Are modern pharmaceuticals to blame for the rise in suicides?
With the recent high-profile suicides of celebrities like Kate Spade and Anthony Bourdain who seemingly have “ideal” lives, I began to wonder if they were on any medications. According to the CDC, there has been a 25% increase in suicides over the past two decades. And many modern pharmaceuticals specifically warn about “suicidal thoughts” in their disclaimers. A friend of mine who never contemplated suicide before was recently prescribed Xanax, immediately began having suicidal thoughts, and had to be taken off the drug.
So has there been any scientific studies linking pharmaceuticals and suicides?
They’re probably a factor. Increased suicidality from some medications is real. But not everybody is on those medications. There’s probably a lot of factors. Drugs, The Werther efffect, social media, etc.
I think for antidepressants, that risk is really just for the first few weeks when your energy levels are improved before your mood, if all the increased suicides were happening in the weeks following starting antidepressants, it’d probably be known.
I suspect social media replacing in-person socialisation could be a factor.
As you might imagine, the compiling of information on the side effects of drugs - including suicidal ideation - is done fairly scientifically, but there are limitations. The process is termed Pharmacovigilance.
So to that extent the answer is a qualified yes. I say “qualified” because of the way the data is compiled, which is a sort of all-sources-count approach and is not properly controlled (basically all reports are compiled, and evaluating causality is rarely straightforward). A typical report would be, I’m a doctor, I prescribed X and the patient reported suffering from Y.
This approach ensures that every possible side effect is captured, but as it’s a catch-all you need reasonably large numbers in order to reach a consensus on causality. Very rarely do you see dechallenge and rechallenge (I took them off the drug and Y went away; I put them back on again and Y recurred).
When a drug undergoes clinical trials, side effects are monitored proactively and intensively. Post-authorisation, adverse event reporting is essentially voluntary. Obviously, the vast majority of data (and arguably the most realistic data) comes post-marketing.
Suicides/attempted suicides/suicidal ideation are side effects. They are evaluated like other side effects.
Beyond this sort of routine safety data assessment, I don’t know if specific studies have been designed to evaluate suicide risks. If they have been, I’d be interested to know.
BTW - and don’t take this the wrong way - I have to note that “…high-profile suicides of celebrities like Kate Spade and Anthony Bourdain who seemingly have “ideal” lives, I began to wonder if they were on any medications” kinda is suggestive of some sort of agenda. I might choose to wonder if they each had horrific dark secrets/terminal illnesses/add-your-own-presumed-motive… Is there any reason to assume a particular cause here, let alone the same cause ?
Suicides rose in the 1920’s with the popularization of gas ovens. They rose during the great depression in the 30’s because of the economy. From the end of the Civil War to the 1880’s, an extraordinary number of veterans committed suicide.
It seems that with each new way of suicide that becomes available and known, the suicide rate spikes. It is also fed by economic issues, post traumatic shock and a host of other reasons.
So I would say that, yes, the availability of another method of suicide - by pharmaceuticals - has brought another rise in the suicide rate.
Although I’d also have to question the accuracy of older numbers, as I’m sure there were plenty of people who were not listed as such because of the religious and social stigma.
Right now unfortunately, we have a perfect storm of available opioids, an ‘economic boon’ that is not benefiting the lower classes, the slashing of social programs and mental health programs, the right wing propaganda stigmatizing lower social classes and the general lack of empathy toward others this brings.
I acknowledge that green space helps mental health and rural people often rank as happier than city people when polled. I’m not disputing that. But can you track the rural/urban divide and peg it to suicide rates in any sort of trend? And how are suburbs generally counted in such calculations, anyway?
Metric tons of loneliness in the countryside, even now. Lots and lots of older farmers, living miles apart, very few women. In the old days, you had 40-80 acre farms, so you’d have 8-16 on a single section (One square mile, 640 acres) with families tending the farm. With the increase in mechanization, farms got larger and larger and needed fewer people to work them.
