Loose Screws Mental Health News: Suicide slide

congregationA new study from the University of Manitoba shows people who regularly attend some kind of religious service are less likely to attempt suicide. The study, published in the Journal of Affective Disorders, surveyed 37,000 Canadians and their connection with spirituality, religious worship, and suicidal behavior. Those who simply said they were spiritual but didn’t attend religious services did not show a reduced risk of suicide attempts. However, I was dismayed to read that researchers didn’t investigate why regular church attendance decreases the risk of suicide attempts. (Note to self: Go to church each Sunday!) (pic via www.assumpta.fr)

Alison Go of U.S. News & World Report cites a study from Academic Medicine (originally reported by Inside Higher Ed) which suggests depression affects 21.2 percent of medical students. The rates is 11.2 percent higher than that of the general population. And unfortunately, 13 percent of black medical student reported suicidal ideation in the survey, suggesting that the demographic is more likely to suffer from suicidal thoughts.

And yet another study about suicide… The University of Gothenberg in Sweden performed a study on people who had nightmares following a suicide attempt and found out that they were five times more likely to try committing suicide again. The conclusion is based on a meager sample size of 165 patients but I suppose it’s a start.

While it appears that other sleeping obstacles do not raise the risk of multiple suicide attempts, patients who have attempted suicide seem to battle sleeping problems on a regular basis.

It is normal for patients that have attempted suicide to suffer from sleeping difficulties. Some 89 percent of the patients examined reported some kind of sleep disturbance. The most common problems were difficulty initiating sleep, followed by difficulty maintaining sleep, nightmares and early morning awakening.

Interesting observation considering that I have pretty much all of the common problems with the exception of early morning awakening.

Finally in a semi-cool story, a 22-year-old New Jersey guy who was friends with an 18-year-old Californian over the Internet called California police when he found out the 18-year-old said he would attempt suicide. Although it sounds like the teen (his name was not disclosed) is pretty upset about being saved (I know the feeling), it’s a (somewhat) happy ending compared to what happened in November when a Florida teenager streamed a webcast of him committing suicide by dying of a drug overdose. The Florida teen died before police arrived.

FDA: No link between Singulair and suicidal behavior

On Tuesday, the FDA announced that an investigation into Merck’s clinical trial data did not discover a link between Singulair (montelukast) and suicidal behavior. The investigation, which began 9 months ago, was prompted by a number of reported suicides, especially that of 15-year-old Cody Miller who took the drug and appeared to have no history of mood or behavioral problems. (It is worth noting here that Singulair “is the top-selling drug for people under 17 years old” and Merck’s biggest seller with annual sales of close to $4.5 billion.)

In attempt to assess Merck’s data better, the FDA also investigated AstraZeneca’s Accolate (zafirlukast) and Cornerstone Therapeutics’s Zyflo (zileuton). Although the FDA did imply that “the data were inadequate to draw a firm conclusion” and said that the clinical trials were not set up to observe any psychiatric behavior. Here are the data the FDA discovered during their review of these trials:

SingulairSingulair: 41 placebo-controlled trials that included 9,929 patients

  • Reports of suicidal thoughts: 1 (treated with Singulair)
  • Attempted suicides: None reported
  • Completed suicides: None reported

AccolateAccolate: 45 placebo-controlled trials that included 7,540 patients

  • Reports of suicidal thoughts: 1 (placebo group)
  • Attempted suicides: 1 (placebo group)
  • Completed suicides: None reported

ZyfloZyflo: 11 placebo-controlled trials (number of patients unknown)

  • Reports of suicidal thoughts: None reported
  • Attempted suicides: None reported
  • Completed suicides: None reported

Forgive me for being cynical but the data sounds fishy. I can’t pinpoint why but it does. The suicide numbers and patient involvement data seem to deviate some from the numbers listed in Merck’s PR issued last March. (I’m seeing 11,000+ patients vs. 9,929 patients.) Regardless of the clinical trial data, it appears that the FDA as of yet have not reviewed post-marketing data.

Scott Korn, a senior safety surveillance executive for Merck said in an article for Reuters:

“‘At the time we did not believe, and we still don’t think a link has been established’ between Singulair and the suicides.”

In the same article, Sanford Berstein analyst Tim Anderson had this to say about the possibility of the FDA finding a link:

“If the… safety review leads to a stern warning about behavioral changes in the Singulair label, this could frighten users of the drug or their parents and give Merck’s competitors ammunition to attack the brand.”

