due to virality but I've done my best to read and hear all of you. I'm glad my message resonated with so many. and pretty much 90% of disagreement/exception was respectful.

Thanks, all.
Honestly I'm touched, sometimes i feel this place is all about fights but most got what I was saying and shared so much about the *why* I've said it. If you ever want to see a "reaffirming ratio" look at that thread.

/2
I understand why parents feel scared and worried about the world and why it seems like intruding on their privacy is safe, but please read the responses and all of the hardship, hurt, and fractured relationships that were caused by such behavior.

/3
Read 5 tweets
29 Oct
Child psychiatrist here. It is a very bad idea to search your teens room, and a very good idea to respect their privacy and develop them into humans who trust their parents instead of reasonably distrust them.

Do not take advice from this account. The proper # of searches is 0.
Are you not convinced, worried parent? Consider two scenarios:

Scenario 1: I am in trouble because I am using drugs and something unsafe is about to happen. Even though I'm worried about their reaction, I can trust my parents so maybe I should call them.
Scenario 2: I am in trouble because I'm using drugs and something bad is about to happen. But I don't talk to my parents because they invade my privacy disrespect me and I know that talking to them will result in punishment. So, no, I will not call my parents.
Read 5 tweets
28 Oct
Really interesting RCT showing 10 days of 100mg 2x per day of fluvoxamine reduced bad COVID outcomes.

No taper start either! Just bam 200mg daily. Makes ya wonder.
thelancet.com/journals/langl…
Participants: less than 7 days of covid like symptoms or a covid+ test

n=1497, fluvoxamine vs placebo

Outcome measures: >6h in an ER or admitted to tertiary care

Results: 32% reduction in the fluvoxamine group
While the ITT sample didn't reach significance (including dropouts) for death, it should be noted that the death rate for per protocol participants was;

Fluvoxamine: 1/548 (0.18%)
Placebo: 12/618 (1.94%)
RR: 0.09 (95% CI 0.01-0.47)

90% reduction in death rate.
Read 4 tweets
26 Oct
The 2020 @samhsagov study on youth suicidality (conducted Q4), was reassuring. Overall 12% of 12-17y kids indicated serious suicidal thinking, with 5% making plans and 2% attempting.

This is quite improved compared to @CDCgov numbers in 2019, pre-pandemic. (18%, 15%, 9%, 14-17y) Image
These improvements seen across the board (age+sex). Though different agencies, both reports are national representative samples. I certainly advise caution comparing the two to any great detail. At a high level, however, it's very reassuring to not see "much higher numbers" here.
I suspect that we will continue to see higher quality data emerge showing globally that children did not show increases in suicide-related measures during 2020 (which includes pandemic, lockdown measures, and everything else that year!)
Read 5 tweets
20 Oct
Therapists: every now and then, you should scan your patient roster, and see whether the makeup of your patient population reflects the population of people in your area. If it doesn't, for whatever reason, you are part of systemic discrimination. Yes, it will require sacrifice.
I've already seen misinterpretation.

"You are part of" does not mean "solely responsible"
"Will require sacrifice" does not mean "must work for free"

I'm sorry that the world works the way it does, but you are either someone who works to correct barriers or someone who doesn't.
Similarly, reducing your carbon footprint barely puts a dent in the climate change crisis yet doing so, while influencing others to do so, and advocating for change at every level is *necessary* to affect climate change.
Read 4 tweets

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