Please note that this article is still a work in progress.  I still need to do a lot more research on it, and the drug companies are just now making the data available.  I didn’t have access to my computer or books for almost a month and I’m still catching up with unpacking, paying bills, selling my house and all that crap.  But this is a huge issue that is on everyone’s mind right now, so I had better deal with what I do know and get it out there.

Once I do get together hard numbers about specific meds, I’ll include them here.Картинки по запросу suicide risk medication

First off, all psychiatric / neurological medications carry a suicide risk.  Antidepressants, antipsychotics, anticonvulsants (a.k.a. mood stabilizers), all of them.  It’s not just SSRIs.  However, many of the illnesses have an inherently greater risk of suicide than you’d get from the meds.


But look at those odds and think about how ill you are now.  Take into account the odds of your illness killing you.

Lifetime chance of death by suicide:

Bipolar Disorder    15.50%
Mixed Drug Abuse    14.70%
Major Depression    14.60%
Epilepsy1      13.00%
Dysthymia      8.65%
OCD     8.15%
Panic/Anxiety    7.15% 
Personality Disorders   5.05%
Alcoholism      4.20%
Cancer      1.30%
General Population       0.72%

From the article where I got the above statistics, Reducing suicide risk in psychiatric disorders:In a review of 22 studies—some including patients with bipolar or recurrent unipolar major depression—risk of death by suicide was reduced at least 5-fold, based on an informal comparison of pooled rates in treated versus untreated samples. Based on quantitative meta-analysis, the pooled risk of death by suicide was reduced nearly 9-fold (or by 89%) in patients who received lithium maintenance treatment compared with those who did not. The risk for suicide attempts fell nearly 10-fold in a compilation of 33 studies (Table 2).For schizophrenia and other primary psychotic disorders, little research exists to indicate that atypical antipsychotics reduce suicide risk. Evidence is emerging, however, that clozapine may offer this benefit, in addition to its well-substantiated clinical superiority in treatment-resistant psychotic illness. Another study associated olanzapine with a 2.3-fold lower risk of suicidal behavior, compared with haloperidol.In Depressionland things aren’t as cheerful.

  • antidepressants of various kinds may tend to reduce the risk of suicidal behavior, but any such effect is small and statistically nonsignificant (Baldessarini et al, 2003, unpublished)
  • tricyclic antidepressants may yield lower rates of suicidal behavior than selective serotonin reuptake inhibitors (SSRIs). Similarly, however, such trends reflect highly variable research methods and inconsistent findings and do not hold up to quantitative analysis (Baldessarini et al, 2003, unpublished).

Some of the above disorders kill in other ways.  In addition to the higher suicide rate, epileptics in general have a higher mortality rate. Treating the seizures reduces the risk of death in all of its various forms.  And, as it turns out, taking the meds DOES NOT increase the risk of SUDEP or status epilepticus after all.  So we’re a lot less likely to die if we just take our goddamn meds. The complex calculus is: how much more likely are you to off yourself sooner by taking a med now than later by not taking anything at all?

I can’t answer that question.

You alone can’t answer that question.

It takes you, the people around you who have seen how your behavior has changed (whomever you like and trust in these matters, e.g. family, friends, coworkers), one goodpsychiatrist and at least one good therapist and preferably another counselor of some kind (e.g. a support group leader, a priest / minister / rabbi / spiritual advisor, a competent school counselor, you get the idea).

It doesn’t matter what the problem is – major depressive disorder, bipolar disorder, epilepsy, schizophrenia, OCD, panic/anxiety, neuropathic pain – they all suck donkey dong and they can all potentially kill you.

If they are severe enough.

Let’s be clear on a few points:

  • Not all things that make us mentally interesting are fatal.
  • Not everyone who is crazy needs drugs.
  • Certain disorders almost always need drugs.  Face it, if you’re bipolar and/or epileptic, meds are the first line of treatment.  I tried going the non-med way and barely got out of it alive.

One of the many problems with the health care “system” in the US is everyone, the patients, doctors and insurers included, wants a quick fix.

But when it comes to the most complicated part of our bodies, the one thing that most defines who the hell we are, there is no quick fix.

Whether you need meds or not, if you’re mentally interesting (a.k.a. crazy, mentally ill, sick in the head, loony, nuts, cuckoo, etc.) you will need the following no matter what:

  • Therapy
  • Coping tools and skills
  • A support group
  • A network of people to check in on you
  • Regular exercise
  • A good, healthy diet

Now some tips to help you decide if meds are worth the risk of suicide and other side effects.

It’s really a very simple decision.

What sucks less, what you’re suffering through now, or all the potential side effects?

If meds are strictly optional, then you can try everything else first.

Let’s take depression as an example, because while I think while some people are avoiding meds who really need them, I really think that modern antidepressants are vastly over-prescribed in this country.

  • There are people taking them who don’t need them at all.
  • There are people taking them at dosages that are inappropriately high.
  • And some folks are taking far too potent meds (e.g. Paxil (paroxetine) or Zoloft (sertraline)) when a milder med would do (e.g. Prozac (fluoxetine)

In the PI Sheets for all modern antidepressants it states that when used to treat depression, they are specifically for Major Depressive Disorder.  But what is it really like to bedepressed as fuck?  Here’s my take on it.  Keep in mind that bipolar depression, with its mixed states, tends to be somewhat worse than vanilla, unipolar MDD, but mileage will always vary.

The thing is, you really have to be laying in bed, staring at the ceiling for days at a time in a world of endless pain for no good reason to be considering meds right off the bat.

Or if you have been laying in bed in a world of endless pain and have finally managed to overcome all the hurt and suffering to stumble across this shitty website – stop beating yourself up for nothing and realize that you do need meds!  Your brain just doesn’t work quite to spec and needs some fine tuning.  You’ll still need the therapy and everything else mentioned above, but you’re not less of a person for needing a little chemical help.  No more so than a diabetic who needs insulin.

And if all that endless pain is going to be the death of you anyway, what have you got to lose?

OK, next up, just why the hell people sometimes get more suicidal on these crazy meds and what you can do to lessen the risk.

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