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Antidepressants and Self Harm Risk in Children and Young Adults

Antidepressants and Self Harm Risk in Children and Young Adults

BCC Staff Note: This blog was first posted at Dr. Hodges’ site, Good Mood Bad Mood and is reposted at the BCC’s Grace & Truth blog site with Dr. Hodges’ permission. You can also read the original post here.

A recent article published in JAMA Internal medicine is a reminder that current antidepressant drugs are not free of side effects or risks.[i] Researchers found that individuals age 10 to 24 treated with higher than normal starting doses were twice has likely to have suicidal thinking as compared to those treated with placebo. (A pill that looked like but did not contain the active ingredient) In this same age group those treated with the higher starting doses were twice as likely to harm themselves.[ii] [iii]

This is very important information for lots of reasons. The first is that no one should think that the selective serotonin reuptake inhibitors such as Prozac, Zoloft, Celexa and Lexapro are as safe as taking Tylenol or a couple of aspirin. These are serious medicines that bring with them significant side effects. Patients who are offered these medicines should be asking their doctors to carefully inform them about the possible side effects.

Second, it is vitally important to be certain that the individual being treated is actually struggling with depression. This is a real problem today because since 1980 normal sadness has been turned into depression. Individuals who are struggling with normal grieving over loss do not have a disease. When they are treated with medication that is meant for a disease they will often simply be sad and then have the side effects of the medicine.

Third, it is important to note that younger individuals seem to have more trouble with this side effect of the SSRI antidepressant than older ones. As the researchers noted, “…the efficacy of antidepressant therapy for youth seems to be modest.” With that being said, taking medicine that has significant side effects and risks should be a last resort, not the first thing we reach for.

In Good Mood Bad Mood, I outline the research that deals with the importance of dealing with people grieving over loss differently than with those who cannot tell us why they are sad.[iv] The latter has been described for years as disordered sadness and used to be the one of the main criteria for making a diagnosis of depression.

Up to 90% of individuals who carry the label of depression today can tell us when it started and what they lost. They are far more likely to be struggling with normal sadness than a disease.  And at the same time, it appears that that nearly 90% of people who take the currently available antidepressant do not benefit from them any more than they would from taking a placebo pill.[v]

The first principle of medicine that all physicians must learn is “first do no harm.” Few of us in medicine would be satisfied with just leaving it at that. I would say that most of us in medicine are always looking for better ways to help and yes, to cure. But, the benefit of taking medicine must be worth the risk.

When we add in the significant problem of side effects, most of these strugglers would probably do better just talking to anyone with training, compassion and skill. And, many could profit greatly from counseling from the Bible that deals with how God wants to love and help them in the middle of their sorrow.


[i]The JAMA Network Journals. “High doses of antidepressants appear to increase risk of self-harm in children young adult.” Science Daily, 28 April 2014. <www.sciencedaily.com/releases/2014/04/140428164111.htm>.

[ii]Matthew Miller, Sonja A. Swanson, Deborah Azrael, Virginia Pate, Til Stürmer. “Antidepressant Dose, Age, and the Risk of Deliberate Self-harm.” JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2014.1053

[iii]David A. Brent, Robert Gibbons. “Initial Dose of Antidepressant and Suicidal Behavior in Youth.” JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2013.14016

[iv]Charles Hodges, Good Mood Bad Mood, Shepherd Press, Chapter 5.

[v]Ibid., 49.

This entry was posted in Cutting and Self-Harm, Depression, Medication, People in Need of Care, People Who Offer Care, People Who Train Caregivers and tagged , , , . Bookmark the permalink.
 
  • Dick Gautraud, MD

    While I agree with your conclusion, medication is at best a two edged sword particularly in young people, the study used “deliberate self-harm” as the outcome. I believe they have erroneously equated self harm with “risk of suicidal behavior” (their term).

    In my long years as an emergency physician almost all deliberate self harm was motivated (in my assessment and many others) by anger and was not an indicator, for example, that admission for suicide potential was necessary.

    I would offer that unless the study found increased suicide in the high dose group there is no finding of increased suicidality.

