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.

Continue reading “Singulair and Suicidal Behavior”

Suicide: Understanding and Intervening – Conclusion

"The basic rule of suicide intervention is this: if the level of suffering can be reduced a little, the individual might choose to live." – Jeffrey S. Black

The quote above is the entire point of this post and the preceding posts on this subject. Suicide’s a difficult and divisive topic. People never seem to run out of opinions on the matter.  Jeffrey Black’s booklet was directed to an audience that wanted to know how to help a suicidal individual. I added a couple of things that I thought were relevant, but for the most part, Black is on target. I stopped harping on this through my posts, but I remained dismayed at the straightforward approach and lack of empathy in the book. While a person struggling with suicidal thoughts shouldn’t be "babied," he should be treated with compassion and care. Tough love works on some people, but its potential for backfire is great. Many people who consider suicide are extremely fragile and the slightest criticism could further convince them that they need to kill themselves. (FYI – I am one of these.) If you’ve known the person for a long time, assess his normal-tempered personality. From there, decide whether he is capable of accepting a bit of a heavy-handed push. A general rule: Avoid tough love if the suicidal person normally wouldn’t consider you "a loved one."

So this post concludes my longest-running series on suicide. This series has been in the works since October, when I entered the hospital, but I never had any time to really devote to it. The semi-meticulous person I am, I went through my posts and tried to edit them as much as possible. (OK, with the exception of this one.) A few mistakes might slip through, but for the most part, they should be relatively readable.

The point of this series wasn’t to bang non-Christians over the head with a Bible. (Uh, so to speak.) The booklet I dissected came from a Christian point of view, but I think there was a lot of helpful information, not just for Christians, but for anyone who wants to help a suicidal person. It’s not foolproof and it certainly isn’t the "be-all and end-all." It’s a guideline and a good start. Purchase the book at Amazon, if you’re interested.

Suicide: Understanding and Intervening – Part IV, Helping A Suicidal Person

Helping a suicidal person is a touchy subject.  Black’s booklet is addressed to people who want to help a person who is suicidal.  Black’s provides some tips to help a suicidal person:

  1. “Acknowledge the reality of [the person’s] pain.”
  2. “Help him see the connection between his pain and his felt need.” Get them to say, “Life without ___ [fill in the blank]___ will be unbearable because ___[fill in the blank]___.
  3. “Challenge constricted options and irrational thoughts.”
  4. “Explore [the person’s] perceptions of hopelessness.” How hopeless is the person feeling? Can the situation be rectified or is it hopeless?
  5. “Help the person to separate pain and need.”

Assessing risk
Black’s following guideline is a good way to assess whether a person is considering suicide:

1. Presenting problem – Assessment begins by evaluating the problem that triggered the downward spiral.  This is difficult to do if the person can’t identify any triggers.

2. Background information – Analyze the person’s life and personality to gain a better understanding of how and why he is driven to a point where he considers taking his own life.  A good warning sign: If someone says, "I can’t deal" repeatedly. "I can’t deal" really means, "I don’t have the appropriate coping skills to handle my situation."

3. Substance abuse – While a person who abuses drugs or alcohol may not be suicidal, the likelihood that a depressed person who abuses drugs or alcohol is.

4. Resources – Encourage the (potentially) suicidal individual to seek out a support network: family, friends, church, therapists, or social groups.  If a person feels needed, he is more likely to realize that his death will have a significant impact.  Perhaps he’ll think twice before making an attempt.

5. Suicidal thinking and intent

A.     "Evaluate the person’s felt experience." Use a mood scale from 1-10 to gauge how good or bad a person is feeling. (Feel free to use mine on the right.)
B.     "Determine how often the person has suicidal thoughts and how intense or compelling they are."  Frequent "passing" thoughts are no longer passing thoughts.
C.     Dry run. A person contemplating suicide might have “tried out” the way he plans on killing himself.

“Has she ever taken a few pills to see what it feels like, tied things around her neck, driven at high speed, or practiced with an unloaded gun? Dry runs help the person to resolve any ambivalence she might feel about suicide.”

If a person admits to attempting a “dry run,” the person likely is in extreme danger of following through.

6. Noble End – A person who is at the point of beautifying suicide as a glorious end to his life is completely disillusioned and should be seen as a high risk.  Watch out for talk of "No one needs me anymore" or "Everyone would be better off without me."

