5 ms·

I've been seeing this pop up on all the major news outlets and science websites, but still have not seen one mention of the side effect that may be behind both

by xlm1717 11y ago

I've been seeing this pop up on all the major news outlets and science websites, but still have not seen one mention of the side effect that may be behind both increased risk of suicide and increased risk of violent behavior: akathisia. Akathisia is a side effect of antidepressants that causes an intense inner restlessness and inability to sit still. This can cause agonizing pain and terrible anxiety, and people can resort to extreme behaviors to relieve their symptoms, often becoming violent. This has been known for a while now. If you look at the references on the Wikipedia page for akathisia, you find one paper linking antidepressant-induced akathisia to violence from 2006: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564177/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564177/ Quoting from that paper on akathisia: “Increased tenseness, restlessness, insomnia and a feeling of being very uncomfortable”. “On the first day of treatment he reacted with marked anxiety and weepiness, on the second day felt so terrible with such marked panic at night that the medication was cancelled”. “The first few doses frequently made them anxious and apprehensive. They reported increased feelings of strangeness, verbalised by statements such as ‘I don't feel myself’ or ‘I'm afraid of some of the unusual impulses I have'’. "Events such as these in clinical trials of antidepressants have commonly been coded under headings such as agitation, emotional lability, and hyperkinesis (overactivity), and only rarely to akathisia." The good thing is that you can treat akathisia with common medicines already used to treat anxiety, such as benzodiazepines. The bad thing is that since information on side effects has been suppressed, patients are not likely to know what is happening to them and how to treat it, won't get the help they need, and run the risk of hurting themselves or others.

existencebox 11y ago
What concerns me as much as the initial side effects is your last paragraph, and the sentiment surrounding it. Benzos have been known to have some additional significant neurological consequences in the long term, and have always felt to me like a rather large sledgehammer for the problems they often treat. As such, "your behavior-modifying drugs give you a side effect so we'll shove more powerful drugs in your face" was an attitude that I've seen multiple times and NEVER to good effect. (I'll be very candid that I was part of the "you have ADHD so we'll treat you with pills" generation, at a much younger age, but will leave it at that it didn't end as planned.) I hope I'm not a total tin foil hatter by looking askew at this trend, but being married to a neurologist and the son of a behaviorist, I'm VERY aware of how little we understand what we're doing when we muck around up there.
- derefr 11y ago
  > As such, "your behavior-modifying drugs give you a side effect so we'll shove more powerful drugs in your face" was an attitude that I've seen multiple times and NEVER to good effect. I don't see why that couldn't make perfect sense, though: someone can be neurochemically imbalanced along multiple axes, but one imbalance can mask the other. For example, if I have ADHD (for real) and depression, then that'll look like I just have depression. If I'm not getting out of bed, you're not going to observe me being very impulsive or notice when I fail to desire to practice things. But now, if I take an anti-depressant and the depression goes away enough for me to get out of bed, it looks to the study like "in some people, a side-effect of treatment X for depression is [the symptoms of ADHD]." What it really was is that I had a comorbidity.
  - existencebox 11y ago
    Let me give a (probably very leaky) programming analogy: You have one library, and it solves 1 class of problems. You use a second library on top of it to try and address some bits introduced by library 1. This may well move the core metric needle to get you what you want, but you will undoubtedly incur unforeseen interactions, and additional potential edge cases. When you add the brain into the equation, it removes all of the (comparatively flawless) understanding we have of the system the libraries are running within, and then when you add benzos, one of your libraries is now an enraged bobcat. In a perfect world, I'd agree with your statements. I do not think we have an effective enough understanding of either the compounds we're using, or the systems we're impacting, to be as laissez faire with cocktails as we often are.
- AJ007 11y ago
  How many studies check the effects of patients taking two, three, or more medications?
iza 11y ago
I always thought the increased suicide risk from antidepressants was because it gives patients the energy and confidence to finally go through with it.
vonmoltke 11y ago
Worth noting that "antidepressant" is used rather loosely as a synonym for "SSRI". There are non-SSRI antidepressants on the market and this paper does not appear to cover those.
- sunnid 11y ago
  This is definitely worth noting. Wellbutrin, aka bupropion is a non-SSRI that some people I've known with depression have recommended. After discontinuing Celexa which is an SSRI, the whole experience was significant enough for me to handle my problems through cognitive behavioral therapy.
cantstop 11y ago
I've had medicine induced akathisia before and it was by far the worst thing I've experienced in my life. Unless you've had it yourself, there is no way to convey just how terrible it actually is. I can easily see why people would want to die when facing this. I've heard this is used as a form of torture in some countries. Being strapped down and injected with a medication that induces akathisia would make the most hardened individual talk.
- cryoshon 11y ago
  Interesting, got a source that you had in mind for that torture claim? I'd like to read more.
  - Zigurd 11y ago
    The Soviets engaged in systematic abuse of psychiatric confinement and medication as a weapon against dissidents.
  - cantstop 11y ago
    Other than having a couple of independent psychiatrists tell me, I have no source. I've searched high and low for years but have always come up empty.
mzs 11y ago
Every time someone in my family has been prescribed an SSRI the doctor has listed this side effect, though they don't always use the term. The doctor that I am most fond of in fact lists the side effects in three categories, this one being in the most unlikely one. Then says should it be a problem it can be treated with therapy and benzos. He also mentions that there are options there for how fast they act. A therapist knowing this can offer coping skills. Insomnia can be a problem in particular and for that there are options outside of benzodiazepines. Finally there are non SSRIs available as well. For our family at least it has not been an unmanageable issue.

