Day 919

Prozacation

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In 2004 the U.S. Food and Drug Administration issued a black-box warning against the use of all antidepressants in individuals up to 24 years old due to concerns about the increased risk of suicidal thoughts and behavior.

Depression often presents differently in children and adults. The very condition that the antidepressants are supposed to treat is made worse by their use in the young because their brains are still developing.

A meta-analysis of 34 RCTs published by Oxford University in the Lancet in August 2016 says that only one drug among all antidepressants is statistically better than placebo and that is Fluoxetine or Prozac. The lead author, Dr Andrea Cipriani claims no influence of the pharmaceutical industry on these findings.

Prozac has made hundreds of court appearances and billions of dollars have been paid out in compensation lawsuits.

‘The idea that it’s been a major step forward for Prozac to select serotonin only is just hypothesis,’ says Malcolm Lader, professor of clinical psychopharmacology at the Institute of Psychiatry. ‘There’s no science behind it.’ Some SSRI users have reported agitation and an inability to keep still, a preoccupation with violent, self-destructive fantasies and a feeling that ‘death would be welcome’. In Germany, Prozac was initially refused a licence after trials resulted in 16 attempted suicides, two of which were successful.

For mild depression, talking therapies are recommended. Young people with moderate to severe depression are often believed to need medication. They need frequent and close monitoring. However, there are huge variations in practice. It is easier to write out a prescription at a brief consultation rather than delve deep into details. As for the usefulness and safety of antidepressants, the jury is still out.

Saagar was on Citalopram for a few weeks before he died. The GP investigator said he should have been on Prozac but she didn’t write it down in her report. The representative of the Psychiatric hospital was a Clinical Psychologist. She said she could not comment on medications. The mud is watery. 

Ref:

Lancet August 2016: http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)30385-3/fulltext

Prozac and lawsuits:
http://thesandersfirm.com/dangerous-drugs/ssri-antidepressant-lawsuits/

History of Prozac:
https://www.theguardian.com/society/2007/may/13/socialcare.medicineandhealth

Day 918

Biggest cause of avoidable deaths in children and young people – Suicide and self-inflicted injuries

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The Office of National Statistics published a report in 2015 saying that the  single cause with the highest number of avoidable deaths in children and young people was suicide and self-inflicted injuries (14% or 206 deaths of all avoidable deaths in this age group).

Of the top five causes of avoidable deaths among children and young people, suicide and self- inflicted injuries was the only cause to see an increase since 2014 by 13% or 24 deaths.

Avoidable mortality accounted for 3 out of 10 deaths of children and young people (aged 0 to 19 years), nearly the same as in 2014. Males accounted for almost two-thirds (63%) of avoidable deaths in children and young people.

The other top causes each saw a decline since 2014, with accidental injuries, which was the leading cause in 2014, experiencing the largest decline of 8% or 15 deaths.

 

Key Points for London

  • The rate of avoidable mortality in London has increased to 210.4 deaths per 100,000 population from 204.6 in 2014. This is significantly lower than for England (222.9).
  • The South East, East of England and South West Regions have lower rates of avoidable mortality than London. The highest rate is in the North East (266.4).
  • As in all other regions, avoidable mortality rates in London are higher for males (274.0 deaths per 100,000 population) than for females (152.9). Rates have increased for males (from 259.9 in 2014) and slightly reduced for females (154.3 in 2014).
  • Ref: https://www.gov.uk/government/statistics/avoidable-mortality-in-england-and-wales-2015

 

 Day 917

Entertainment or murder?

Screen Shot 2017-04-30 at 12.35.22The Blue Whale ‘suicide game’ is believed to be an online social media game which is encouraging people to kill themselves. An administrator assigns daily tasks, such as self-harming, watching horror films and waking up at unusual hours. The tasks get progressively more extreme which the members have to complete for 50 days. On the last day, they are instructed to end their life.

