War of Ideas, Part 5

Thomas Friedman sees the Iowa results as a vindication of support for the Iraq incursion by ‘liberal hawks’, like his unrepentent self, whom he calls ‘Blair democrats.”

God bless the Democratic Party’s primary voters in Iowa. They may have rescued our chances of succeeding in Iraq and even winning the war of ideas within the Arab-Muslim world. Go Hawkeyes!

How so? Well, it seems to me that Iowa Democrats, in opting for John Kerry and John Edwards over Howard Dean, signaled (among other things) that they want a presidential candidate who is serious about fighting the war against the Islamist totalitarianism threatening open societies.—New York Times op-ed

Panel says SSRIs do not increase suicide risk

“Adding to the debate over using antidepressant drugs for depressed teenagers and children, a group of prominent researchers issued a report yesterday saying that Zoloft and similar medicines did not increase children’s suicide risk.

The group, drawn from members of the American College of Neuro- psychopharmacology, also found that the drugs were effective in treating children’s depression.” —New York Times As readers of FmH know, the backlash against the antidepressants has been one of my pet peeves, and I have long felt that the risks of undertreating major depression far outweigh the risks of the antidepressants. Recently, the consensus has been that Big Bad Pharma has concealed evidence of mrobidity and mortality associated with these cash-cow medications. But, while I am no fan of the pharmaceutical industry, I do not think they are so nefarious — mostly because it would not be good for business. This study echoes a FDA review panel’s 1991 finding putting to rest worries that Prozac increased suicidality. Most of those raising concerns about SSRI-induced suicide (and, for that matter, violence and homicide, which in several highly-publicized lawsuits have also been associated with drugs of this class) arise from anecdotal associations. Pooled data ends up showing no statistical correlation. The current committee echoes my belief that most SSRI-associated suicide comes from undermanagement by the prescribing doctor (because of the pharmaceutical companies’ marketing strategy, this is increasingly a primary care doctor rather than a psychiatric specialist) and trivialization of the treatment of an urgent and dangerous condition. Paying adequate attention to:

  • the fact that patients regain their energy and resolve as they recover with antidepressant treatment, sometimes before they become more hopeful, and therefore may have the wherewithal to act on their despair;
  • the small number of patients who develop unbearable restlessness and agitation during treatment
  • the patients whose despair is increased by the perception that the last-ditch treatment has failed them, often during the lag time before the medication has ‘kicked in’ or been properly titrated upward
  • patients who are chronically suicidal and would be just as dangerous to themselves off the medication as on
  • patients who are receiving medication treatment (often from practitioners with inadequate training and experience in mental health issues) without concomitant psychotherapy to explore the torments of their life
  • patients with an unrecognized psychotic component to their depression, extremely lethal if not treated along with the depressed mood

is what is called for, rather than throwing out the baby with the bathwater.