The Washington Post has Dr. David Weldon, director of the Allergy and Pulmonary Lab Services at Scott & White in College Station, Texas, on record saying that he had not “seen any increase in psychiatric problems with the drug but that some patients had complained of nightmares after starting on Singulair.” (Note: It appears that the closest conflict of interest Weldon would have here is that he served as a consultant and is honoraria for AstraZeneca.)

Dr. Rauno Joks, head of the SUNY Downstate division of allergy and immunology, made an interesting point in the Washington Post article:

“The physician really needs to review whether there are symptoms that have developed since patients started taking the medication, if there’s an underlying depression that was there before medication started.

Also, seasonal allergies in and of themselves can cause fatigue and lethargy, which makes it harder to assess, because those are some of the symptoms you have with depression.”

The FDA says they’ve completed analyses of submitted clinical trial data but their “safety review will continue” for several more months before they come to a concrete conclusion. For customer testimonials, check out medications.com that has over 2,300 people reporting side effects and askapatient.com that has an average 2.3 rating from 524 reviewers. The most commonly reported mood-related side effect on both of the sites is irritability.

2-Year Anniversary: The Long and Winding Road

I’m aware that my blog has taken a significantly dark turn.  This may alienate some of my readers who seek happier, brighter topics. I don’t think my posts have been negative; on the contrary, I think they’ve been positive. Positive and educational.

I’ve been exploring the topic of suicide recently because it’s a subject that’s quite near and dear to me, now more than ever before.

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The Act and Follow-through of Suicide: Wrap-Up

I’ve always found it annoying when people say a suicide attempt is
"a cry for help." And the best one — "She’s just looking for
attention." I ran into that quite a bit in high school.

While a suicidal person may not realize it (I certainly didn’t), a suicide attempt is a cry for help. It’s  an action that says "I’ve come to my breaking point. I’ve run out of options
and I don’t know what else to do. My problems are too much for me to
handle and the only way out of them is to die." Suicide is the action
which stem from thoughts that likely were never verbalized.

The majority of people who commit or attempt suicide aren’t just
seeking to die "just because."

…[T]wo doctors who are among the most often-cited experts on suicide…readily acknowledged the high degree of impulsivity associated with [jumping], but also considered that impulsivity as simply another symptom of mental illness. “Of all the hundreds of jumping suicides I’ve looked at,” one told me, “I’ve yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn’t happen. There’s almost always the presence of mental illness somewhere.”

They feel as though they truly have "run
out of options" and ending their life is the least favorite backup
plan. The common thread that runs through all suicides is hopelessness.

So to wrap this series up, is it possible to prevent someone  from committing or attempting suicide?

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The Act and Follow-through of Suicide: Part IV

Compilation of Statistics Regarding Suicide

Scott Anderson in his NYT article weaves the grim statistics of suicide in and out of his story. Here’s the morbid list:

General

  • mental illnessThe nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.
  • In 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.
  • The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder.

Demographics

  • Both elderly men living in Western states and white male adolescents from divorced families are at elevated risk.

Premeditation vs. Passion

  • [T]he person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
  • In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
  • “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total. By the early 1970s, the amount of carbon monoxide
    running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

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The Act and Follow-through of Suicide: Part III

Premeditation vs. Passion

Author Scott Anderson in his NYT magazine article, "The Urge to End It All," notes:

Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide.

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The Act and Follow-through of Suicide: Part II

The British Coal-Gas Story

According to Scott Anderson’s NYT article, the little-known British coal-gas story — even among mental health professionals — is a good example of how suicides can be prevented if one takes away the means:

Coal-gas ovenFor generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

Experts seems to insist that committing suicide is proof of an underlying mental illness. Suicide that stems from impulsivity, among these experts, is also considered part of a mental illness. Anderson subtly argues against this, and I find myself agreeing with him:

How can this be? After all, if the impulse to suicide is primarily rooted in mental illness and that illness goes untreated, how does merely closing off one means of self-destruction have any lasting effect? At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly — “the execution chamber in everyone’s kitchen,” as one psychologist described it — and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

Would this mean that if people had less access to suicidal means that promoted “ease, speed, and certainty of death” (ESCOD), a number of suicides could be averted? It appears so. Anderson continues to make a case using the Ellington Bridge in Northwest Washington as an example:

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The Act and Follow-through of Suicide: Part I

“What was immediately apparent was that none of them had truly wanted to die. They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution.”Dr. David Rosen, psychiatrist and Jungian psychoanalyst

A recent article in New York Times magazine suggests that those who exhibit suicidal behavior or have had unsuccessful attempts are least likely to die by way of suicide.

The author, Scott Anderson, delves into the psyche of what drives a person to commit suicide. And he attempts to answer the "what" question by evaluating the "how."

