Thanks for commenting on this difficult story. I had a similar reaction in terms of the link between SSRIs and this tragic outcome.
More generally, I think it’s so tricky to talk about rare, serious side-effects from medical interventions (eg vaccines) because, for the person unfortunate to have such an adverse effect, it is little comfort to know they were particularly unlucky and on the whole most people experience a net benefit. As medical professionals it can feel easier to deny such rare side-effects even occur at all.
Why not address the actual cause of death? The gun. Was he competent with firearms? Why wasn’t it in a safe? We cannot talk about causal inference of completed suicide and not talk about means.
Certainly. Gun ownership itself comes with a substantial risk of accidental, intentional, and impulsive harm. The chances of a successful suicide death would’ve been much lower if he didn’t have ready access to a firearm.
A thorough analysis Awais of a sad story. I particularly like the comment about checking on a patient after starting an SSRI or other antidepressant. After I had my rare severe reaction to an SSRI my GP basically just did🤷. There wasn't really a plan if things went wrong.
I also particularly relate to Thomas's comment. So many times I have mentioned the severe reaction and had blank looks. Weird mental gymnastics occurred frequently. As if the severe reaction never happened.
Still, I do understand that I was an extremely rare case and that SSRI's on the whole provide a net benefit (or at least have only mild side effects).
Oh for the days before everyone was benzodiazepine-phobic and and one might give an agitated patient a bit of ativan to help them get through until the SSRI kicked in (and a bit to use for a crutch on bad days....). Maybe that would have helped, we will never know. Or perhaps the balance of risk that our medical exposure to benzos while in distress might lead to an addiction with all its attendant risks (including suicide).
These cases are so hard to prove one way or another -- we just can't know why people do what they do, especially when they are not here to ask.
When I have seen suicidal ideation on antidepressants, it has almost always been presented as an ego dystonic intrusive thought. People who say that a thought would appear in their head, though they did not “feel” suicidal. Several mentioned that while watching movies or TV shows with intense emotional content or violence they would get the thought. Almost like an OCD intrusive thought that was not “from” them but just “appeared” in their head. Of course I have also seen the restlessness or increased anxiety response to these medications at times, and we stop and switch to a different medication or pursue treatment only with therapy. I don’t deny that the side effect could happen, but as a clinician I see it very rarely.
Nice summary of this which I heard of recently and was surprised that the coroner was convinced of the chain of cause of his death.
What isn't mentioned in your article (and maybe isn't in the news and other information available) was the zopiclone, and how disrupted his sleep was over what period of time.
I can be going along fine, including meds helping, including talking things out in therapy, and including family relationships. Then I'll suddenly drop into suicidal thinking, wishing for death, making plans, self-harming. I've never felt it was from meds I was taking. It usually happens from a combination of factors, such as a family gathering was contentious, and then I feel failed by my therapist who I feel isn't listening, or doesn't want to, instead listing skills I could practice. It comes from a lifetime of falling into depression, lack of motivation because nothing seems worth it, and not even feeling at times that I exist. I can hide all this for a short period around people, interacting in ways I see as normal enough. Those close to me have nearly always said something about how they didn't see self-harm or a suicide attempt coming and it took them by surprise. Nobody can see or figure out completely the machinations in my head and so an understanding is only based on perceptions.
Thanks for commenting on this difficult story. I had a similar reaction in terms of the link between SSRIs and this tragic outcome.
More generally, I think it’s so tricky to talk about rare, serious side-effects from medical interventions (eg vaccines) because, for the person unfortunate to have such an adverse effect, it is little comfort to know they were particularly unlucky and on the whole most people experience a net benefit. As medical professionals it can feel easier to deny such rare side-effects even occur at all.
Why not address the actual cause of death? The gun. Was he competent with firearms? Why wasn’t it in a safe? We cannot talk about causal inference of completed suicide and not talk about means.
Certainly. Gun ownership itself comes with a substantial risk of accidental, intentional, and impulsive harm. The chances of a successful suicide death would’ve been much lower if he didn’t have ready access to a firearm.
A thorough analysis Awais of a sad story. I particularly like the comment about checking on a patient after starting an SSRI or other antidepressant. After I had my rare severe reaction to an SSRI my GP basically just did🤷. There wasn't really a plan if things went wrong.
I also particularly relate to Thomas's comment. So many times I have mentioned the severe reaction and had blank looks. Weird mental gymnastics occurred frequently. As if the severe reaction never happened.
Still, I do understand that I was an extremely rare case and that SSRI's on the whole provide a net benefit (or at least have only mild side effects).
Oh for the days before everyone was benzodiazepine-phobic and and one might give an agitated patient a bit of ativan to help them get through until the SSRI kicked in (and a bit to use for a crutch on bad days....). Maybe that would have helped, we will never know. Or perhaps the balance of risk that our medical exposure to benzos while in distress might lead to an addiction with all its attendant risks (including suicide).
These cases are so hard to prove one way or another -- we just can't know why people do what they do, especially when they are not here to ask.
When I have seen suicidal ideation on antidepressants, it has almost always been presented as an ego dystonic intrusive thought. People who say that a thought would appear in their head, though they did not “feel” suicidal. Several mentioned that while watching movies or TV shows with intense emotional content or violence they would get the thought. Almost like an OCD intrusive thought that was not “from” them but just “appeared” in their head. Of course I have also seen the restlessness or increased anxiety response to these medications at times, and we stop and switch to a different medication or pursue treatment only with therapy. I don’t deny that the side effect could happen, but as a clinician I see it very rarely.
Nice summary of this which I heard of recently and was surprised that the coroner was convinced of the chain of cause of his death.
What isn't mentioned in your article (and maybe isn't in the news and other information available) was the zopiclone, and how disrupted his sleep was over what period of time.
I can be going along fine, including meds helping, including talking things out in therapy, and including family relationships. Then I'll suddenly drop into suicidal thinking, wishing for death, making plans, self-harming. I've never felt it was from meds I was taking. It usually happens from a combination of factors, such as a family gathering was contentious, and then I feel failed by my therapist who I feel isn't listening, or doesn't want to, instead listing skills I could practice. It comes from a lifetime of falling into depression, lack of motivation because nothing seems worth it, and not even feeling at times that I exist. I can hide all this for a short period around people, interacting in ways I see as normal enough. Those close to me have nearly always said something about how they didn't see self-harm or a suicide attempt coming and it took them by surprise. Nobody can see or figure out completely the machinations in my head and so an understanding is only based on perceptions.
1. Excellent post Awais!
2. Happy Christmas!
Also: Very nice to receive and leaf through your 'Conversations' book this week. Such a pretty cover too! Congratulations!
Thank you Richard! I’m glad you received the book 😊