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Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3596 (Published 18 June 2014) Cite this as: BMJ 2014;348:g3596

Re: Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

This study is fundamentally flawed:

1. Visit the Harvard Center For Placebo Studies. There, you will find conclusive evidence that not a single anti-depressant has any efficacy above that provided by placebo. In the face of that evidence, it is difficult to reach a conclusion that the absence of antidepressants causes suicidality. Since 1/3 of patients respond to placebo, there will be an increase in suicidal behavior by stopping the placebo. That does not mean the correct clinical approach is to give the patient what amounts to an active placebo.

2. Implicit in the data provided is that the young patients were given those other psychotropic drugs most likely in place of anti-depressants. The analysis does not appear to account for the natural increase in accidental overdose due to the increase in prescribing.

3. Those other drugs have themselves been known to instigate suicidal behavior. That also does not appear to be accounted for.

By failing to account for these three factors, the analysis has probably reached the wrong conclusion. The study presents a statistical association and proposes a causal relationship with no proof and three key assumptions that anti-depressants have efficacy, increases in overdose were due solely to suicide attempts and the two were somehow linked. The study does not demonstrate causality and the preponderance of secondary evidence would suggest there is no causality at all in the way implied.

Competing interests: We offer a non-traditional treatment for depression using the operating room anesthetic ketamine.
20 June 2014
Gerald W Gaines
mental health clinic owner
Depression Recovery Centers
14362 N Frank Lloyd Wright Blvd. Scottsdale, AZ 85260
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