by xlm1717 11y ago

existencebox 11y ago

What concerns me as much as the initial side effects is your last paragraph, and the sentiment surrounding it. Benzos have been known to have some additional significant neurological consequences in the long term, and have always felt to me like a rather large sledgehammer for the problems they often treat. As such, "your behavior-modifying drugs give you a side effect so we'll shove more powerful drugs in your face" was an attitude that I've seen multiple times and NEVER to good effect. (I'll be very candid that I was part of the "you have ADHD so we'll treat you with pills" generation, at a much younger age, but will leave it at that it didn't end as planned.) I hope I'm not a total tin foil hatter by looking askew at this trend, but being married to a neurologist and the son of a behaviorist, I'm VERY aware of how little we understand what we're doing when we muck around up there.

derefr 11y ago
> As such, "your behavior-modifying drugs give you a side effect so we'll shove more powerful drugs in your face" was an attitude that I've seen multiple times and NEVER to good effect. I don't see why that couldn't make perfect sense, though: someone can be neurochemically imbalanced along multiple axes, but one imbalance can mask the other. For example, if I have ADHD (for real) and depression, then that'll look like I just have depression. If I'm not getting out of bed, you're not going to observe me being very impulsive or notice when I fail to desire to practice things. But now, if I take an anti-depressant and the depression goes away enough for me to get out of bed, it looks to the study like "in some people, a side-effect of treatment X for depression is [the symptoms of ADHD]." What it really was is that I had a comorbidity.
- existencebox 11y ago
  Let me give a (probably very leaky) programming analogy: You have one library, and it solves 1 class of problems. You use a second library on top of it to try and address some bits introduced by library 1. This may well move the core metric needle to get you what you want, but you will undoubtedly incur unforeseen interactions, and additional potential edge cases. When you add the brain into the equation, it removes all of the (comparatively flawless) understanding we have of the system the libraries are running within, and then when you add benzos, one of your libraries is now an enraged bobcat. In a perfect world, I'd agree with your statements. I do not think we have an effective enough understanding of either the compounds we're using, or the systems we're impacting, to be as laissez faire with cocktails as we often are.
AJ007 11y ago
How many studies check the effects of patients taking two, three, or more medications?

iza 11y ago

I always thought the increased suicide risk from antidepressants was because it gives patients the energy and confidence to finally go through with it.

vonmoltke 11y ago

Worth noting that "antidepressant" is used rather loosely as a synonym for "SSRI". There are non-SSRI antidepressants on the market and this paper does not appear to cover those.

sunnid 11y ago
This is definitely worth noting. Wellbutrin, aka bupropion is a non-SSRI that some people I've known with depression have recommended. After discontinuing Celexa which is an SSRI, the whole experience was significant enough for me to handle my problems through cognitive behavioral therapy.

cantstop 11y ago

I've had medicine induced akathisia before and it was by far the worst thing I've experienced in my life. Unless you've had it yourself, there is no way to convey just how terrible it actually is. I can easily see why people would want to die when facing this. I've heard this is used as a form of torture in some countries. Being strapped down and injected with a medication that induces akathisia would make the most hardened individual talk.

cryoshon 11y ago
Interesting, got a source that you had in mind for that torture claim? I'd like to read more.
- Zigurd 11y ago
  The Soviets engaged in systematic abuse of psychiatric confinement and medication as a weapon against dissidents.
- cantstop 11y ago
  Other than having a couple of independent psychiatrists tell me, I have no source. I've searched high and low for years but have always come up empty.

mzs 11y ago

Every time someone in my family has been prescribed an SSRI the doctor has listed this side effect, though they don't always use the term. The doctor that I am most fond of in fact lists the side effects in three categories, this one being in the most unlikely one. Then says should it be a problem it can be treated with therapy and benzos. He also mentions that there are options there for how fast they act. A therapist knowing this can offer coping skills. Insomnia can be a problem in particular and for that there are options outside of benzodiazepines. Finally there are non SSRIs available as well. For our family at least it has not been an unmanageable issue.