Thursday, May 03, 2007

SSRI warnings

Yes I'm back, thanks. Italy was wonderful. it is all it is cracked up to be. I really felt away. Didn't really worry too much about anyone until the last couple of days when some of the people walking by began to remind me of my clients. It is surprising how the gene pool seems to have lingering effects. The clients I was reminded of all have last names that end in vowels.

Back to work, and it was difficult to walk into the building and see that it was all the same. By the second hour I could remember how the process is supposed to work, and I was cruising along. I notice how before a vacation I can make myself know that I am so exhausted, and now that I'm back it seems so easy, even after a day of traveling for twenty hours. I was eager to see everyone again.


Opened up the paper this morning to see that they are putting a black-box warning on SSRIs. They warn that people up to the ago of 26 are at risk of impulsive suicidal actions when they are on these drugs. They state that the incidence is low and that the beneficial effects of the drugs should be considered when deciding whether to prescribe or not.

I don't want to get into another discussion about how useful medication is. What interests me here is to wonder about what process must be at work in the brain. You give someone a drug that allows the chemicals that make someone feel more stable and content to remain in their brains, and sometimes it makes them want to kill themselves. Why is that?

Does it allow then to lose the inhibitions that were keeping these actions in check, or does it just radically alter their emotional state?

In older people, especially those over 65, SSRI seems to decrease suicidal thoughts. Is this because older people are more prone to hopelessness and this allows them not to care so much, while in younger people it allows them to care too much?

All of this speculation is probably way off the mark. The brain is very complicated, and it is attached to the rest of the body. The body does strange things, and it often does them with other people. Now, we know that other people are certainly strange, so anything can happen in these interactions.

Just today a woman was telling me that she gets very jealous when she feels that her boyfriend is cheating on her. She says she can tell he is because he lies to her in the same manner that she lies to him. "He's just like me in that way. That's why I love him." But it drives me crazy that he lies to me."

"But you lie to him?" says I, knowing that means nothing.

"Yes" she says, "but that doesn't bother me. I know what I'm doing, and I know that I can keep it under control."

Now, if we put her on medication, would she do more of it or less of it?

I happen to know that it wouldn't make any difference because she does the same things when she is on medication as when she isn't.

But still, what makes young people react to the drug that way? And more to my point, is that a question that we can expect to answer or are we in a new world that is only brains and chemicals and physical processes, where such things as motivations, intentions, and personal decisions are antiquated concepts?

Or maybe I've been walking around too many walled cities who fought each other over pasta and olive oil.

4 comments:

Ms. Meander said...

hmm, i don't know why it's more likely to happen in young people than old. the theory i've heard is that the SSRIs can lead to a mixed state effect, where you are still having the bleak thoughts and emotions of the depression only your energy level improves...therefore, you're not too sluggish to act upon them. from my perspective, this makes a lot of sense. i can empathize with that sort of mental situation.

Grad007 said...

I heard a similar thing to melanie.

My antidepressant is not an SSRI, (and I'm not under 26 ;), but in the first two weeks or so that I took it, thoughts of suicide did enter my mind, even though I don't consider suicide a solution or an option. I would take the medication once per day, in the evenings as prescribed, and enjoy the enhanced feelings of confidence, security and relaxation. These feelings would slowly subside over the course of the following day. In the two to three hours before the next dose, I would be trawling the emotional depths, and my brain would suggest suicide. However, I only thought of suicide during this initial emotional rollercoaster period, before my mood stabilised.

I hope this story won't put anyone off taking antidepressants; these days I like my medication. I just wanted to share my experience of how one can have suicidal thoughts during the initial phase of taking antidepressants.

Amanda said...

From my uneducated point of view, it's very hard to gauge the reactions of a particular person to any kind of brain candy.

Warning labels serve only as a way for the industry to abdicate responsibility.

I'd much rather hear that the doctor will expect the patient to call up and report to someone twice a day the first two weeks of treatment.

And I'd like to see the doc hand out a number that can be reached at any hour of the day or night.

In the past couple of years I had to help out several folks who were having an adverse reaction in the middle of the night and didn't know what to do. All too often they weren't even aware it was due to the new pills.

Ms. Meander said...

suicide is such a rough topic...of course i don't have any answers, my own mom succumbed and statistically my daughters and i are at pretty high risk, although so far i have felt safe from it. i know that this could change at any time. it's important, when you're thinking suicidal thoughts, to talk to someone. however, even a depressed person is rational enough to know that if they talk about suicide, people are going to try to stop them. and if you really feel like it's your best option, of course you're not going to want to be talked out of it. some people, including myself, have "safe kits", emergency kits of a sort that have a whole slew of self-made reasons for not going through with it, for giving it a week or a month to see if things turn around. but even the "emergency kit" can't stand up to constriction, that mental state that you get into where all other options, all other outcomes fade away and the ONLY solution, the ONLY thing that seems to make sense at all is to kill yourself.

i'd never heard of constriction until after mom died, and i think a lot of people are unaware of the concept. i make it a habit to frequent depression communities and such and when someone is talking about suicide as if there's nothing else possible for them, i send them a few quotes that define the concept really well. i don't know if that has helped or not, i mean, all the folks i've done this with are still alive and did not attempt, but who can be sure what the outcome would have been otherwise? any rate, knowing the definition of constriction and having a good internal understanding of the phenomenon is definitely one of the tools in my own emergency kit, hopefully it will help me remember that i'm in a rabbit hole if i'm ever in the position to need reminding...and if, by chance, i'm willing to let myself listen to myself.