130 teenage deaths in Russia between November 2015 and April 2016 have been linked to this game. Yulia Konstatinova, 15, joined her friend Veronica in jumping from the roof of a 14-storey block of flats. She left a note saying ‘End’ on her social media page after she posted a picture of a big blue whale. The game is making inroads into Europe. Teenagers in Portugal, Devon and Cornwall have been found to have accessed it.

It must take a certain special kind of a sick mind to create ‘games’ like this.

’13 Reasons why’ is a Netflix series about a teenage girl’s perplexing suicide followed by tapes to unravel the mystery of her tragic death. The haunting images in it and the traumatic content is inciting self-harm within the teenage community. It is highly controversial to introduce such material into the media.

Both the above are perfect examples of everything that goes against suicide prevention best practices in the media. They are intense and they romanticise suicide.

Parents beware. Young minds, be ware.

Ref:

Blue Whale:
https://www.thesun.co.uk/tech/3003805/blue-whale-suicide-game-online-russia-victims/

13 reasons why:
https://www.netflix.com/in/title/80117470

Day 906

Last September I started writing a case study on patient safety for an academic paper. For every sentence, it required evidence. Unfortunately, the level of evidence for some of the material is not high because of the nature of the subject. Secondly, research in mental illness is poorly funded in the UK.

I am reminded of a young friend who is looking for a job but she can’t find one as they require her to have experience which she cannot gain unless she has a job. A classic chicken and egg situation.

So, the deadline has been extended time and again and finally we are going to have another attempt at submitting it before the end of this month. The lowest level of evidence to be found is Level 5 – ‘Case series or studies with no control’.

Here is one that I am going to use to support my statement: “Almost everyone who is suicidal is ambivalent. They don’t necessarily want to die. They just want the pain to end.” Hopefully it will be accepted. 

Kevin Hines is one of less than 1% of people to survive a jump from the Golden Gate bridge in a suicidal attempt. He is now a mental health advocate and works actively towards suicide prevention.

“The millisecond my hands left that rail, I thought, ‘what have I just done? I don’t want to die, God please save me’, and then I hit the water,” he said.
“You fall four seconds, you hit the water and get vacuum sucked down 70 or 80 ft – when I opened my eyes I was alive. “All I desperately wanted to do was survive – suicide experts call this being ‘shocked into reality’.”

Ref:

Kevin Hines:
http://www.bbc.co.uk/news/uk-northern-ireland-29995470

Youtube clip:
https://www.youtube.com/watch?v=WcSUs9iZv-g

Website: http://www.kevinhinesstory.com/bio/

Day 901

In the USA, the number of suicides in 2014 was 42,773. Of these, deaths by firearms were 21,334. So, approximately one-half of suicides are completed by firearm, accounting for two-thirds of all firearms deaths.

In the UK, the most common method used in the United Kingdom is hanging. Suicide using firearms accounts for only a very small fraction, possibly due to tight gun control. Only 4% of households in the UK possess them. Self poisoning and overdosing are the common methods used by women.

Removal of methods is one of the basic strategies for suicide prevention.

Details of suicide methods in the media have been shown to prompt vulnerable individuals to imitate suicidal behaviour. With this in mind, Samaritans recommend these media guidelines:

Avoid giving too much detail.
While saying someone hanged themselves or took an overdose is acceptable, detail about the type of ligature or type and quantity of tablets used is not. Avoid any mention of the method in headlines as this inadvertently promotes and perpetuates common methods of suicide.
Extra care must be taken when reporting the facts of cases where an unusual or previously unknown method has been used. Incidences of people using unusual or new methods of suicide have been known to increase rapidly after being reported widely. Reporting may also drive people to the internet to search for more information about these methods.
Remember that there is a risk of imitational behaviour due to ‘over-identification’.
Vulnerable individuals may identify with a person who has died, or with the circumstances in which a person took their own life. Never say a method is quick, easy, painless or certain to result in death. Try to avoid portraying anything that is immediate or easy to imitate – especially where the ingredients or tools involved are readily available.

