Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.

I’ve taken Zoloft on and off (but mostly on) for over eight years. If you’ve read the posts Philip Dawdy made last month or last week about an article in The New England Journal of Medicine, “Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression,” or read this news article about it, you know that this study shows that antidepressants aren’t effective in treating bipolar depression.

Okay, so you probably could have figured that out anyway.

At this point, I am taking Zoloft for two reasons:

1. I’ve mostly been feeling good since I started taking meds again, so I don’t want to screw with my medications in case Zoloft is helping me avoid depression.
2. Some medications have made me extremely tired. Since Zoloft does the opposite, I assume it is helping me wake up in the morning. I have trouble falling asleep, but I wake up and I can function. I think it’s balancing out any drowsiness that my Epival might cause.

I don’t know if either of these are valid long-term reasons to be taking Zoloft, but they’re good enough reasons for me in the short term.

Zoloft is the only SSRI I’ve ever taken, but I took Effexor in January and February of 2006. Three weeks starting on it, and then three weeks coming off it. See, I was taking it all by itself without a mood stabilizer or an antipsychotic. I had gone off all of my medications in the fall, felt fine, then got really suicidal really quickly and wound up in the hospital. The psychiatrist on the unit discharged me with a prescription for Effexor although I told him I didn’t think it was a good idea for me to take an antidepressant without a mood stabilizer.

He told me it would be fine, and I figured I might as well listen to the doctor, because stopping all my meds all by myself hadn’t worked out too well for me. I was also not thinking very clearly and it didn’t occur to me that this could have more dire consequences than a mild hypomania followed eventually by another depression.

So what happened? Well, I once read the phrase “rapid cycling/mixed state hell” on an online forum, and that describes it perfectly. I don’t feel like going into any detail today, but suffice it to say that I wound up back in the hospital exactly three weeks later. It wasn’t pretty. It was, in fact, really ugly. I mean the situation, but come to think of it, the hospital was ugly, too.

I’m sure my being bipolar rather than unipolar had a lot to do with that in my particular case, but we all know that you don’t have to be manic-depressive for antidepressants to make you flip out. So it’s nice that the FDA has finally ordered updated black box warnings on antidepressants “to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months),” whereas the warning only applied to those under 18 before that.

Health Canada had already issued a warning about this:

Health Canada is advising Canadians that Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants, now carry stronger warnings. These new warnings indicate that patients of all ages taking these drugs may experience behavioural and/or emotional changes that may put them at increased risk of self-harm or harm to others.

The new warning for each of these drugs, which are listed below, appears in the information package received by patients and in the prescribing information available to health professionals.

Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others…

That’s from a press release issued June 3, 2004.

It’s a bit different, though — it applies to all ages, not just people under 25; it includes harm to others as well as self-harm; and it doesn’t include all antidepressants, just newer ones.

This afternoon, I was talking to my mother. She’s been talking to an acquaintance who was recently diagnosed with bipolar disorder, and she’s been thinking about the Virginia Tech shootings, and she’s also getting worked up about the college mental health crisis. Specifically, she was talking about how irresponsible the psychiatrist at the student health centre at one of the universities I attended was, but since I don’t feel like getting into that right now, here’s something that’s at least tangentially related.

This is the non-story of how I could have gotten kicked out of my university residence merely for cutting myself. The residence life manager gave me the following letter on December 8, 1999:

Dear Polly,

Since January 1999 the residence staff, particularly [name of residence assistant], RA, have been working with you in trying to help you cope with the stresses that have been present in your life. I am aware that you have been seeking help from both Psychiatrists and Counsellors and I am very pleased to see you take the initiative in helping yourself through these difficult situations. However, I am also aware that there are still certain behaviours that you have engaged in both last semester and currently this semester that have me concerned. Firstly, I am concerned for your well being and safety, and secondly I am concerned for the well being of the community of [name of residence]. Examples of behaviours which are unacceptable in the residence community and have to stop immediately are:
• cutting yourself using razor blades or other means
• lying in the elevator or other common areas in a state of depression
• taking an overdose of medication

Polly, the intent of this letter is to put forth a contract that I feel must be adhered to for the well being of not only yourself, but the [name of residence] community as well. I encourage you to continue to obtain help from your Doctor and Counselling Services in order to be able to live by the guidelines as stated here in this contract and remain a resident of [name of residence].

Sincerely,
[name]
Residence Life Manager

Behavioural Contract
I understand the behaviours as set forth in this letter will not be tolerated in the residence community. I agree to abide by these terms and conditions and I am aware that any breach of the contract above will result in the termination of my Residence Agreement.

________________
(signature)

________________
(date)

I signed the contract because it seemed less humiliating than fighting against it would have been. I know I should have stood up for my rights, but I didn’t.

