Jeez – here we go again. Yesterday’s BMJ article that found antidepressants double the risk of suicide and aggression in young people, made headlines worldwide. From America, Australia to india, caution was advised when prescribing in this age bracket. Not so in Ireland. The one newspaper article referring to the BMJ article can be found in today’s Irish Examiner here, entitled ‘Drug link to child suicide queried by expert’. So did it warn prescribers of the suicide and aggression risks, advise stricter guidelines or just advise caution when prescribing to children? None of the latter. Instead the Irish Examiner published an article allowing Professor Patricia Casey to question the findings of the Nordic Cochrane Centre.
Coincidentally, Professor Casey was also in the newspapers yesterday, having brought a High Court action against the Irish Times for alleged defamatory comments made by the public online. The anonymous online comments stated that Professor Casey was an unprofessional psychiatrist who was unfit to treat suicidal pregnant women and further, that she misrepresented psychiatric research in order to promote a Catholic agenda. The Times kowtowed apologised and the action was settled between the parties; therefore, no legal precedent was established. Professor Casey’s legal letters are legendary and many, including me, have been on the receiving end. Whatever happened to ‘truth’ and ‘honest opinion’ being defences to defamation?
Furthermore, regarding the comment that Professor Casey is pushing a Catholic agenda. Similar to defending antidepressant use in children, she’s certainly not pushing a Catholic agenda when she says antidepressants can be life-saving in pregnancy, while keeping quiet about the harms SSRIs can cause to the foetus, an issue that she’s well aware of. Another scientist (and psycho-pharmacologist) David Healy, has brought to her attention that these drugs can increase the rate of abortion, miscarriage and birth defects – but Professor Casey chose not to explore the data. May God forgive us all..
As for the BMJ article, far be it for me to contradict Professor Casey, so I asked the scientist at the centre of the study, Peter Gøtzsche, what his thoughts were on her Examiner article. See his detailed reply (in blue) below –
Prof Casey, however, said the jury was still out on the risks and benefits of prescribing the antidepressants, commonly known as SSRIs.
She believed psychiatrists dealing with children and adolescents should decide on a case-by-case basis.
“If a child is depressed and is not responding to evidence based treatment on offer, like talking therapies or some other anti-depressant, the psychiatrist might only then go and prescribe the SSRIs,” she said.
I consider it bad medicine to use antidepressants in children. They don’t work, according to the children themselves when asked in placebo controlled trials, and they double the risk of suicide and treble the risk of aggression.
“I am not a child or adolescent psychiatrist — I deal with adults. But I know from speaking to colleagues that there are differing views on prescribing SSRIs. Some say no, SSRIs should not be prescribed while others say, yes, we should, otherwise there will a greater risk of dying by suicide.”
Psychiatrists who claim that antidepressants protect children from committing suicide should not be allowed to practice; they are too dangerous to have around.
Prof Casey said it was found in the US and in the Netherlands that the suicide rate in children and adolescents increased after members of that group stopped being prescribed SSRIs.
All such studies have been found to be seriously misleading. I explain why in my recent book, Deadly Psychiatry and Organised Denial. The randomised trials provide far more reliable evidence and they show that the suicide risk doubles when children get antidepressants, which is why the drug agencies warn about using these drugs in children.
This was noticed particularly in the Netherlands, where the drugs carry a ‘black box’ warning.
This is not correct. Robert Whitaker writes about this under the heading “The Triumph of Bad Science” (http://www.madinamerica.com/2012/07/the-triumph-of-bad-science/):
Critics quickly pointed out the dishonest science that Gibbons had employed to make this case. He reported that SSRI prescriptions to youth declined by 22% in the U.S. from 2003 to 2005, and that suicide rates in youth rose 14% between 2003 and 2004. But since he had only the suicide rates for the U.S. through 2004, he should have focused on prescribing rates during that same period of time.
In fact, there had only been a very small decrease in the prescribing of SSRIs to youth between 2003 and 2004, when the number of suicides rose. It was between 2004 and 2005 that the there was a significant decrease in the prescribing of SSRIs to youth, and–as the critics noted–once the suicide data for that period became available, it showed that during that time, the number of suicides for persons ages 5 to 24 declined.
In other words, the data showed that as the number of prescriptions to children and youth declined, the number of suicides in this age group declined too. But Gibbons reported that the opposite was true. He did so by matching the increase in suicides in 2003-2004 to the decline in prescribing in 2004-2005. This is not the sort of error a scientist “accidentally makes.” This is the sort of presentation of data one makes when he or she is trying to deliberately tell a story that fits a preconceived end.
In the Netherlands, Dutch academics were incensed with Gibbons and his statistical antics. In the Dutch Drug Bulletin, they noted that the increase in suicides in the Netherlands was so small that it was “not statistically significant.” They described his conclusions as “astonishing” and “misleading,” and stated that Gibbons and his co-authors had been “reckless” to publish such claims.
“Child psychiatrists should not be eliminating SSRIs totally from their armory but using them when other treatments don’t work because there is now clear evidence of an increase in suicide in young people that appears to approximate to the time when the reduction in their prescription occurred,” said Prof Casey.
This is total nonsense. There are no reliable studies that have shown this. And interestingly, when the usage of SSRIs went up in the UK in youth, suicides in youth also went up, but no one has felt compelled to publish a paper about this, as far as I know. Selective reporting is certainly an issue here.
However, the research led a British expert to call for stricter prescribing rules.
Professor of evidence-based psychological therapies at University of Reading, Shirley Reynolds said only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
No. No one should prescribe antidepressant medication to children and young people. I consider this a medical error. They don’t work and they are harmful.
“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.
They need not think hard. They should just say no. This will save many lives.
“But do the results mean that children and young people should never be prescribed antidepressant medication? No.
Yes! It should be forbidden to use these drugs in children and young people. We also need to face the fact that these drugs can cause suicide at any age, and they can also cause homicide.