    • mrbill0083

      Interesting. 1 lady, no “credentials” listed.
      One MD.
      So who? Am I? A *Former patient. If anyone cares about the INDIVIDUAL “patient” anymore, I would just be so humble as to *direct both of your attentions to the exact third sentence in “Debra R.’s statement above. In my *individual *diagnosis : medication increase was a direct reason for the last two words used in D.R.’s third sentence. The two before the question mark.
      Why put it to you two like that? Simply. So you can “C” differently perhaps, how privileged I was on one occasion to “sit in” on a conference where Dr. Hodges once spoke. I take no exception to any comments made here, other than this :
      *Individual *Diagnosis’ do not determine any individual patient. They didn’t ID-entify me in 2001 (when I started taking “mental health” meds), and they have been replaced. ALL of them. 29 meds, 495 med changes and 11 years, *replaced by 100 mg. Seroquel. I am just simply stating and saying this (which most “doctors” will dispel), I am proof how some “doctors” write on a form thousands of times a year a number and attach it to a “patient”. Like for example. Me.
      11 years labeled 295.70 “Bi-Polar 1 Manic Depressive with Psychotic Tendencies”. The good doctor above brings up anger. We talk of “anger directed inward as one form of definition of what? Depression. I had “loss”, I had “anger”, I had “grief” and the good doctors put me on a drug with Suicidal Thoughts as a “side effect” and I’m so happy to tell you of something involving “scripture” and The Life of Jesus Christ.
      Oh look, now all the minds have “left the page”. I’m not in your or anyone else’s “studies”, I’m not in your “petri dishes” either. A chief of psyche once, wanted to do “studies” WITH me. I declined.
      Dr. Hodges “touched” my heart after a steady diet and study of The Life of Christ, Cured my “heart”.
      Problems of the Heart, all we do is treat and slow the mind and “hide” problems of the heart. Science knows the heart so much better than the mind. Still such a mystery. Society in its Search Still Seems Surprised when someone like me, makes Sense. But what makes Sense to Science? Things they See? Scripture can be read, but when Scripture, makes Sense to Someone who Science almost destroyed, what happens? S-urprise doctor and mS., you are loved by me, thanked, by me. I’m back and one day hope to meet Dr. Hodges and thank him and to tell him how I’ve read about his life. “S-mart People, Intelligent People”, no ones know’s “Gods Plan” but my immediate one I hold dear is to put science and faith (based on the Life of Christ), in the same room while I give my “testimony” and then what? Have -you two- talk and walk away. The one’s that have witnessed my “story” are the one’s who have seen “walking proof” but all science wants to do is look to a blood test in 2012 in Cleveland and Search for a connection they’ll NEVER find…the “missing **link” located between the “heart and head” – The Soul. No MRI, No X-RAY, no machine ever will “find it”. I “Stores” things unseen and never will be Seen by Science. Belief in The Truth. Silly isn’t it? So Sorry I didn’t make Sense, did I? We’ll C. 1 day, 1 person because of The One Life will “walk out”
      Saying Silly Science/Scientists………Scripture.
      See it? You can’t. The Power of the Mind, controlled by The Power that Healed the problem of my heart. Still Searchin’ for Sense aren’t you? I gave you a S-impler rabbit trail then a chief of psyche gave me 11 years ago. Good Luck. None of this makes sense to you, does it? Did you hear what Dr.? Anger? So Silly. It’s a form of love, returned because that is exactly what God and His S-on did for me. C it or not. You have to see beyond Dr. Hodges comments, he “appeases” your minds because he can’t make U C what you cant C or touch. 295.70 turned to love 4 U 2 C Y I did this. All I do is wait and C the doctors faces that were in my past. Wait. Time. Surprise. Guess who “taught me to love you for what you did FOR me?
      Privilege. Honor. 11 years of S-uffering. Glory to God. Amen.
      Lost U, didn’t I? DSM 5. Y? Doctor did they “lose” the roman numeral? I’ve “studied” the latest version. Y? I ask U? Did they not use the roman numeral? I “think” I know. U? Any guesses? So Silly…1 patient, no “credential, no “S-tudy”, just me. S-aved!

      • Dick Gautraud, MD

        I see you have intense inner tumoil. I can only pray for you.

        • mrbill0083

          Expected.

          • mrbill0083

            A caring doctor, would have never made that comment. Fact. God Bless.

  • http://www.doorofhope4teens.org Debra R. Cornacchia

    This is interesting, as a crisis care advocates for teens who struggle with cutting, I have seen an increase in depression for those teens under 18 on anti depression medication. Self-injury is fueled by anger, shame and depression.Can medication increase the desire to self harm? I think more research needs to be done on this before we draw any conclusions.

  • mrbill0083

    Dear Dr, Hodges. We met once. I’ve read of your life. As “Debra” states below “interesting to me”, I also commented on a doctor’s comment below and actually look forward to it being (surprise) “removed”. I invited the mind of a doctor (MD) into a “rabbit trail” on purpose, for a purpose. A chief of psyche once found me very “interesting” too and it caused me my marriage and (almost) my life. I “invited him” into something, So a Simple doctor can see perhaps, what he can’t see?
    One day I pray I meet you again. All I do is “learn, change and grow”, exercise a heart and “wait” for a chance.
    I’ll never speak publicly like you, I just HOPE to allow someone to “use” my life, For Christ’s purpose. You are quite a special doctor. You met another doctor who is becoming more and more special to/for me all the time. One day. God love you doctor, I hope I somehow (if you see through my writing) how, you affected my life and gave me *further hope for doctors, everywhere. I just hope I returned a favor, long overdue. Pls remove the comments. :)

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