anti-depressants

Day 228

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All day today 55 years old Charles Kennedy has been on the news – a prominent political figure found dead at his residence yesterday. He struggled with alcohol, his father passed away earlier this year and he lost his parliamentary seat of 32 years in the recent elections. Police are treating his death as ‘not suspicious’.
Interesting description. Isn’t it? I, on the other hand, am very suspicious.
My thoughts and prayers are with his family. For them the nightmare begins.

From the documents that have been sent to me for the inquest, it is revealed that my son’s depression score on PHQ-9 was the highest possible, ie. 27/27, sixteen days prior to Day 0. It indicates severe depression. It doesn’t get any worse. Yet, no alarm bells rang for anyone and he was sent home on the same medication and no escalation of care, despite it being requested. On the follow-up visit 2 weeks late, the test was not repeated. Wonder why?

PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression and it is a validated tool for monitoring depression.

Eli Robins and colleagues at Washington university studied 134 suicides and came to this conclusion: “If we had found that suicide was an impulsive, unpremeditated act without rather well defined clinical limits, then the problems of its prevention would present insurmountable difficulties using presently available clinical criteria. The high rate of communication of suicidal ideas indicates that in the majority of cases it is a premeditated act of which the person gives ample warning.”

Identification through proper assessment of suicide risk must precede any attempt to treat psychiatric illness. Asking the patient directly about suicidal thoughts or plans is an essential part of history taking. Other major risk factors that need to be evaluated are: the presence of severe anxiety or agitation; the type and severity of psychiatric illness, the extent of hopelessness; presence of severe sleep disturbance, current alcohol or drug abuse, ease of access to lethal means, lack of access to good medical and psychological treatments (!), a recent setback, family history, close proximity to a first episode of depression, mania or schizophrenia and recent release from a psychiatric hospital.

Once identified, acutely suicidal patients need hospitalisation as a protective measure and for further evaluation. It does not prevent all suicides but definitely saves lives.

Hospital beds are like gold dust. Patients verbally and clearly proclaiming suicidal intent are sent home due to lack of beds. ‘Length of stay’ is another criterion for assessing how well a hospital is doing. So, even if they do manage to find a bed, patients are discharged earlier than they should be. There is tremendous pressure on the system and the carers at home.

There is almost nothing doctors can do about major stresses in patient’s lives as they are difficult to predict and govern but there are things that can be done to influence the underlying biological vulnerabilities to suicide. The proper management of mental illnesses, especially those closely linked to suicidal behavior, is vital.

Day 205

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Depression can have various physical manifestations.
One may feel “sick” or weak and worry about ones health. Back pain, headaches and muscle aches are the most common complaints. Depression is one of the most common reasons for people visiting their doctor and for missing work.

“People with migraines are two to three times as likely to have depression as the general population,” says Richard B. Lipton, MD, Director of the Montefiore Headache Center in New York City. People who experience migraines 15 or more days of the month are about twice as likely to have depression as people with episodic migraine, meaning those who experience migraines less than 15 days a month.

The research on migraines and depression shows that the relationship goes both ways: People with depression are more likely to get migraines, and people with migraines are more likely to become depressed. In fact, 40 percent of people with migraines also have depression. “Migraines and depression have common underpinnings in the brain, which can develop due to environmental factors, genetic causes, or a combination of both,” Dr. Lipton says. “Migraine pain and depression are also linked because both conditions respond to some of the same medications.”

Chest pain, joint pains, sleep disturbances (too much or too little), fatigue, abnormal appetite (increased or decreased) causing a gain or loss of weight, dizziness, diarrhoea or chronic constipation are other physical symptoms. They are not “all in your head.” Depression can cause real changes in your body. For instance, it can slow down your digestion, which can result in stomach problems.

Depression seems to be related to dysregulation of nerve cell networks or pathways that connect brain areas that process emotional information. Some of these networks also process information related to how the body senses physical pain. Many experts think that depression can make you feel pain differently than other people. Medicines that treat depression “tweak” the chemicals involved in how these nerve cell networks communicate, making them work more efficiently, hence reducing the pain.

As these symptoms occur with many different conditions, a lot of depressed people never get help because they don’t know that their physical symptoms might be caused by depression.

Unfortunately a lot of doctors miss the symptoms too.

Day 193

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“Antidepressants (Citalopram) may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.”

(http://www.drugs.com/sfx/citalopram-side-effects.html)

My son was on Citalopram for the depressive phase of his illness for 4-6 weeks before Day 0. We could call it ‘short term use’. He was 20 years of age. He also had a major depressive disorder. The dose of Citalopram had been increased from 5 to 7.5 mg 2 days before Day 0. Were any side effects mentioned to me? No. Was he warned about this? No. Was he being monitored for this? No. Was he under specialist care? No. How many others out there are in the same situation? We don’t know. We do know that in some parts of UK, such as Blackpool, as many as 6 out of 10 people are on antidepressants.

Brain is the most poorly understood organ in the body. Hence it is not surprising that the drugs that are designed to treat a particular ‘brain disease’ might make it worse for a period of time.

“The bottom line is that rather than an enlightened and compassionate mental health system attending to the needs of our young, we have a dangerous and coercive system that stands impassive, not only in the face of repeated failures, but, unbelievably, of child deaths due to treatment.”

Jan Eastgate, International President Citizens Commission on Human Rights. USA.

Apparently it is not very different in America. Here is a detailed account:

http://www.fightforkids.org/silent_death_of_americas_children.pdf