I think we just had that thread a couple of weeks back.
In the days of the early settlers, loneliness was also a huge issue, especially for the wives.
I think you’d have to weigh this against the number of suicides prevented by modern pharmaceuticals.
There are now medical drugs that are effective treatments for serious mental illnesses like depression, paranoia, schizophrenia, bipolar, etc. Previously the only treatment was psychological counseling, which was much less effective alone. These drug treatments must have prevented many more suicides.
I personally know of one family where 2 older siblings suicided, then doctors recognized this, and 3 younger siblings are doing fairly well controlling their depression/bipolar (as long as they stay on their meds). If not for those modern pharmaceuticals, the younger siblings probably would also be dead from suicide.
The biggest jump in suicide rates, among men and women, is age 45-64. Is that age bracket the most likely to use anti-depressant medication? Also suicide rates have declined for those age 75+ for both genders.
I can’t find info on race though. I read that black suicide rates have gone down and Indian rates have gone up dramatically, but I’m not sure how much white rates have gone up.
So I really don’t know. Why are Indian rates skyrocketing while black rates go down? Why are rates going up for middle aged men and women, but going down for people age 75+. No idea.
Note that depression comes in many forms and there are anti-depressants for several of these. A drug that works well for one neurotransmitter problem makes a person with another form much worse.
So there’s a lot of trial and error during treatment. Give a patient a drug. Have them come back in 2-4 weeks. Not better or worse? Try something else. Repeat.
I think the warnings about not giving certain anti-depressants to kids due to increased suicide risk is because they were simply trying the wrong one in some cases. But that other teens might be helped by those same drugs. A real YMMV situation.
Depressed people are not the best sorts of folk for being patient and going thru the cycle of trying different meds. I can see someone being put on Prozac and not feeling better, maybe even worse, and really getting depressed. They blame themselves for the drug failure, see no point in trying something else. Bad Stuff ensues.
So, in a way, it could be the mere existence of popular anti-depressants that make some people feel worse about themselves even if they didn’t try more than one, if that.
They are also not the best for taking their meds reliably, nor for getting their scripts refilled regularly. Anti-depressant withdrawal is also a terrible thing, and one of the risks of using anti-depressants is going through unmonitored withdrawal. Twenty something years ago, I stopped taking Welbutrin abruptly, and the rebound/withdrawal depression hit so hard and so fast that it was like I literally didn’t understand what had happened to me. Benzos can also have terrible withdrawal symptoms and it’s stupid easy to get Xanex prescriptions.
I dunno. I feel like anytime you prescribe drugs to a depressed person (maybe any person), it should be understood that there will be periods of acute withdrawal and that needs to be taken into account when considering the cost/benefits of the treatment.
Your suspicion is most likely due to your own particular biases against urban living.
I would suspect that depression and suicide are on the rise due to a combination of economic and social factors. Factors such as the unobtainable celebrity lifestyles of Kate Spade and Anthony Bourdain being portrayed as the “ideal”. Forget “celebrity” standards of ideal life. I think it’s getting harder to maintain what most people would consider a “normal” standard of an ideal life. Living someplace with low crime, good jobs, decent schools and other infrastructure. Maintaining a circle of friends, family and acquaintances. Physically and emotionally healthy hobbies and interests. Some level of job security, career progression and economic stability.
A psychiatrist wrote a guest column for a certain major news organization whose coverage of the news isn’t always reliable. He spoke of the Kate Spade and Anthony Bourdain suicides and, as Og is my witness, blamed it on God being removed from public schools dating back to Engel v. Vitale.
Consider that in the past people were motivated to hide suicide - it was treated as something shameful, not just for the suicide but for the entire family, like it was contagious or something. I wonder if some of the increased suicide rate is more honestly in regards to cause of death?
I think a huge stigma is the belief that you go to hell when you die (or if you believe in reincarnation, you are forced to come back and relive all your traumas again). Now that we are getting more secular maybe people just care less about these myths.