Consequences Of Taking Antidepressants - Research Paper Example

Consequences Of Taking Antidepressants Selective Serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are generally known as anti-depressants used for the treatment of depression, anxiety and personality disorders. Many studies have been conducted which claim that they have only a mild benefit when compared to placebo.SSRIs have been discovered by the process of rational drug design. There has been intensive debate regarding SSRIs being the cause of suicides in patients suffering from acute depression. We analyze the works of Healey and Whittaker against Lapierre in this essay and try to analyze their views on the subject. Psychology is the science which deals with behavior and mental processes. Psychologists attempt to understand the role of mental functions in the context of the individual as well as social behavior. Depression as a disease is of mental origin. It is the mind of a person which makes him depressed. Thus a psychologist has an obvious interest in understanding the behavior of depression. SSRIs as a form of depression try to control depression by selectively blocking the reuptake of serotonin. So it is relevant for students of psychology to understand how SSRIs work and the side effects they might have on the person concerned. David Healy is currently a professor in Psychological Medicine at Cardiff University School of Medicine, Wales. Healy has argued that Prozac and SSRIs can lead to suicide and has been criticised by many for having these views. He has also been critical of the amount of “ghost writing” that has been taking place in scientific literature. His views have to lead to the “Toronto Affair” which was a debate about academic freedom. Whittaker is the famous psychologist who has been a part of a large number of researches on the subject of dementia. He is a professor in the department of informatics, university of Wales Bangor, UK. He also conducts research on the causes of depression and thus studying SSRIs was a logical step forward for him Healy and Whitaker have stated in their study that a null hypothesis cannot be claimed on whether SSRI cause suicide or notion the basis of analysis of data collected from RCT as well as from clinical practice Healy and Whitaker claim that although evidence suggests that anti-depressants may reduce suicide risk for some individuals but it is significantly increased for others. They also suggest that monitored treatment of all patients and also restrictions on treatment will be the optimal suicide reduction strategy. They also caution against the mismatch between patients and the treatment type. Lapierre claims that there is not enough evidence to suggest that anti-depressants led to suicides. He declares that suicidal tendencies are a part of depression as a disease and SSRIs cannot be said to have a class effect which increases suicidal rates. He also refutes the use of RCT data to come to a conclusion as this data is unreliable and not suited for the study of unwanted side effects. Healy &Whitaker and Lapierre disagreed on the issue whether there is a temporal cause-effect relation between administration of SSRI and suicidal ideation and suicides, SSRI- induced suicidality being a class effect and the analysis of RCT data to come to a conclusion. Summary David Healy begins with the hypothesis that SSRIs cause problems in some individuals and may lead to suicides. He then tries to nullify this hypothesis on the basis of various researches that have been conducted. In order to do this the paper reviews available randomized controlled trials (RCTs), meta-analyses of clinical trials and epidemiological studies that have been undertaken to investigate the issue. On the basis of this analysis the authors come to the conclusion that warnings and monitoring of the SSRIs are likely to reduce the overall risk and state that further research is required to clarify the issues. He analyses different studies and says that a null hypothesis cannot be generated from the studies conducted so far. He also claims through analysis of present studies that mismatching the personality type and agent may lead to problems and suicides. Thus a null hypothesis was not established at the end of the analysis. Lapierre begins the paper with the hypothesis that SSRIs cause the increased rate of suicides among patients suffering from depression and tries to disprove it. Lapierre criticises the use of RCT data for analyzing unwanted side-effects by Healy and Whitaker. He says that selection of patients for an RCT generally excludes those considered to be at risk for suicide and thus is not reliable data for analysis. The writer says that suicide is a major risk in patients who are suffering from depression. These cases of depression take place whether SSRIs are given or any other class of medicines is given to the patients. He states that although there have been instances of increased suicidality in some patients an equally large number of patients have reduced suicidal tendencies after using SSRIs. Critical Review Existence of cause-effect relationship between SSRIs and suicides Healy &Whittaker and Lapierre disagreed on the existence of a cause and effect relationship between SSRIs and increased rate of suicides and suicidal ideations. Using the stages of conjecture and procedure Healy & Whittaker claimed that there exist a cause and effect relationship between SSRIs and suicidal tendencies. The stasis of conjecture entails whether the issue at hand exists or not. Healy & Whittaker state that induction of SSRIs has been convincingly demonstrated using the methods which have been laid done for establishing this relationship according to clinical trial methodologists, company investigators, medico-legal authorities and the federal courts. The stasis of procedure tells us about the proper format or procedure for dealing with the issue at hand. He states that far less consistent evidence than available with respect to SSRIs had been used for Medicines control agency in Britain to declare that benzodiazepines can cause suicides. This example is used to prove that the stasis of procedure has been satisfied. They also state the need for specifically designed randomised controlled trials (RCTs) on depression-related suicidality. However in the absence of any such study RCT data on newly released