Friday, March 27, 2015

SSRIs and suicide

The factors we'd need to consider to relate these two things may be impossible to acquire for study:

1) How many people are depressed and don't see a physician, either because they can't afford it in terms of money or time, they're embarrassed, etc.?

2) How many of those people then go on to commit suicide?

3) How many suicides are not classified as suicides, but rather, as drug overdose, incautious driving, sleepy driving, etc.?

4) How many people who were going to commit suicide anyway happened to take SSRIs before doing so?

5) How many people would have committed suicide if they hadn't been stopped from doing so by their SSRIs (as opposed to the minority of their peers who weren't so stopped)?

6) The connection between SSRIs and suicide was evident before, during, and after their approval process(es). So why did the media wait until now to make a big fuss over it? Some of the more cynical people in the health care industry suggest that it's because all the major SSRIs are now readily available in generics, while many new neuroleptics (antipsychotics, some of the popular ones being Latuda, Fanapt, and Saphris) are still in the patent-protected phase, and thus generate significantly higher returns when prescribed to patients where a generic option is not yet available.

For (theoretical rational) grown-ups, this means that the anti-SSRI message is being broadly disseminated now in order to switch people to name-brand drugs out of fear of suicide (even though the antipsychotics also correlate with suicide--which no one will care about until they run past patent, and something new gets developed, at which point Saphris will be blamed for the Nut Of The Hour, and everyone will switch to some new billion-dollar miracle with as-yet-undisclosed suicide risks).

Maybe increased suicide risk is a good thing--maybe SSRIs help their users be more true to themselves, more filled with a sense of mercy and goodness, etc., ergo they walk away from Omelas in the only way possible. No, that doesn't apply to the Latest Nut We Noticed® (Clint Eastwood has no plans to make a movie about him, because the body count isn't high enough), but it could arguably apply to the vast majority of others, who simply exempt themselves quietly from the process of georapine.

It's beyond debate that western culture is a causal factor in suicide; far be it for me to halt any bashing of big pharma, which deserves any and all conceivable bashing, but it's pretty cheap to blame [insert problem here] on a single drug (or a single subset of drugs, or all drugs). You want to end drugs? Then everyone stops going to work, and eventually revolts. Inhibiting serotonin reuptake is the cheapest way to keep the rabble from tearing down Manhattan.

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