[ckw]

This is one of the most shocking things I have ever read. There is a black box warning for Prozac:

‘Warning: Suicidality and Antidepressant Drugs

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for Major Depressive Disorder (MDD) and other psychiatric disorders’

Read the package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/01...

The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.

[ksenzee]

Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication.

> This is one of the most shocking things I have ever read.

Good grief. I hope you're exaggerating for effect.

[hajile]

> Note that the black box warning has nothing to do with long-term effects of the medication

What are the long-term effects of suicide?

A 7-year-old kid doesn't understand what suicide really means. Putting them on something that encourages a behavior that they don't understand and has completely catastrophic results isn't a risk I would take with my children.

[ksenzee]

I respectfully submit you might feel differently about it if your child were suicidal. When someone has to be watching them 24/7 already for fear they'll hurt themselves, the black box warning is a lot less worrisome. SSRIs prevent more suicides by far than they cause. It's that first few weeks where they can have a paradoxical effect.

[ckw]

Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.

Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).

Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.

[ksenzee]

It sounds to me like you're saying suicidality in children either doesn't exist, or shouldn't be treated, or should only be treated with talk therapy. If what you're saying instead is "this SSRI is especially dangerous" then ok, you and I just disagree about what information sources are reliable, and that's probably not a difference we can resolve. But if you're saying suicidality in children shouldn't be treated with medication, I'm curious whether you've ever met a six- or seven-year-old who wants to die. It is terrifying. It needs treatment. And talk therapy in children that age is honestly a joke. In the OP's place I would give my child an SSRI without any hesitation.

[undeveloper]

right which is why they are treating the depression (which leads to suicidal tendencies) which is a symptom of depression, with prozac. that's what the prozac is for. to prevent death

[hajile]

Prozac and other SSRIs are proven to cause MORE suicidal tendencies in children.

[ryandrake]

I'll raise my hand in agreement. This thread is definitely one of the most disturbing sub-threads I've ever read on HN.

[Dylan16807]

The specific thing they were shocked by was the claim of no long-term effects.

Are you disturbed by that claim? That's what you're raising your hand to.

[ksenzee]

It’s disturbing that a seven-year-old was treated for suicidality? Or it’s disturbing that people are opposed to such treatment?

[robertakarobin]

We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.

[ckw]

I have many reasons for distrusting physicians, but here's a particularly good one: the large drug companies have been fined repeatedly billions of dollars for illegal schemes to convince doctors to prescribe drugs off-label. From a justice department press release (https://www.justice.gov/archives/opa/pr/pharmaceutical-giant...):

'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Departments of Justice and Health and Human Services’ Health Care Fraud Enforcement Action Team (HEAT) announced today. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.

[..]

The United States alleges that AstraZeneca illegally marketed Seroquel for uses never approved by the FDA. Specifically, between January 2001 through December 2006, AstraZeneca promoted Seroquel to psychiatrists and other physicians for certain uses that were not approved by the FDA as safe and effective (including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness). These unapproved uses were not medically accepted indications for which the United States and the state Medicaid programs provided coverage for Seroquel.

According to the settlement agreement, AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.

[..]

The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.

"Illegal acts by pharmaceutical companies and false claims against Medicare and Medicaid can put the public health at risk, corrupt medical decisions by health care providers, and take billions of dollars directly out of taxpayers’ pockets," said Attorney General Eric Holder. "This Administration is committed to recovering taxpayer money lost to health care fraud, whether it’s by bringing cases against common criminals operating out of vacant storefronts or executives at some of the nation’s biggest companies."

The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute. '

The takeaway is that anytime a physician prescribes you a drug, at the very least you have to check that there hasn't been a gigantic fine levied against the drug maker for illegally tricking your doctor into prescribing it to you.

[hapless]

It remains legal to provide drugs off-label because physicians sometimes know better than federal regulators

It's horrible that A-Z would illegally market drugs for off-label uses -- I would not disagree for a minute with your reasoning! -- but we retain this "escape hatch" because it is important to patient health

without the off-label "escape hatch," we would not have, for example, the glp-1 class of anti-obesity drugs, or, buproprion for smoking cessation, the most effective drug ever found in its area.