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Calls for VA's top official to resign

I’d been meaning to talk about this story but it’s progressed faster than my typing hands can keep up.

An e-mail sent around at the Veterans Health Administration among Dr. Ira Katz, the VA mental health director, and other officials, discussed the issue of hiding the number of suicides committed by veterans from the public—an estimated five out 18 of them being under VA care. Now, a number of senators (and bloggers) are calling for Katz’s resignation.

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Scary statistic

Here's one scary statistic:

In a study, the first of its kind, scientists have found that websites encouraging suicide pop up more frequently in Internet search engines than those which aim to prevent it.

The story, reported by the Times of India, must be speaking of Web sites outside of the U.S. because I sure can't find such a phenomenon on U.S. sites. (Yes, yes, I've previously tried.)

"Lies, damned lies, and statistics":

While one in five sites that popped up on the click of a mouse were dedicated suicide sites, and over 50% of them encouraged, promoted or facilitated suicide. Over 43 of the websites studied contained personal accounts of suicide methods. In contrast, only 13% focused on suicide prevention or offered support, while another 12% actively discouraged suicide.

The article mentions that the three highest ranked sites were pro-suicide. The top four sites gave detailed information on various ways to commit suicide. Most of these pro-suicide hits were found via Google and Yahoo. MSN had the highest hits of prevention and support sites.

As I resist the urge not to investigate the data further, I think of a Web site I was introduced to recently called everyminute.org. According to the site, about 30,000 people commit suicide in the U.S. annually. Suicide also is the second highest cause of death of those in the 25–34 age range. Untreated mental illness tends to play a big role in suicides. This statistic makes me glad that my mental illness is being treated, however, I still struggle with suicidal thoughts (I have lately). The silver lining in this is that I have a higher chance of overcoming my suicidal actions and behavior thanks to my counseling, medication, and self-education via this blog and the blogs of others.

Brief update on Singulair-suicide link

Merck issued a press release today responding to the FDA’s investigation. Along with the standard "we didn’t know about this problem until after it the market" disclaimer, the PR mentioned:

In a cumulative analysis recently provided to the FDA of Merck’s randomized, double-blind, placebo-controlled clinical trials, which included over 11,000 adults and children in over 40 studies who were treated with SINGULAIR, there were no reports of suicidal thoughts or actions and no completed suicides in the patients who received SINGULAIR.

Additionally, in a cumulative analysis recently provided to the FDA of Merck’s randomized, double-blind, clinical trials that compared SINGULAIR with other active agents to treat asthma (which included over 3,900 adults and children who were treated with SINGULAIR and over 3,400 who were treated with other asthma therapies), there was 1 patient who attempted suicide who received SINGULAIR, and there were 3 patients who attempted suicide who received other asthma therapies (including inhaled corticosteroids and long-acting beta-agonists).  These studies were not designed to compare the rate of suicide in patients taking SINGULAIR with the rate of suicide in patients taking these other asthma agents.

Did Merck report that one suicidal attempt when compared to "other active agents to treat asthma"? It doesn’t say anything in their patient safety or prescribing information when I checked. Perhaps someone can find out whether they reported this in their clinical trials?

In the meantime, the Singulair section of medications.com is ablaze with parents who are now expressing concern over their children’s well-being on the drug. Apparently, issues have cropped up with the drug even before the FDA announced their investigation.

Singulair and Suicidal Behavior

SingulairIn a particularly odd link, the FDA is looking into Singulair, the asthma and allergy drug and its correlation with suicidal behavior. I’ve taken Singulair in the past and not once did it ever occur to me to think about an allergy medication being linked to suicidal behavior. The FDA also says that it could cause mood and behavior changes. The situation that alerted the FDA to this possibility is the story of 15-year-old Cody Miller who killed himself 17 days after switching from allergy medication Allegra to Singulair. Miller’s mother, Kate, approached his medication switch with extreme caution and informed herself of the possible side effects:

She checked the Merck website and the information sheet she got from the pharmacist on Singulair and found no red flags, so they were stumped when Cody started acting out of character.

I have to hand it to Merck: Once the Millers reported Cody’s death, they immediately updated Singulair’s warnings to include suicidal thoughts and actions. However, Cody died on August 4, 2007. Merck updated their information two months later. As of February 29, 2008, the FDA still hadn’t taken any action. Despite the updated warnings, however, doctors and pharmacists were unaware of the new information.

The Singulair website carries the updated side effects, but you have to search it out in the patient information PDF on the fourth of five pages.

If you check with the FDA, you’ll find nothing. That’s because they admit they haven’t updated their website on Singulair since 2001.

