SSRIs and Black Box Warnings

[Blitz2006]

So I was doing some reading, :

MMS: Error

Whats your take on SSRIs and black box warning. Legitimate concern? Should I run this by my patients that I start SSRIs on, or is it clinically non-significant?

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[OldPsychDoc]

So I was doing some reading, :

MMS: Error

Whats your take on SSRIs and black box warning. Legitimate concern? Should I run this by my patients that I start SSRIs on, or is it clinically non-significant?

Read the article: it's fairly clear that the risk of failing to treat depression is much worse. THAT is what you should be "running by your patients"--along with education about depression and safety planning for suicidal ideation.

 

[Blitz2006]

Read the article: it's fairly clear that the risk of failing to treat depression is much worse. THAT is what you should be "running by your patients"--along with education about depression and safety planning for suicidal ideation.

Oh I agree. I just meant statistically in the real world, should I be concerned about increased risk of suicide for the first week or so of treatment. By no means am I deterred at all to prescribe, but curious as to how I closely I should monitor for high risk behavior...

 

[TexasPhysician]

Oh I agree. I just meant statistically in the real world, should I be concerned about increased risk of suicide for the first week or so of treatment. By no means am I deterred at all to prescribe, but curious as to how I closely I should monitor for high risk behavior...

The last study I read showed the highest risk of suicide being the week before a psychiatric evaluation.

I could theoretically see how a SSRI could increase suicide risk as they do not cure depression over night. Say someone with suicidal thoughts is very fatigued without motivation. The person may see suicide as being too much effort to carry out. The SSRI starts to demonstrate mild improvement by increasing motivation and energy. Now when this someone with poor frustration tolerance hits a major stressor, they may have the energy to follow through with a suicidal thought. Even then, I don't believe the SSRI caused the suicidal thoughts. Just my thoughts.

 

[WingedOx]

The last study I read showed the highest risk of suicide being the week before a psychiatric evaluation.

I could theoretically see how a SSRI could increase suicide risk as they do not cure depression over night. Say someone with suicidal thoughts is very fatigued without motivation. The person may see suicide as being too much effort to carry out. The SSRI starts to demonstrate mild improvement by increasing motivation and energy. Now when this someone with poor frustration tolerance hits a major stressor, they may have the energy to follow through with a suicidal thought. Even then, I don't believe the SSRI caused the suicidal thoughts. Just my thoughts.

Still the latest paxil suit in the news this week shows that the general laity and therefore the courts now think otherwise.

 

[Merovinge]

Keep in mind that the warning is based on pooled data from SSRIs. Paxil heavily skewed the average and should never be used in children outside of extremely rare circumstances (it's just a terrible drug in general but most people reading here know that). If you just look at Prozac alone, which is THE 1st line treatment for depression in child/adolescent population there is no statistically different rate of SI.

I do cover the BBW with all my families but only insofar as to explain how it happened and why it should not be a major concern, everybody googles everything these days so I like to head it off at the pass.