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NEWS: Owen Dyer Teen suicide rate rises as prescribing of SSRIs falls, study finds BMJ 2007; 335: 531 [Full text]

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Black box behaviours

Christopher L Manning   (17 September 2007)

Very interesting study

AK Al-Sheikhli   (19 September 2007)

Black box behaviours 17 September 2007
Christopher L Manning, CEO Primhe Twickenham TW11 9HG Send response to journal: Re: Black box behaviours	Dear Sir, Healy is quoted as saying that "a drop in the script rate may involve primarily those on treatment chronically," accompanied by a "constant or even increased rate of new patients being put on the drugs." "The beginning of treatment with SSRIs is a period that carries a high risk of suicide". I would find it very hard to accept that, as one group of patients (those on chronic treatment) are taken off treatment, another group (new patients) is being placed on them at a constant or even increased rate. Who exactly are the clinicians, following a Black box labelling, who would seek to behave in such a perverse manner? As for those coroners re-labelling suicide - well, let's ask them? It is significant that Healy's other interpretations for these figures, specifically in regard to antipsychotic prescribing, are refuted by Gibbons, the study author. What we do need to know is the incidence of suicidality occasioned by the act itself of highly vulnerable people seeking help from clinicians (many practitioners will be familiar with the concept that people get worse before they get better, especially when a meta or unstable situation is acted upon) and the incidence when people are either referred for further intervention or admission or commence on psychotherapeutic treatment. I used to see people not on any medication whose underlying state was rapidly destabilised initially by all such approaches. Where are those comparator figures? No, I really do think that, despite the truly appalling overegging of the SSRI antidepressant marketing souffle, we are seeing a genuinely therapeutic benefit for these medicines in many people and that, despite the worthiest intentions of researchers, the pendulum has become caked with other agendas and has swung too far now in the other direction. That many young people may have taken their lives as a direct result of SSRI treatment being withdrawn(and not as a result of any SSRI-induced reaction) should now be both a cause for further urgent research and possibly the beginning of some self-reflection concerning the cause-related marketing of this issue by a number of key individuals and organisations. Yours Faithfully, Dr Chris Manning Competing interests: Primhe receives grant funding from pharmaceutical companies that manufacture SSRIs
Very interesting study 19 September 2007
AK Al-Sheikhli, Consultant Paychiatrist CRHT,Gambier House,St.Leonards on Sea,East Sussex,TN38 0NG Send response to journal: Re: Very interesting study	Editor--I must admit that Gibbons et al study (Am J Psychiatry,164,1356- 1363,Sep 2007) is an important one which needs further and more extensive work, to support one of the two views: either the SSRIs increase or decrease the suicidal behaviour in adolescents. Is it possible we are denying patients effective treatment? Regards, AK .Al-Sheikhli Competing interests: None declared