Thursday, November 2, 2006

Medicine: All the public hears from Star*D IV: A New Hope, and more on SSRIs and childhood suicide

For depression relief, try variety of medications
Study: Antidepressants help most patients if they sample several kinds
Well that's nice. At least they're not accusing psychiatrists of killing children today. It's amazing that such a landmark study can be distilled into such a vanilla, yet pretty accurate, headline.

Instead, we just have a study of dubious design tying lower suicide rates to higher rates of prescriptions of SSRIs to kids. There's a certain macro-attractiveness about the study design, and as one commenter in the article mentions, at least we know we're probably not creating this raging army of childhood suicides by giving out medicines to try to treat their depression. But the statistical value of such removed exposure and outcomes are pretty minimal, given just how much better we could probably design (more expensive) studies to measure the same outcome so much more accurately.

But it seems like we already have all the info we really need about SSRIs and childhood suicidal behaviors. We know that, in no study, has a kid actually committed suicide because of an SSRI, but that some kids probably have an increase, at least in the short-term, of likelihood of self-harm. Solution: monitor the kids closer! I think we can be comfortable with the idea that sometimes, things have to get worse before they can get better. If we admit such, we can design interventions to minimize dangerous thoughts and behaviors in the critical window following the beginning of treatment in a depressed patient.

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