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Europe's answer to depression: doctor-assisted suicide

Have you heard about the new cure being touted for so-called “treatment resistant” depression? This new intervention is not available in the U.S. or the U.K., but it is in the Netherlands and Belgium, and Canada is considering adopting it as well. This remedy is 100 percent effective in ending depressive symptoms, for good.

The remedy I’m talking about is doctor-assisted suicide.

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If you think this is a joke, think again. The Economist and BBC News have each produced lengthy features about despondent women in their 20s, with no measurable physical signs of illness, who made their final exit this way. Both of the young women had been under the care of the psychiatric profession since they were young children. Neither of the stories mentioned what was going on in these women’s lives that made them feel so distressed, as if this were an unimportant detail.

These accounts are also maddeningly vague in regard to the treatment these young women received before this final solution was considered. What drugs were they prescribed? How did they react to them? Did anyone consider the possibility that the drugs were making their problems worse? We are never told any of this. But, obviously, if there were drugs, they didn’t help.

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I won’t venture an opinion as to what is the most appalling aspect of this whole business, but certainly not the least appalling is the staggering lack of curiosity on the part of the media regarding the possible role of the psychiatric profession in contributing to these young women’s despair — and that of the thousands of people diagnosed with depression worldwide.

There is a growing body of evidence showing that so-called “antidepressants” can cause suicidality in people who are not depressed and worsening of depressive symptoms in those who are. Psychiatrist David Healy of Bangor University in Wales administered the antidepressant sertraline to 20 healthy volunteers, two of whom were thrown into a state of intense suicidal obsession. Dr. Healy later calculated the odds of two healthy women with no significant legal or financial or interpersonal problems becoming suicidal by chance within a given two-week period as less than one in a million.

In his blockbuster work of nonfiction “Anatomy of an Epidemic,” author Robert Whitaker reels off a long list of studies showing that the relapse rates for depression are higher in medicated patients than in unmedicated ones, although he himself acknowledges there is an obvious potential confounding factor at work here: Perhaps the patients who were prescribed antidepressants were more impaired to begin with.

A coroner in a rural area of northeast Ohio says a woman suspected of killing her two young children before taking her own life had been taking medication for depression.

A 2011 meta-analysis found a way to control for this, by comparing two different kinds of studies. One of these was extension studies, in which patients are randomized either to antidepressant medication or placebo, and those whose symptoms go into remission are maintained on the same treatment (antidepressant or placebo). The other kind was discontinuation studies, in which all patients are given antidepressant medication, and then randomized either to continued treatment with antidepressants or placebo.

The researchers compared relapse rates between subjects who remitted on placebo and were maintained on placebo (placebo-placebo), to those who remitted on antidepressants are were switched to placebo (drug-placebo). After controlling for all the potential confounders they could think of, they found the relapse rates were higher among the drug-placebo group than in the placebo-placebo group. Apparently, then, these drugs are causing changes in the brain in some patients that make them more susceptible to relapse in the future.

But this research has largely been ignored by the media, which instead presents sensational accounts of forlorn young women as victims of some inexorable disease process without a shred of credible evidence for this.

“My reaction is to be completely appalled,” Dr. Healy said, when asked for his reaction to assisted suicide for young women with treatment-resistant depression. “The illness these young women have is not a medical illness. It’s a system problem. These women have been killed by the system.”

Indeed. Doctors have always had the prerogative of burying their worst mistakes, but these days some of them seem in an unseemly haste to do so.

Patrick D. Hahn lives in Roland Park. He can be reached at patrickhahn@hotmail.com.

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