Join the fight – learn how to help prevent suicide

The Pediatric Insider

© 2018 Roy Benaroch, MD

Suicide is among the most common causes of death of teens and young adults, and the rates are rising. Unfortunately, people at the most risk of suicide may not be able to get themselves the help and resources they need.

I’ve written and taped a short, 45 minute lecture series, A Practical Guide to Suicide Prevention, to help family and friends recognize the warning signs of suicide risk, and to help people learn the best steps to take when someone is in danger. It’s part of The Great Courses Plus streaming service, and you can watch or listen to the audio as part of a free trial.

If you do join The Great Courses Plus, please check out my other courses. I have three audio/visual series titled Medical School for Everyone. They’re all presented as medical mystery cases for laymen to figure out. While figuring out the mysteries, you’ll learn about medicine, physiology, therapeutics, and how doctors think through solving diagnostic mysteries yourself. The feedback has been great – I think you’ll enjoy the courses! You can watch them via the free trial on The Great Courses streaming service, or buy them individually (with a no-hassle money back guarantee) from The Great Courses. Links below!

Next year I have a new course coming out called A Skeptic’s Guide to Health, Medicine, and the Media. It’s going to be great – look out for it around February 2019.

My courses:

A Practical Guide to Suicide Prevention – via The Great Courses Plus

Medical School for Everyone: Grand Rounds Cases – medical mysteries for you to solve! From The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

Medical School For Everyone: Emergency Medicine – mystery cases from the Emergency Department. From The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

Medical School For Everyone: Pediatric Grand Rounds – mystery cases from the world of pediatrics! The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

Is the FDA’s antidepressant warning killing people?

The Pediatric Insider

© 2014 Roy Benaroch, MD

In 2004, the FDA launched a program to “strengthen safeguards for children treated with antidepressant medication.” Among other steps, they started requiring manufacturers of several kinds of antidepressants to include a warning in their product labeling, a so-called “black box,” that explicitly and loudly proclaimed a risk for children taking these medications. The warning said that children taking these medications were at an increased risk of suicidal thoughts and behaviors. Later, the black box warning was expanded to include young adults. The warning was required to be added to the labeling of medications including Prozac, Zoloft, Celexa, Wellbutrin, and several other medications.

What prompted this action was an observation from studies of children taking these medications that in the weeks after starting them, there seemed to be increased thoughts of suicide. Not suicide attempts, and not deaths from suicide (there were actually no suicide deaths at all among the study groups), but self-reported thoughts about suicide.

Now, depression is a serious illness—and suicide is a very serious consequence of depression. People with major depression have about a 15% cumulative lifetime risk of death by suicide, so this is a very significant and serious problem not to be taken lightly. We know that people with depression often think of suicide, and are at grave risk for attempting suicide—is it possible that anti-depressant medications actually make this risk worse?

A June, 2014 study from The British Medical Journal has looked at the consequences of the FDA’s decision (and the ensuing broad media coverage.) Researchers examined data from a total of 2.5 million teens and young adults from 11 health care plans in the United States. After the warning, the use of these medications dropped by about 24-31% (depending on age grouping.) This was accompanied by an increase in the rate of suicide attempts, by 22-34%. The rate of deaths from suicide did not change at all—just the rate of attempted suicides.

So, no, the FDA’s warning, based on this study, didn’t increase actual deaths. But it did increase suicide attempts, which likely means it increased the rate and severity and consequences of depression. It certainly hasn’t done any good. The warning has scared many families and doctors away from one mode of therapy for depression. Antidepressant medications aren’t perfect—they do have important side effects, and they don’t always work, and they’re certainly not for everyone with symptoms of depression—but they can be one important part of the treatment of some depressed adolescents. It’s a shame that this misguided “black box warning” is doing more harm than good.