We needed doctors working firsthand with patients, and building "anecdotal" (i.e. case-based) evidence to learn things that really matter on a population level

[wredcoll]

This is such a blatant misrepresentation of the parent post that it feels almost bad faith.

The subject was specifically about long term brain chemistry changes.

People committing suicide after taking it, while incredibly sad, is completely unrelated.

[ckw]

There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:

Lower bone mineral density, increased risk of fractures, osteoporosis

Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)

extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)

emotional blunting / apathy

slowed thinking, brain fog

increased risk of gastrointestinal bleeding

QT prolongation

[robertakarobin]

I, like every other person who hasn't been living under a rock, am abundantly aware of corruption in Big Pharma and medicine. If my mother and I have both taken a given well-known medication for decades and found it effectively treated a condition that may be hereditary with no negative side effects, and my son is demonstrating symptoms similar to mine and my mother's, is it unreasonable to tolerate my son trying the same medication? That's a far cry from committing to forcing him to take the medication his whole life, or trying some mystery drug with which I have no familiarity.

[ckw]

My deepest views on this subject are personal, subjective, and more controversial. I have watched several family members take antidepressants for upwards of four decades, and I myself suffered terrible depression throughout my childhood and teenage years. Despite my depression, I always avoided antidepressants for some ineffable reason-- a hunch, a nebulous suspicion, I'm not sure what to call it. Somewhere in my mid twenties my depression lifted and never returned. I look back on my life, which has been filled with hardship, and I feel positively disposed to the suffering. The suffering made me who I am. I feel strongly that my character would be diminished had I not experienced it.

On the other hand, I watched family members take these drugs, and their lives seem somehow dulled-- filled with banal tragedy, like staying in a bad marriage, or not being particularly interested in their grandchildren. I have a theory that the drugs make palatable that which otherwise wouldn't be, hence they stay in the bad marriage, the bad job, and they watch their bad TV and eat their bad food and everything is fine. I've also seen one of them go off the drugs, and for a couple months they were a much more vibrant person. I saw them express joy. I feel a low grade rage toward the industry that I've been deprived of this version of them. I do entertain the possibility that I'm imagining it all. Maybe things really would have been worse without the drugs. But I am glad no one ever insisted, or even strongly advocated I take them myself.

[robertakarobin]

To be clear, nobody ever insisted or strongly advocated that I take medication — suggested maybe, but it was entirely my decision. And I completely agree about the importance of hitting "rock bottom." That's something I struggle with as a parent: wanting to make sure my kids have plenty of opportunities to fail, yet fail in a way that isn't irreversibly damaging. If at rock bottom I had simply killed myself rather than starting Prozac I wouldn't be around to have benefited from it.

A large part of me dislikes being on any sort of medication long-term, and think most people have the same dislike. I have gone off of Prozac a few times and always found that I gradually became frustrated and depressed again, and as you said the reason for the dislike is ineffable, so I chose to go back on. I'm fortunate to have a life with no bad marriage, no bad job, and very little trauma at all, which is also unfortunate since it means despite years of therapy and introspection and travel and hobbies and other varied experiences I've never been able to find any cause for the depression and therefore no way to fix it, other than medication. It makes me think of Captain Picard: "It is possible to commit no mistakes and still lose. That is not a weakness; that is life."

[ivell]

> palatable that which otherwise wouldn't be

Medication does not remove the need for therapy. If they are stuck in a bad situation and do not have the tools to come out of it, then in therapy they can learn about the tools and techniques.

Medication avoids having that particular day where everything hits rock bottom and the only solution seems to be suicide.

For some people just therapy is not sufficient but need also medication.

Psychiatric illness is something where many people have misunderstandings. Since many people go through depressive episodes, they feel that their experience is the same as others who are facing chronic depression. And since it is not physically visible, it is also hard to empathize with.

No one says you can come out of heart disease or diabetes by just bearing it bravely. Somehow for psychiatric illness people assume that it is something that can be braved out.

[wredcoll]

> . Despite my depression, I always avoided antidepressants for some ineffable reason-- a hunch, a nebulous suspicion, I'm not sure what to call it.

Yeah, I did that too, then I took some and I was less goddamn depressed aftwards.