Analysis of Antidepressant Paxil Finds Data on Teen Risk Was Held Back

I've been seeing this pop up on all the major news outlets and science websites, but still have not seen one mention of the side effect that may be behind both increased risk of suicide and increased risk of violent behavior: akathisia.

Akathisia is a side effect of antidepressants that causes an intense inner restlessness and inability to sit still. This can cause agonizing pain and terrible anxiety, and people can resort to extreme behaviors to relieve their symptoms, often becoming violent.

This has been known for a while now. If you look at the references on the Wikipedia page for akathisia, you find one paper linking antidepressant-induced akathisia to violence from 2006:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564177/

Quoting from that paper on akathisia:

“Increased tenseness, restlessness, insomnia and a feeling of being very uncomfortable”.

“On the first day of treatment he reacted with marked anxiety and weepiness, on the second day felt so terrible with such marked panic at night that the medication was cancelled”.

“The first few doses frequently made them anxious and apprehensive. They reported increased feelings of strangeness, verbalised by statements such as ‘I don't feel myself’ or ‘I'm afraid of some of the unusual impulses I have'’.

"Events such as these in clinical trials of antidepressants have commonly been coded under headings such as agitation, emotional lability, and hyperkinesis (overactivity), and only rarely to akathisia."

The good thing is that you can treat akathisia with common medicines already used to treat anxiety, such as benzodiazepines. The bad thing is that since information on side effects has been suppressed, patients are not likely to know what is happening to them and how to treat it, won't get the help they need, and run the risk of hurting themselves or others.

What concerns me as much as the initial side effects is your last paragraph, and the sentiment surrounding it. Benzos have been known to have some additional significant neurological consequences in the long term, and have always felt to me like a rather large sledgehammer for the problems they often treat. As such, "your behavior-modifying drugs give you a side effect so we'll shove more powerful drugs in your face" was an attitude that I've seen multiple times and NEVER to good effect. (I'll be very candid that I was part of the "you have ADHD so we'll treat you with pills" generation, at a much younger age, but will leave it at that it didn't end as planned.)

I hope I'm not a total tin foil hatter by looking askew at this trend, but being married to a neurologist and the son of a behaviorist, I'm VERY aware of how little we understand what we're doing when we muck around up there.

> Now let's find out if this anti-depressant really helps anyone, or is it just another terrible drug with horrid side effects? If it doesn't help better than placebo; take it off the market?

The claim that SSRIs are no better than placebo is increasingly popular on the internet and among some researchers eager to make headlines, but the claim is not backed by the data. At best, it represents a misunderstanding of how the studies work, what they're showing, and how surprisingly effective placebo is in cases of mild depression.

Scott Alexander has already done a great job debunking these claims: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

> I do know drug companies have pretty much stopped all research in new anti-depressants. Why--they were caught with their pants down, lying, hiding bad studies, and fooling doctors and patients alike with their Slick claims.

This incident is deplorable and highlights a huge problem in our clinical trials process that needs to be addressed, but your extrapolations here not only don't make sense but they are flat-out incorrect.

There is quite a huge amount of research on new antidepressants. In the past few years alone we've added Vilazodone and Vortioxetine to our arsenal, both of which are primarily SSRIs but have some additional properties that might reduce the side effects due to requiring lower doses. We also have Levomilnacipran which is the first SNRI that favors norepinephrine over serotonin, which can be very helpful in some patients.

There are many interesting compounds in the pipeline as well, from rapid-acting compounds for addressing suicidal patients (ketamine infusion, esketamine nasal spray, GABA-A5 antagonists) to completely novel antidepressant compounds: opiod-modulating drugs like ALKS-5461 which have been very impressive in clinical trials, NMDA and sigma-1 antagonists, mGluR5 antagonists, NR2B antagonists, some very impressive BDNF modulators, anti-glucocorticoid strategies, and so on.

Contrary to your claims that "ruthless drug companies" have stopped all research, this is the most exciting time for anti-depressant research we've ever seen.

I don't want to get too far into things, but I'm currently on an antidepressant (Lexapro) and it has absolutely changed my life for the better.

These are very powerful drugs, and are almost certainly grossly overprescribed. But they definitely work for "major depression" (which has a clinical meaning behind it).

Just another anecdotal data point.

marincounty just uses a lot of question marks. Your nasty attack is incorrect, and you should probably apologise.