anti-depressants and suicidal acts will be used for the analysis. The type of evidence which has been presented by Healy is largely quantitative. He has taken RCT data and analysed them presenting different facts and relating them with suicidal rates. The writers have also considered the effect by removing the figures of placebo washout period. Thus the data analysed is largely quantitative Using the stasis of conjecture and definition Lepierre tries to disprove the hypothesis that a cause effect relationship exists between SSRIs and suicidal tendencies. The stasis of conjecture questions whether the issue being discussed actually exists. Lepierre states that it is assumed by people that suicidal ideation is the precursor to and is likely to lead to suicide being carried out. Suicidal acts in the past as well as number of other factors are also responsible for the act to be committed. HE also claims that SSRIs are being used for other diseases apart from curing depression. No case of suicide has been reported by patients who take SSRIs for diseases other than depression. So the writer questions whether the act of suicide is an integral part of the depression problem and there is no relevance of the use of anti-depressants in these acts the stasis of definition tries to analyse that what the thing at issue is? Lepierre claims that there is a difference between suicidal ideations and actually committing of suicides. The former he claims is a part of the problem of depression and every person who faces depression of even mild form suffers from suicidal thoughts at some point of time or another. Committing the act is altogether a different issue. The type of evidence which has been presented by Lepierre is largely qualitative; although he also presents some quantitative data to support his facts. The qualitative studies analyses the facts and explores the issue in an attempt to understand the phenomenon and answer the questions that have been posed. SSRI Induced suicidal tendencies being a class Effect Healy &Whittaker and Lepierre disagreed on the fact regarding suicidal tendencies induced by SSRIs are a class effect or not. Using the stasis of conjecture and procedure Healy & Whitaker come to the conclusion that SSRI induced suicidal tendency is a class effect. Healy points out the initial research done in 1990 by Teicher, Glod and Cole which describe the cases in which intense suicidal preoccupation emerged during fluoxetine treatment. A subsequent series of reports pointed out the SSRI induced suicidality being a class effect as the effects of sertraline, paroxetine on suicidality and akathisia were studied. Efficacy studies, Meta analysis and epidemiological studies analysed by Healy and Whittaker also prove the above hypothesis that SSRI induced tendency is in fact a class effect. The type of research which is used by Healy & Whittaker is qualitative research. The analysis basically revolves around analysis or reports and numeric information presented in the report published by Khan et al and other researched which had been conducted on this topic. On the other hand Lepierre use the stasis of procedure and definition in order to state that there is no class effect in the issue being discussed. Arguing the stasis of procedure Lepierre claims that Meta analysis of RCTs have lead to conflicting results and are thus not reliable. He states that meta-analysis have an inherent deficiency because of the intrinsic limitations of post hoc analysis. Meta analytic studies have suggested that there is class effect; however the same studies have also strongly suggested that emergent suicidal ideation has been lessened by these same SSRIs. SSRIs have also not been compared critically with other classes of antidepressants. SSRIs can have different effects in different circumstances. Fluoxetine is known to occasionally cause some agitation. This may be experience along with akathisia. The combination of the two leads to increased suicidal tendencies. However it is unlikely to be a class effect but can be defined more as a consequence of a rare side effect of the drug. The argument presented by the author is qualitative in nature. Lepierre focuses mainly on the procedural issues and whether the suicidal effect is a side effect or a class effect. He says that the procedure used for coming to the conclusion by Healey is wrong and also contests the claim that acute depression patients commit suicides due to SSRIs. Thus the information which has been analysed is mainly qualitative in nature. Analysis of RCT data Healy &Whittaker and Lepierre disagreed on the fact whether RCT data can be used for analysis of drug related side effects. Using the stasis of definition and value Healy &Whittaker state that specifically designed randomised controlled trials on depression would have been ideal in order to establish the fact that use of SSRIs increase suicidal tendencies. However in the absence of such data they have used the RCTs that form the basis of licence application of recent antidepressants. I order to analyse this data Healy and Whittaker have made some modifications; the first modification has been to distinguish between placebos and wash out period. They have also stated that the use of use of only patient exposure years or PEY is insufficient for assessment of problem that is linked to the first weeks of therapy. Use of PEY leads to selection of only those patients who have responded positively to the use of SSRIs as others who have issues drop out of the study thus making the study lose its validity. Keeping this limitation in mind the data available was modified accordingly in order to use this RCT data. The argument presented by the author is mainly qualitative in nature even though there is a presence of facts and figures in the analysis. Whether the analysis of RCT data should be done or not; this fact has been proved by qualitative means by the authors. They have tried to modify the RCT data in order to remove the anomalies present and make it suitable for use in this case. Lepierre on the other hand uses the stasis of procedure in order to disapprove the use of this data for the analysis of suicidal tendencies caused due to SSRIs. He argues that RCTs are designed primarily to identify clinical efficacy and acute or short-term safety of antidepressants there are limitations on using this data to study the unwanted