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Comment by hristov | Hacker News Reader

There have been many articles on rising suicide rates especially among kids and young adults, but they tend to not mention a very important possible factor. And that is antidepressants.

It is well known that antidepressants increase the risk of suicide for children, teenagers and young adults (i.e. people under 25). The FDA has acknowledged this and even put warnings on the drug packaging. Yet antidepressants are still routinely prescribed for children and teenagers.

This is something the media does not like to talk about considering how pharma companies spend a lot of money on advertising. But it is a very important possible factor and it should be considered.

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When I was 11 or 12 I was put on anti-depressant and anti-psychotic medications (some off label). Several years later, it's discovered the company had illegally marketed one of the drugs to minors and it had developed into negative side effects in some patients, for which there was a class action lawsuit. Luckily, I never developed said side effects personally, but it did leave a level of distrust with pharma companies and to an extant the medical field

Do you think you got any benefit from the aforementioned medications? If you did then maybe it was luck that you did not incur the negative side effects and yes, any profit generating device is to be a a bit distrusted and treated with somewhat skepticism.

> any profit generating device is to be a a bit distrusted and treated with somewhat skepticism.

Yes, but I feel that these days, at least on the internet, speaking with skepticism about medicine and pharma companies will have people equating you with anti-vaxxers, given the arguments are often similar

Conspiracists are not skeptics. Skeptics question commonly accepted beliefs to arrive at a deeper understanding of those beliefs, while conspiracy theorists replace commonly accepted beliefs with less commonly accepted alternatives with only superficial scrutiny of either. The conspiracists takes a dogmatic stance of opposition while the skeptic sees adherence to dogma as a pitfall to be avoided.

https://en.wikipedia.org/wiki/Skepticism

Conspiracists will always tell you they're skeptics, though.

I've found that individuals in physical or psychological pain tend to have limited capacities for criticality while also searching for solutions to their pain. 9/11 and anti-vax conspiracies can be attributed to this. Having two skyscrapers fall on your neighborhood has to be traumatizing and finding out your child is not what you expected her to be is no walk in the park.

The largest source of trauma in the country right now is school gun violence. The gun control movement being led by the traumatized victims of gun violence, regardless of it's ultimate effectiveness, is the healthiest response to trauma I've seen in the US. It took suburban middle class children access to therapists, to start moving that conversation towards a place of sanity. If their pain never subsists, what kind of adults do you think they'll be?

How about, instead of putting derogatory labels on people to belittle their efforts to understand truth, we all simply strive for truth?

> The conspiracists takes a dogmatic stance

What, all of them? And who are the "conspiracists"? Those who disbelieve the 9/11 myth, who question the long-term health effects of drugging water systems, who question the safety of wireless transmitters installed in every cubic inch of the world, who see through war propaganda and manufactured history? There are a thousand more "trigger topics".

All of these people are the same, huh? Dogmatic dolts who can't do research? Dummies who don't accept official narratives simply because they're trouble-makers?

The power system maintains its stranglehold over the population because our implicit slavery has been normalized. Is there any earthly reason why we should have billionaires next to people starving to death? We accept this because it has been normalized. There has always been a war on information, but we finally have the means to take back control. But in order to do so, we have to want it.

I mean big pharma creates mistrust time after time. Look up Bayer selling HIV infected blood products in Africa after removing it from the North American market.

Opiates were marketed as sleeping aid for babies.

Synthetic opiates, such as tramadol were marketed not to be addictive that turned out to be a lie.

Many medications were taken of the market due to side effects, and often the pharmaceutical company knew and downplayed the side effects.

Anti-depressants were also supposed to be safe and non addicting, but withdrawals are actually insane.

I have been nearly crippled by an antibiotic and again side effects are downplayed, and FDA is updating the label year after year adding more and more side effects and not recommending the medication as first line treatment anymore.

It's also an issue that sometimes statistically insignificant adverse side effects can be successfully used to litigate against pharma companies.

For example as a teenager, I desperately needed accutane. Other solutions weren't working and some had actually more severe side effects than accutane; one tetracycline gave me heartburn so severe I basically couldn't eat anything, whereas the most accutane did was dry out my skin.

But because of studies that found a link to increased rates of depression/suicide among people taking accutane, it took years for me to work my way up to taking it, with very bad damage to my self esteem over that time. And if you look up the studies that promote this link, they are obviously not properly controlled, because they compare accutane users to the general population, and not to a subpopulation that has acne bad enough to need accutane. Which is dumb because lots of people (like me) who were taking accutane already had depression not because of the medicine, but in part due to very low self esteem and social ostracization due to the acne that was bad enough to warrant taking that drug.

