Barry Blackwell: The Baby and The Bath Water

Leonardo Tondo’s reply to Bruno Mueller-Oerlinghausen’s comment on Leonardo Tondo’s comment on Barry Blackwell’s essay

            I entirely agree with Bruno Mueller-Oerlinghausen that most of the studies have not found a reduction of suicide acts (attempts or fatal events) with the use of antidepressants, with some exceptions for suicide ideation. 

            I tend to disagree with Bruno’s statement about the conviction that a causal relationship between suicidality and antidepressants does not exist.  Actually, I keep that in mind all the time.  I keep that in mind so much that when I see patients with some clinical features, such as psychic or motor agitation, inner tension, irritability or mood lability (depression with mixed features), I do not treat them with antidepressants but with sedatives, preferably small doses of new antipsychotics and mood stabilizers, lithium first. 

            As for Stübner et al.’s 2018 report, if I am not wrong, the occurrence of 5 suicides in 219,635 people over a period of 11 years shows an annual rate of 0.20 x 100,000 which is about 45 times lower than the German general population (9.1 x 100,000 in 2016).  It is likely that the study was not able to record all events, but it certainly does not prove an increase of suicides during treatment with antidepressants.   If the study proves something, it proves a significant protection against suicide during treatment with antidepressants.

Reference:

Stübner S, Grohmann R, Greil W, Zhang X, Müller-Oerlinghausen B, Bleich S, Rüther E, Möller HJ, Engel R, Falkai P, Toto S, Kasper S, NeyaziA.Suicidal Ideation and Suicidal Behavior as Rare Adverse Events of Antidepressant Medication: Current Report from the AMSP Multicenter Drug Safety Surveillance Project.Int J Neuropsychopharmacol. 2018; 21: 814 -21.

May 2, 2019