Did this contract help me? No, it did not. I don’t even think it helped the university. My very first thought upon reading the contract was how much I wanted to die. It made me realize that the residence life manager, who I used to confide in, did not actually care if I got better, she just wanted to keep me from disrupting everyone else’s lives. I never did lie on the floor of the elevator again, but I only did that once in the first place and I never would have done that again anyway because I realized how phenomenally stupid it was. I kept cutting, but I made sure to always wear long sleeves whenever I left my room. I stopped talking to the residence life manager and my RA about my problems.

I made it through the rest of the school year without being kicked out of residence. When I returned in the fall, I was told that I was expected to abide by the same contract. No, wait — they actually sent a letter to my home address telling me this. Luckily, I checked the mail that day and found the letter before anyone else in my family did. I don’t think my parents would have been mad at me, but I still would have been embarrassed to have them read it.

I still cut, and I still hid my self-injury from The Powers That Be in residence. TPTB found out about my near-fatal overdose in December of 2000, of course — you can’t really hide the near-fatal ones that land you in the hospital for three weeks — but they didn’t have to kick me out of residence because by that point, I had already told them that I planned to transfer to another university in January. And I did.

You can’t fire me, because I quit.

It’s so depressing. From the Times Online, Bullied girl ’stepped in front of train’.

A 14-year-old girl stepped in front of a train after her stepbrother confronted a classmate accused of bullying her, an inquest heard yesterday.

Kay Miller, who suffered from anorexia and a borderline personality disorder, panicked after her brother, a Welsh Guardsman, pushed the alleged bully over a wall and warned him to leave her alone…

…In a written statement her sister, Chloe, said: “I was with Kay, my stepdad and Geraint when we saw Scott Walker.

“He was in Kay’s class at school and he was saying things to her. Geraint went over and said, ‘Leave Kay alone.’ More of Scott’s friend’s came along. Scott’s sister slapped Geraint across the face. But he didn’t react. Tim told us to go home but Kay just ran away crying. She was a bit hysterical.”

God, I hate bullying. I’m so glad I’m not in junior high anymore. I’m so glad I got through it without killing myself, even though one of the bullies suggested that I should commit suicide. Yeah, like I was going to do anything that they said to do.

The inquest heard that the teenager had suffered from “borderline personality disorder” for six years. But she was tackling her problems and had lectured to more than 300 people on her eating disorder.

Also, how much do you think it helped this girl to diagnose her with borderline personality disorder at the age of eight? Would you say not at all? I would. Would you say it probably hurt her more than it helped her? I certainly would.

I’m just mentioning that this Associated Press article exists: Benefits trump risks for children taking antidepressants: study. I don’t remember reading about it before.

The authors of a new comprehensive analysis of antidepressants for children and teenagers say the benefits of treatment trump the small risk of increasing some patients’ chances of having suicidal thoughts and behaviours.

The risk they found is lower than the one the U.S. Food and Drug Administration identified in 2004, the year the agency warned the public about the drugs’ risks for children.

After the warning, U.S. youth suicides increased and some mental health experts said reluctance to try antidepressants might be to blame.

The new analysis includes data from seven studies that were not part of the FDA analysis…

The abstract of the actual journal article is here, but I don’t think I can read the whole thing for free and don’t really feel like commenting on the study results without having read it.

Anyway, more from the AP article:

“The medications are safe and effective and should be considered as an important part of treatment,” said study co-author Dr. David Brent of the University of Pittsburgh School of Medicine. “The benefits seem favourable compared to the small risk of suicidal thoughts and behaviour.”

Effective, when only Prozac worked better than placebo in depressed children under twelve, and none of the other antidepressants in the studies did? When overall, 61 per cent of depressed kids and teens in the studies improved on antidepressants and 50 per cent on placebo? (The data are better for OCD and other anxiety disorders, which I think we already knew, but I’m less personally interested in anxiety disorders.) I know that research-wise, you can define this as “effective,” but as a patient, it’s not good enough for me. So I at least appreciate that the article mentions the need for careful monitoring of the effects that antidepressants have on children and teens taking them:

Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center, welcomed the study as “the most comprehensive analysis of the data yet put together.”

He said the suicidal behaviour risk, although lower than that found by the FDA, demands that doctors and families watch for warning signs…

If I thought antidepressants were completely evil, I wouldn’t be taking them. I’ve taken them since I was a teenager. I have found them beneficial at times. I’m finding Zoloft beneficial now. But I think that even if this study is accurate and antidepressants will cause suicidality in only one out of 101 kids who take them (and I’m not saying it is accurate; I haven’t even read the thing), that’s still a cause for concern. And so do the parents of kids who are suicidal or dead because of antidepressants.

Is it wrong for me to be amused that one of the co-authors of the study has the same name as the incompetent boss from The Office? Probably, but hey, if it’s wrong, I don’t want to be right. No offense meant to Dr. Brent, I swear.