It's been 19 years since the FDA required a black-box warning on product labels & advertising, alerting doctors & patients that antidepressants can cause suicidality in teens. A new compilation of research finds that the action caused a dramatic increase in deaths by suicide. 2/ Here's the relevant graph. It's stunning. You almost never see public health interventions that cause an inflection point, a dramatic worsening of public health. The red line shows a steady decrease in teen suicides followed, after the warning, with a steady increase.

2/ Here's the link to the full study: thelancet.com/journals/lanps… 3/ The rate of serious withdrawal syndromes is something under 3%, with most of the problems related to imipramine, paroxetine, & [des]venlafaxine. Sertraline & fluoxetine trials showed severe withdrawal syndromes only rarely.

1/ New study, important enough to appear in the @NEJM, seems to show that, even for primary care patients, staying on antidepressants prevents relapse.
~40% of patients tapered off antidepressants decided to go back on within the following year.
But...

nejm.org/doi/full/10.10… 2/ The research did not include patient with first episodes of depression who were tapered after doing well for 9 months or a year—the old standard of practice. Those patients may, indeed, continue to do well. Only patients w multiple episodes or long usage were studied.

Suicidal behavior peaks in the month *before* meds are prescribed and lessens each month after.
Important paper, looking at a large population, that emphasizes the need to think about who receives a treatment before attributing subsequent adverse results to the treatment.

https://twitter.com/seenafazel/status/1443137701058842625

This fallacy, confounding by indication, is rife in discussions of antidepressants. Consider this paper in which the rate of falls in nursing home patients was highest four days before a psychotherapeutic med was prescribed. bmcgeriatr.biomedcentral.com/articles/10.11…

1/ This scandal—misuse of the diagnosis 'schizophrenia' to hide the use of high-risk drugs in the elderly—is a crisis for psychiatry. We need to speak out—and demand the disciplining of doctors who misdiagnose to hide understaffing.
nytimes.com/2021/09/11/hea… 2/ That said, the scandal appears to arise from well-intentioned policy-making. You don't want to punish nursing homes that admit residents with mental illnesses or neurological disorders. Changing the metrics will only risk further unintended problems.

@NYTObits writes of John Gunderson: "He was adamant over the years that psychiatric drugs did not help resolve #borderline symptoms." nyti.ms/2E6UmHv This statement is narrowly true. In lectures, he specified circumstances that warrant the use of a range of medications... 6 months ago, while arguing against widespread use of lamotrigine in #BPD, Gunderson wrote, "Clinical experience has shown that medications can help build an alliance, can relieve states of distress, and can sometimes be helpful for comorbid disorders." ajp.psychiatryonline.org/doi/10.1176/ap…

1/ Thread: New study forthcoming on whether #gene-testing can help guide #antidepressant selection for #depressed patients who have failed to respond to 1 or (on average) 3-4 trials of medication. bit.ly/2LQU75I I have been skeptical: mostly, scant added value… 2/ & I found the reporting of this study annoying. On the primary endpoint, improvement in average #depression rating scores, the gene-testing failed. Patients whose MDs chose new meds w/o help of gene tests did just as well—& yet news reports suggested that tests can help…

1/ Important study on #antidepressants & #heartdisease. 6 months of Rx for even minor depression in #cardiac patients offers protection against adverse events (heart attack, death, etc) seen for many (8+) years out. bit.ly/2LBZPuM @JAMA_current # of interesting points... 2/ The effects of meds on mood were the same as those in many other studies, 2-3 points difference on symptoms, NNT to remission between 5 & 6, effect size under .4 …& this difference, often dismissed as minor, was associated with marked benefits in terms of overall health...