SSRI's and Teen Suicide

Let’s start on an understanding that the SSRI’s do work. In fact from my clinical observation it is due to their efficacy that they landed in the courts. They probably lift you out of the vegetative state of depression before the serotonin has had an effect on the mood and the brain. (suicidal thoughts included) We need to know though how the serotonin deficiency causes depression and where it acts centrally for us to get a clearer picture.

It was the drug companies themselves who found out that a small number of people on SSRI are suicidal and potentially dangerous to others. These were higher than both placebo and the old anti depressants comparable group, so could not be dismissed. It was the drug companies who settled court litigation even up to six million dollars to quell inquiry into SSRI's. This helped to cloud this issue even further.
The fact that the patient is depressed to start with and probably suicidal complicates the task even further. Most patients on SSRI’s sings praises for the drug companies and the doctors once treatment is started and will probably not want to be off them for a long time. The SSRI’s are more frequently prescribed now than ever irrespective of the subsequent litigations and complications.
The psychiatric society is not known for its objectivity. For a long time semi quacks of medicine, they are now holding scientifically proven drugs like SSRI’s and GABA receptor agonists, with known action and supposedly known disease pathophysiology to act on and patients screaming for more. To reduce them to quackery again would have been a little more difficult than wrestling a toy from a kid. They had to look a little more objectively at the wonder drug though because the pathophysiology was concretized by drug effect, TB drugs as the catalyst and the SSRI’s the end point.

I have previously written about social anxiety disorder in children. Shy children are being given a high to survive in real life. These drugs are not from the drug peddler at the street corner, the prescription is from a doctor.
To give a drug without a disease is unknown in medicine. To give a drug that will be difficult to withdraw is peddling. SSRI’s should be indicated for a specific group and that is depression. The above situation is like adding a potential complication (possibly suicide) to healthy child in the hope an end result that is not quantifiable even. You only know how good the effect was after the drug has been given. The child was never an extrovert, what gives us as doctors the right to drive her into an unfamiliar territory.
Exercise and the right diet with serotonin precursors in the right amounts has been found to be more effective in this ‘drug before disease conditions’ and should be the first line of treatment. We know what SSRI’s do, but that doesn’t necessarily make us know how they make depression resolve. Depression is not simply the lack of serotonin.

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