Barry Blackwell: The Baby and The Bath Water
Bruno Mueller-Oerlinghausen’s comment on Leonardo Tondo’s comment on Barry Blackwell’s essay and Edward Shorter’s comment on it
First of all it should be stressed again what so many colleagues just can not believe, i.e. that no any serious, acceptable study has ever shown that antidepressant treatment can reduce the inherent risk of suicide in patients with mood disorders. They might be able in the case of responders to diminish the suicidal ideation associated to an acute depressive episode, but they do not reduce the risk of suicide in this patient group.
Let’s assume that in Leonardo Tondo’s practice, as he wrote, there might have been 600 cases of suicidality (Very unsuitable term as Dr. Tondo already has pointed out. How many attempts how many suicides? ) in at least temporal association with the use of antidepressants, then the question arises according to which criteria has a potential causal relationship between the antidepressant and the suicidal event been examined ? The problem is: if I’m convinced that such a causal relationship practically does not exist I will not recognize it. In our most recent paper by Stübner et al. in the Int J. Neuropsychopharmacology we have documented under which circumstances we would consider such a causal relationship as likely in a given individual case (Stübner, Grohmann, Greil, et al 2018). Our data shows that such cases exist as a rare adverse drug reaction and that obviously SSRIs/SNRIs are overpresented as the provoking compounds. This is in full accordance with the findings from the German spontaneous reporting system published by the Drug Commission of the German Medical Association already in 2004.
Stübner S, Grohmann R, Greil W, et al. Suicidal Ideation and Suicidal Behavior as Rare Adverse Events of Antidepressant Medication: Current Report from the AMSP Multicenter Drug Safety Surveillance Project International Journal of Neuropsychopharmacology 2018; 21: 814 -21.
November 22, 2018