ANALYSIS:Group challenges view people could take own lives or become violent when taking SSRIs, writes DR MUIRIS HOUSTON
THE TRAGIC deaths of two young men in a stabbing episode in a house in Bray, Co Wicklow, in the early hours of August 16th last year is the background to yesterday’s lengthy statement on anti-depressants from the College of Psychiatry of Ireland.
Citalopram, marketed under the trade name cipramil, is a class of drug known as selective serotonin re-uptake inhibitors (SSRIs). There is nothing in the medical literature to suggest a link between cipramil and homicide. In fact there is some evidence that SSRIs may reduce impulsive, aggressive behaviour.
But there is epidemiological evidence that the risk of self-harm in depressed patients is greatest around the time of presentation to medical services. And it seems the risk of suicide may increase in the early stages of treatment for depressive illness.
These findings led to a number of regulatory agencies, including those in the US and Europe, to formally examine the thesis that this specific group of anti-depressants was the cause of suicidal tendencies, especially in young adults recently prescribed these drugs. They found no evidence of cause and effect, but advised that young adults treated with SSRIs be closely monitored.
The inquest heard expert evidence that some people could take their own lives or become violent when taking SSRIs. This is the evidence that is challenged by the College of Psychiatry of Ireland. Specifically they reject the assertion a “frenzied” attack suggests delirium, as was claimed. They also reject an explanation that the tragic events could have been caused by a “mental automatism” caused by SSRI intoxication.
The statement also challenges the alleged link between antidepressants and violence. It says there is no scientific basis for this assertion and that it “risks perpetuating a false and stigmatising stereotype that people living with mental illness are violent”.
Referring to a large study of 35,000 people published last year in a major psychiatry journal, the college asks that people avoid linking acts of violence to the symptoms or treatment of mental disorder without considering the evidence and facts of each case.
After prescribing anti-depressants for people who are considered to be at greater risk of suicide or are under 30, doctors should see the patient again after one week and then frequently until the suicide risk is no longer clinically important, according to guidelines from the UK National Institute of Clinical Excellence