So the symptom they were trying to prevent was something I already had, and withholding the drug because of concerns about that symptom contributed to making the symptom even worse for me.

To contrast your experience, I was prescribed an oral retinoid as a teenager. As someone who was already depressed, what followed was one of the worst depressive episodes of my life.

There's definitely a fine line to walk between effective treatment and harm reduction when it comes to that class of medication.

Sorry to hear about your experience. I hope things are better now.

An argument / possible explanation that I've heard is that the increased risk for suicide can be attributed to the beneficial effect of reducing lethargy and fatigue, effectively removing one major barrier between suicidal ideation and carrying out the act.

That is a possible explanation, but it does not explain why the effect is so pronounced in younger people and goes away with age. The truth is we just do not know how the popular antidepressants work to begin with and we sure as well don't know what makes them create suicidal thoughts. It is best to gather and publicize available evidence as best as possible and thread carefully.

The right tool for the job. Every patient is a little bit different, and a small but noticeable portion are very different.

Antidepressants worked very well for my S.O. for a stretch of their life. The long term benefit is not so clear, but they have clearly helped. With me, they made everything worse.

This all comes down to how we value/price medical labor in my opinion. More extensive conversations, bringing mental health experts with proven track records into the loop, more custom tailored medication approaches-- all of these things are needed to get a better grasp of the overall societal problem and how best to deal with it.

This is absolutely fascinating to me. Is there any hypothesis as to why this is?

I think its a damn shame where the conversation on depression is going. Depression is tested and diagnosed by a questionnaire (presumably well-designed, with redundancies to make it robust). Antidepressants are serotonin reuptake inhibitors, a drug inspired by a monoamine hypothesis now discarded. We still prescribe them because they modestly lower the score on an observer rating scale better than placebo. If you take an SSRI, it should be bioavailable instantly! Why does depression take months to recover from?

With this all said, all severely depressed people should get medical treatment; moderately depressed people should consider trying it. I also don't want to strawman medicine, science or psychiatry, and claim that they think we are serotonin vessels. They acknowledge all the stuff I said above. I just don't know if its communicated to the layman or the media, especially when we see horrendous, exponentially growing rates like this.

Speaking from experience at the very lowest you can "shut down" lacking motivation to do anything.

The thing is mood and motivation are shockingly separate and antidepressants are a "try and see what fits". So if it combos to improved motivation while still feeling suicidal that is a bad combination.

As for the why biochemically it not certain but it involves longer cycles.

Ketamine is one faster acting hope but it isn't widely used from other concerns.

Administration of antidepressants initiates with up-regulation of target receptor sites along with many, many non-target receptor sites. Over time, those target receptors down-regulate and that is what is theorized to contribute to the antidepressant effect.

The period of initial antidepressant use and its associated up-regulation of receptors can increase activation, anxiety and akathisia, a feeling of intense physical discomfort and restlessness, with many people finding the anxiety and akathisia to be inescapable. One receptor associated with this is the 5HT2C subtype, which is not a targeted receptor, but still is activated as a side-effect of SSRI therapy.

It's hypothesized that people might harm themselves in order to decrease or escape the discomfort they feel while beginning antidepressants. Another hypothesis is that the anxiety and activation might drive someone who is struggling with suicidal thoughts to act upon them before the antidepressant's therapeutic effects kick in.

One of the reasons Prozac is approved for minors is 1) it has an extremely long half-life such that a missed dosed isn't the end of the world and 2) it antagonizes the 5HT2C receptor site, theoretically minimizing activation, anxiety and akathisia associated with starting an antidepressant regimen.

Double worse because being diagnosed for a lot of these issues is just a matter of telling your doctor you're feeling a little down and crying a bit more than you think you should. All of a sudden you're diagnosed with whatever (which really cheapens the case of people with real issues who really need help). So a lot of people take medications they really shouldn't.

Add to that: - Obesity and its impact on sleep quality (eg: a LOT of people with undiagnosed sleep apnea, which can have depression-like symptoms)

- Nutritional deficiencies (big lack of reliable info around this so its hard to figure out whats real and whats not, but shit like lacking magnesium supposedly can have consequences in this area?).

All around, lots of stuff can lead to depression, suicide, etc, beyond "the world sucks".

What's the rise in absolute risk? In relative risk?

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