Between the recent tragic passing of Aaron Swartz, and the increase in interest in mental health care following the Sandy Hook massacre, I’ve seen a lot of confusion and misunderstanding lately about the role of anti-depressant medication, and the increased risk of suicide and homicidal behavior. I want to set the record straight on this.
Anti-depressant medication, in particular SSRI’s like Prozac, Paxil, Zoloft, Effexor, etc., have been linked to an increased risk for suicidal behavior. But not for the reasons most people seem to think.
When someone is suffering from clinical depression, it causes a number of symptoms. One is the actual sadness from which the condition draws its name—depressed people frequently feel lonely, miserable, abandoned, and that life is not worth living. Another symptom of depression, though, is a lack of energy, and a lack of motivation. Many people with clinical depression are so depressed that it actually prevents suicide—because how can you go through all the motions of finding a way to kill yourself when you can’t even convince yourself to get out of bed in the morning?
For clinically depressed patients, SSRI’s frequently work on both of these different symptoms. But in a number of cases, the patient will see an improvement in one set of symptoms before the other. What this means is that every so often, you wind up with a patient who begins to recover from his lack of energy and lack of motivation, without immediately recovering from his feelings of sadness, loneliness, and the conviction that life is not worth living.
The result: Someone who is still miserable, and still convinced that suicide is their only option—but who for a brief window, has the energy and conviction to do something about it. Suicide.
This is not a signal that anti-depressant medication does not work.
In fact, it’s a signal that anti-depressant medication DOES work—it’s a sign that the patient is getting better. But taking anti-depressants is something that should not be done lightly, and should not be done without close, careful supervision from medical professionals and from loved ones who are AWARE OF THE POSSIBLE CHANGES IN BEHAVIOR that can result from taking anti-depressants.
I beg of you, do not jump on this as an opportunity to dismiss psychiatric medication as quackery, or “crazy pills,” or anything like that. By doing so, you contribute to the stigma of depression, and make it harder and harder for people who have psychiatric problems to seek the help they need.