An addendum: A person who says "I hate myself" may be a suicidal risk, but not always.  An admission of self-hatred provides evidence that he may want to eliminate the hatred in some way.

Suicide: Understanding and Intervening – Part III

A “situational crisis” may lead a person to have “intense psychological pain.” As a result of this psychological pain, a person can begin to experience “distorted thinking” and/or may “abuse medication.”

1. Situational crises

These include financial problems, illness, bereavement, relational conflict, or public humiliation. Black notes that situational crises tend to act as a “catalyst to suicide,” driving the person to believe he or she has no other solutions to solve his or her problem(s).

2. Severe psychological pain
Black gets to the heart of suicide attempts:

“The goal of suicide is often simply to end that pain: ‘I just want the pain to go away.’ … ‘I just want to die’ most often means, ‘I want to stop feeling bad.’”

This, above all things, is the biggest reason behind a suicide attempt. If people felt like they had other options to their problems apart from suicide, most would take the alternate routes. In a suicidal moment – whether planned or not – the suicidal person is thinking about ending the “pain.” Death itself is not the goal; it’s an end to emotional pain. Death seems to serve as a means to that end.

3. Distorted Thoughts
Distorted thinking is a characteristic of suicides. Black writes:

“Problems may seems catastrophic when they are not. Predictions about the future can become arbitrary and unrealistic.

While problems get unbearable and circumstances may seems bleak, instead of looking for assistance, those who are suicidal convince themselves that only death or loss of consciousness can release them from emotional pain.

4. Abuse of medication
A person who attempts to overdose on medication seeks one of two things: death or loss of consciousness. Abuse of medication that requires hospitalization provides a legitimate reason to “escape” the problems of life. Abusing medication is a person’s way of saying that he needs, as Black puts it, “an emotional vacation.” The person feels overwhelmed by the stressors of life and temporarily need to block out all distractions. At this point, it is safe to say a person is mentally ill. The need for escape from problems is the mind’s way of saying that it needs time to recover and become mentally healthy again. Abusing medication is the desperate way of doing this.

Suicide: Understanding and Intervening – Part II

In 10 years of struggling with suicidal thoughts, I’m practically a “suicidal” expert. (I said "practically," not actually.) I know quite a bit about suicidal ideations and many of the thought processes behind them. Jeffrey Black lists more common features in suicidal thinking:

  • Extreme psychological pain related to unmet psychological needs.
  • A view of self that says she cannot tolerate such intense pain.
  • An overwhelming feeling of hopelessness, and the belief that she is helpless to solve problems.
  • A sense of isolation or desertion accompanied by the belief that others cannot, should not, or do not want to offer support, nurture, or care.

Not all suicides are planned. I, for one, can attest to the fact that they can be impulsive. The combination of elements that Black identifies can seem to lead someone to a suicide attempt. Black’s pattern of identifying someone who possibly could have suicidal tendencies is as follows:

  • Sense of hopelessness
  • Pattern of poor coping skills
  • Limited tolerance for pain
  • Need to flee from help

All four are likely to be present to classify someone as suicidal. Two out of four does not a suicidal person make. Desperate, yes, but not undeniably suicidal.

“Hopelessness can be both a source of psychological pain and a result. A person’s belief in her inability to change things is probably bound up with her experience that the pain is intolerable.

Here’s the equation for a suicidal mind, here is the equation:

problems + inability to change problems = intolerable pain.

If the equation becomes problem + inability to change problems + intolerable pain, then the only solution – as perceived – is suicide. Black breaks down the facets of suicide:

  • The result of a continuous transaction between a person’s heart
  • The symptoms of depression
  • The kinds of stressors in the person’s environment
  • The strategies a person uses to cope with depression and other life events

A person turns to suicide if he is suffering from severe depression; has poor coping strategies; feels that his stressors are too much to handle; and in his heart, has decided that as a result of these circumstances and feelings, he must end his life.

Suicide: Understanding and Intervening – Introduction

“Won’t you share a common disaster? Share with me a common disaster. Oh, a common disaster.” – Cowboy Junkies, “A Common Disaster”

SuicideI receive weekly counseling at CCEF (Christian Counseling and Education Foundation) in Glenside, Pennsylvania, The foundation has an outreach program called Resources for Changing Lives that publishes educational material on different topics. One of the small booklets I purchased was “Suicide: Understanding and Intervening (SUI)” by Jeffrey S. Black. The booklet is a tad bigger than a 3 x 5 index card and consists of 31 pages. Of all the things I read in the book, the last paragraph stood out in my mind:

“In the years I have been involved in biblical counseling, I have not completely fathomed the hopelessness and despair in a believer that makes death more attractive than life. I pray that my inability is not merely a lack of empathy for someone who struggles. I hope that it is a vision for Christ and his kingdom that keeps the true ‘meaning’ of suicide out of my reach.”