The Golden Gate Bridge is identified as the scene of the most suicides in the world. Today a ceremony in San Francisco launched the building of a net to prevent suicides from occurring on the bridge. Excellent leadership has led this effort. Eduardo Vega explains beautifully how this leadership has impacted the decision to move toward a prevention of suicide on this world famous landmark in this video: https://youtu.be/bUSpiGOwoMk

Ref: Media Guidelines:

http://www.samaritans.org/media-centre/media-guidelines-reporting-suicide/advice-journalists-suicide-reporting-dos-and-donts

 

Day 890

UNIVERSITIES MISS CHANCE TO IDENTIFY DEPRESSED STUDENTS
– A study from Chicago, by Marla Paul in Jan 2011.

This study surveyed 1,622 college students. One out of every four or five students who visits a university health center for a routine cold or sore throat turns out to be depressed, but most centers miss the opportunity to identify these students because they don’t screen for depression, according to new Northwestern Medicine research.

About 2 to 3 percent of these depressed students have had suicidal thoughts or are considering suicide, the study found.

“Depression screening is easy to do, we know it works, and it can save lives,” said Michael Fleming, professor of family and community medicine at Northwestern University Feinberg School of Medicine. “It should be done for every student who walks into a health center.”

The consequences of not finding and treating these students can be can be serious and even deadly. “These kids might drop out of school because they are so sad or hurt or kill themselves by drinking too much or taking drugs,” Fleming said.

“Things continually happen to students – a low grade or problems with a boyfriend or girlfriend — that can trigger depression,” Fleming said. “If you don’t take the opportunity to screen at every visit, you are going to miss these kids.”

The frequency of depression and suicidal thoughts among campus health clinic users was nearly twice as high as rates reported in general college samples.

Depressed students need treatment, which may include counseling and medication. These students are more likely to drink, smoke and be involved in intimate partner violence, the study found.

With new technology, screening students is simple. While waiting for an appointment at the health center, the student could answer seven simple questions – a depression screening tool that that could be immediately entered into his electronic health record. “They can answer those seven questions in a minute,” Fleming said. Universities typically separate mental health treatment from primary care treatment. If a student comes to a campus health center and complains about depression, he is referred to a counseling center.

“If we screen, we can try to find every student that is depressed.”

Historical perceptions and biases against preventive screenings are that kids who need treatment the most don’t go to campus health centers, and they won’t tell the truth about their depression.

That’s wrong. “Students will tell you the truth,” Fleming said. “If they are sad and depressed, they will tell you that. And, kids who are drinking too much or who are suicidal do go to the campus health centers.”

 

Day 888

Dying from Inequality – Samaritans commissioned eight leading social scientists to review and extend the existing body of knowledge on socioeconomic disadvantage, ie. being poor, addressing three key questions:

  • Why is there a connection between socioeconomic disadvantage and suicidal behaviour?
  • What is it about socioeconomic disadvantage that increases the risk of suicidal behaviour?
  • What can be done about it?

A few excerpts:

Neighbourhoods that are the most deprived have worse health than those that are less deprived and this association follows a gradient: for each increase in deprivation, there is a decrease in health. Additional support for those living in deprived areas is needed to reduce geographical inequalities in health and the risk of suicidal behaviour.

Economic uncertainty, unemployment, a decline in income relative to local wages, unmanageable debt, the threat or fear of home repossessions, job insecurity and business downsizing may all increase the risk of suicidal behaviour, especially for individuals who experience socioeconomic disadvantage.

Unmanageable debt is an important risk factor for suicidal behaviour. Financial advice and support for those at risk of having unmanageable debt can help reduce the risk of mental health problems and suicidal behaviour.

Suicidal behaviour and mental health problems, such as mild-to-moderate anxiety and depression, could be reduced through labour market policy design, such as higher spending on active labour market programmes and unemployment benefits.

People living with socioeconomic disadvantage and inequalities are more likely to experience negative events during their life, such as job loss, financial difficulties, poor housing, and relationship breakdown. This can lead to negative emotions and increase the likelihood of suicidal behaviour.

Ref:

Dying from Inequality: http://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans%20Dying%20from%20inequality%20report%20-%20summary.pdf

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