side effects of the drug being examined. The selection of RCT usually excludes those who are considered to be at the risk of suicide. The analysis has been basically qualitative as effort has been made by the writer to question a procedural flaw in the use of RCTs which have been designed for a different purpose. He argues that data which has been collected for other reasons should not form the basis of proving hypothesis which is of such important value. Logos Logos is an appeal based on logic or reason. Logos refers to any attempt to appeal to the intellect of the person, to persuade him to use his reasoning or logic in order to come to a conclusion. Logos is the backbone of almost all academic arguments. Healy & Whitaker have used logos very effectively in their article. They have started with the meta-analyses of the RCTs and have presented both the cases – the cases in which SSRIs have reduced suicidal tendencies in patients but have also analysed the cases in which suicidal tendencies have increased. By using logos the authors try to claim that use of Patient number of years in RCTs is flawed as the patients who respond positively over a long period of time do not include patients who have dropped out of the study and these are the actual patients on whom SSRIs do not work. The writers have also used epidemiological studies to show that SSRIs increase suicidal tendencies and cases. The writers purpose a hypothesis that SSRIs do not cause problems and logically try to inform the reader that a null hypothesis cannot be achieved in this case. Lepierre in his article uses logos in the form of presenting epidemiological studies on the issue of antidepressants and proving that these studies do not prove that increased use of SSRIs have led to increased suicidal tendencies. He has also tried to use logos in trying to question the validity of using RCTs as well as clinical trials for analysing suicidal behaviour. He also logically distinguishes between suicidality and suicides. The former is claimed by the writer as an integral part of depression problem and is experienced by all and is thus declared non-harmful unless it is acted upon. He also uses Meta analytic study in order to point out that a firm case cannot be made against SSRIs and it cannot be declared without reasonable doubt that use of SSRIs increases suicidal tendencies among patients of depression. Ethos Ethos is an appeal based on the credibility of the of the speaker. This type of appeal uses the character of the speaker or the past reputation of the speaker or writer in order to appeal to the audience. David Healey has been famous for the “Toronto Affair” in which he had a debate over academic freedom. The use of this characteristic can be seen when the article talks about use of RCTs which have been designed for some other purpose for this issue. Lepierre also relies on the reputation of David Healy and tries to refute the claims in paper of Healy by saying that he has tried to sensationalise the issue by making strong claims which do not have a logical foundation. Pathos Pathos means creating an emotional connect with the readers. The writer tries to convince the readers by playing up their emotions and asking them to think emotionally. The article by Healy tries to rake up emotions among the readers by saying that the concern for the safety of patients is valid and hence the public debate on the matter is justified. He says that it is not desirable that a medicine which is supposed to be used for controlling suicidal cases leads to an increased number of suicide cases. Lepierre also tries to appeal emotionally by saying that due care needs to be taken in order to ensure safety of the patients; however the progress of medicine should not be hampered on the basis of certain claims by research that has not been fully substantiated or proved. Appropriateness of Stasis The writers have a lot of experience in the academic field and have used the correct stasis for the paper. All the four stasis have been used by the writers at different points in the 2 articles. An explanation of the same has been provided above. Logical Fallacies In the article by Healy there has been an attempt made to separate the placebo washout period. This has been a logical fallacy committed on the part of writers as there was no need to do so. This has raised questions on the validity of the research by Lepierre. Even if this data was not segregated according to washout period they would have been able to make the point as effectively. Use of Language Both paper use highly technical and complex language and have been targeted at academic population only. The paper cannot be easily understood by a person who has no psychology background. Healy has been quite succinct and to the point in his language use whereas Lepierre has increased the length of the passage which could have been reduced. Both the articles have stated their points conclusively and have been able to put forward their point of view. The article by Healey uses a more open language and leaves a lot to the imagination of the reader whereas Lepierre tends to take the user towards the direction, almost forcing him to reach there. Conclusion Arguments in both the articles have been presented very well by the authors. Although they have taken contrasting stands on the issues we can safely say that in the basis of meta-analysis of RCT data and other forms of analysis done by both the authors it has been proved that SSRIs do tend to increase suicidal ideation; although the number of actual suicidal cases due to SSRIs is suspect. Both papers also agree on the fact that there have been many success stories related to the use of SSRIs. Healey claims that further research is required and Lepierre also claims that a null hypothesis cannot be proved with the current sources. There is need for further research in this area in order to increase the understanding on the effect of SSRIs on the cases of suicides. Bibliography Lapierre, Y. D. (2003). Suicidality with selective serotonin reuptake inhibitors: Valid claim? Journal of Psychiatry & Neuroscience , 340 -347. Slife, B. (2010). Taking Sides: Clashing Views on Psychological Issues, 16th Edition. New York: McGraw-Hill Higher Education. Whitaker, D. H. (2003). Antidepressants and suicide: risk–benefit conundrums. J Psychiatry Neurosci. , 331 - 337. Read More