While I understand Mr. Black has years of counseling those who struggle with suicidal ideations, I can’t help but wonder: What made him qualified to write this book?

In reading SUI, I felt as though the author took an objective stance in writing this. It came across as matter-of-factual rather than empathetic or sympathetic. I read the book – in all honesty – looking for answers and some kind of sympathy. I only received a slew of answers. The book should aptly be renamed “Suicide: A Factual Guide to Intervention.” No understanding required.

The book wasn’t bad; it just felt like the author wanted to keep his distance. “Don’t get too close to the reader lest you understand what a suicidal person is experiencing!” But the lack of emotion to relate to the reader detracted from many of the positive aspects of the book.

Out of five stars, I give the book three stars. Despite the absence of emotion, the book gives great bits of information I hope to share. As a person who struggles with suicidal thoughts on a recurring basis, the book was a bit of a disappointment. I know of other counselors at the foundation who could have written a more sympathetic book than Mr. Black. But he wrote it, so it’s time to delve into it.

Suicide: Understanding and Intervening Series

Beginning next week, I’ll be unveiling a series on a booklet that I read called, "Suicide: Understanding and Intervening," by Jeffrey S. Black. According to the booklet, Mr. Black pastors Calvary Chapel in Philadelphia and is an adjunct faculty member for the Christian Counseling and Education Foundation’s School of Biblical Counseling. (Since the booklet was written in 1998, I don’t know if the previous sentence still holds true.)

The book is directed at readers who want to know how to help a suicidal person. I quote much of the book and offer some comments, but I also try to add some important pieces that I think Mr. Black overlooked. The booklet relies on the Bible to support many of its points so it is heavily Christian-themed. However, there are other interesting tips that anyone – Christian or non-Christian – can use to help those who are suicidal.

I’ll be honest: I read the book myself, and as a person who struggles with suicidal thoughts, I found it to be disappointing. This probably stems from the fact that suicidal people are not the target audience. Those who care about suicidal people are. Regardless, reading the book allowed me to gain some insight into my thought processes when I become suicidal. These thoughts aren’t evident to me when I am suicidal, but they do occur. Perhaps the coming book analysis can be a helpful tool for readers of this blog, not only for those who want to help suicidal people, but also for those who have attempted suicide and are looking for a way to thwart the process.

Suicide and baseball

I’m suicidal right now. And it sucks.

According to my mood rating, yesterday I was a 0. Then I forced myself into a 10. I really felt more like a 5. I’m a 3.2 today: moderately depressed, passing thoughts of suicide with some difficulty functioning.

I know exactly what’s triggering my suicidal thoughts: my stupid assumptions about how my co-workers and boss feel about me.

I’m a total people-pleaser. Despite my assumptions, I have a tendency to read people quite well. I can tell when they don’t like me, when they do, and when they’re pretty much ho-hum about me.

I have two co-workers that are basically annoyed with me because of my absence on my birthday Friday (I know this because they were fine on Thursday), my boss is "ho-hum," and the rest of my co-workers don’t really care. (More later throughout the week on my birthday weekend.)

My husband continues to remind me that I need to keep my thoughts focused on God. My suicidal tendencies develop because I’m so self-absorbed that I take my focus off of God.

I want to kill myself as I way to punish my co-workers. There. I said it. I want to kill myself because two people are annoyed with me. (And I know they’ll get over it; they always tend to.) But I can’t stand the cold, stony silence. I can’t stand not knowing what people are thinking about me. I can’t stand the cold e-mails I receive when I try to be warm and friendly.

I have a lot to do at work. I’m a little overwhelmed because I’m still quite new, but I’m doing my best to keep up with things here. I should be currently working, but I’m taking the opportunity to use my 15-minute paid break as a way to relieve the pain that’s beginning to develop in my mind and heart.

It’s totally stupid to kill myself because TWO people don’t like me. I have a whole bunch of family and friends who love me to death (npi) and I’m suicidal because TWO people are currently annoyed with me.

I realize how silly that is.

Continue reading “Suicide and baseball”