According to the FDA’s MedWatch safety information, they have only begun their investigation today. They say it will take 9 months for them to “complete their investigation.” We may not hear of the FDA’s conclusions until early 2009. If this is a single, isolated incident, the FDA may just say the results are inconclusive and allow Merck rip the warning off their patient safety information. It is also important to note, however, that Singulair has also been linked to depression and anxiety.

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Loose Screws Mental Health News

An article in the NYTimes addresses the issue of diagnosing mental health in developing countries. A startling fact:

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

emoIn India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

Looks like depression is really more than just a whiny rich American kid who chooses to be upset because he’s got nothing better to do. That’s “emo” for those who aren’t hip-to-the-jive. 😉


On The Elite Agenda, Dr. Fred Baughman mentions Swedish writer Janne Larson who asserts that “over 80 percent of persons killing themselves were treated with psychiatric drugs.” Thank God for FOIA that provides the docs to back this up:

According to data received via a Freedom of Information Act request, more than 80 percent of the 367 suicides had been receiving psychiatric medications. More than half of these were receiving antidepressants, while more than 60 percent were receiving either antidepressants or antipsychotics. There is no mention of this either in the NBHW paper or in major Swedish media reports about the health care suicides.

I guess Sweden isn’t the only country in the world that wants to sweep unfavorable mental health coverage under the rug. By the way, Sweden also is considered to be the seventh happiest country in the world.

While the FDA has recognized that antidepressants can cause an increase in suicidal behavior (as indicated by the “black box warning”), antipsychotics seem to have fallen under the radar. In fact in 2002, Clozaril was approved to combat suicidal behavior in schizophrenic patients. Since then, research has shown that antipsychotics can increase suicidal behavior in schizophrenic patients twenty-fold.

Akathisia – a serious side effect that has occurred for nearly all psych drugs in clinical trials – has been found to be linked to suicidal behavior with not only antidepressants but also in conjunction with antipsychotics.

Finally, Baughman closes with this:

It is important to note that nearly every school shooting that has happened in the United States over the last decade has been conducted by young males who were taking antidepressant drugs. The drugs not only cause suicidal behavior, they also seem to promote extreme violence towards other individuals. In most school shooting cases, the young men committing the violence also committed suicide after killing classmates and teachers. These are classic signs of antidepressant use.

I don’t know if that’s wholly true but it’s a trend I’ve seen with Cho, Kazmierczak, and Eric Harris of Columbine. Since 1996, there have been 55 major school shootings all around the world; 43 of them occurred in the U.S. Makes you wonder how many of these gunmen were on a psychotropic drug – prescribed or not – of some kind.

(Image from Style Hair Magazine)

Who I Am

I am a 26-year-old black female who suffers from bipolar disorder. I was diagnosed with the illness in November 2006. I’d been diagnosed as suffering from major depressive disorder (MDD) beginning at the age of 14. I still consider myself to suffer primarily from depression although I do have occasional manic episodes.

This blog has helped me to recognize many of the things that I am. That
I truly am more than my diagnosis and that my diagnosis does not define
me. I am not just a person with manic and depressive episodes. I am a person with a personality. I’m smart, witty, drop-dead gorgeous—okay, I wish, but I’m not ugly—musically inclined, and ambitious. And that’s just scratching the surface.

I can be happy, sad, angry, and joyful. I have so many emotions that could classify me as anything. I have a short attention span, for instance. The docs missed the attention-deficit hyperactivity disorder (ADHD) diagnosis (although I lack the hyperactivity).  I suffer from anxiety as well but not a single medical record lists me as suffering from generalized anxiety disorder (GAD). So I self-diagnose. It helps me to realize that all of my flaws can pigeonhole me into any diagnosis I choose. I accept my flaws – “diagnosable” or not – and my strengths. This is my journey to learn more about myself, my diagnosis, my medical treatment, and anything relating to my personal life and general mental health.

I’m skeptical of pharmaceutical companies. I don’t hate them; however, many of their practices are shady and I—along with some of my favorite medical blogs —hope to shed light on the “unfavorable” news they choose to keep hidden from the public.

I highlight celebrities who admit to mental illnesses. Many of them suffer from depression, which is the fashionable mental illness of the moment, but others truly suffer from problems that are worth talking about.

I also write about my personal life relating to mental illness. I struggle with constant thoughts of suicide. Readers of this blog will note a pronounced emphasis on suicidal thoughts and behaviors.

Feel free to read on to the next entry about my Perfectionistic Tendencies. Chronicling my journey to managing and treating my illness can hopefully aid me. And eventually, someone else.