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Antidepressants linked to increased suicide and self-harm in teens
A new study pushes back on psychiatry industry talking points.
- Australian researchers note a link between rising antidepressant usage and rising suicide rates in youth.
- Their research pushes back on psychiatry talking points that SSRIs decrease suicide risk.
- The top method for self-harm and suicide in younger age groups is overdosing antidepressants.
In 1947, Dr. Howard Rusk published an article in the NY Times. The doctor is advocating for better public education on issues of mental health. Considered to be the founder of rehabilitation medicine, Rusk was trying to destigmatize mental disorders in the same manner as physical disorders.
Psychiatrists were facing an upward battle. "Madness" was considered an aberration, not a treatable ailment, in a health care system that was increasingly relying on pharmacology. Thanks to a new class of tranquilizers showing promising results, Rusk drew a parallel between diseases of the brain and diseases of the body.
"We must realize that mental problems are just as real as physical disease," he wrote, "and that anxiety and depression require active therapy as much as appendicitis and pneumonia."
As a rehabilitation specialist, Rusk knew the importance of physical movement for trauma recovery. He was likely aware of the connection between physical and mental health. Unfortunately, his good intentions were usurped by the psychiatry industry. Desiring status equivalent to medical doctors, psychiatrists understood that having a "painkiller" in their arsenal would cause the public to treat their profession with the same regard.
The process took another four decades to unfold. By the time Prozac was released on the American market in 1987, the chemical imbalance theory of anxiety and depression had become the going narrative in the psychiatry industry. Once a narrative grips the public's imagination, it's difficult to overturn. Psychiatrists finally achieved a similar status as medical doctors thanks to the parallel Rusk drew forty years before.
A safety narrative has long been attached to the chemical imbalance story: antidepressants are a safe intervention in the treatment of anxiety and depression. As three Australian researchers—Martin Whitely at John Curtin Institute of Public Policy in Perth and Melissa Raven and Jon Jureidini at the University of Adelaide's Critical and Ethical Mental Health Research Group—write in a new study, that story is suspect.
Published in Frontiers in Psychiatry, these researchers push back on the narrative that antidepressants decrease the risk of suicide. Since the FDA first issued a black box warning citing an increased risk of suicidal thoughts and behaviors in adults under age 18, psychiatrists and public officials have contested any link between antidepressants and self-harm.
Antidepressants Can Cause Suicide and Homicide — Peter Gotzsche, M.D.
Australia, which ranks second in the world in per-capita consumers of antidepressants among OECD countries, has never been provided the same safeguards as America—and the efficacy of America's safety measures are questionable at best. The FDA first issued that block box warning in 2004, updating it to reflect adults under age 25 three years later. In 2005, the Australian Therapeutic Goods Administration (TGA) required leaflets be included in antidepressant packages to reflect the risk of suicidal ideation.
The researchers write that the data put forward by psychiatrists and mental health organizations was misleading. Much like the industry ran with Rusk's assertion, many professionals cite a 2007 ecological study by Robert D. Gibbons that incorrectly associates SSRI usage with a decreased risk of suicide among U.S. youth. This misreading is the basis of the narrative of minimized harm.
The data tells another story. The researchers point out that between 2008-2018, prescriptions for antidepressant (predominantly SSRIs) increased by 66 percent in the 0-27 year age group, while suicide rates increased by 49 percent in a similar age group (0-24 years). Between the years of 2006-2016, there was a 98 percent increase in intentional poisonings in New South Wales and Victoria. An overlap emerges: the most common method of attempted self-harm and suicide is prescription antidepressants.
"There is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them."
The researchers note that the FDA has long been criticized for not offering more non-pharmacological treatments. The cost of psychotherapy is prohibitive for many in the U.S. health care system. The reflex action of the medical establishment is to write a script. When one pill doesn't work or loses efficacy, it's usually replaced by another pill or added to an ever-growing pharmacological cocktail. Some people take four to six (or more) drugs to manage mental distress, each one countering the side effects of the other.
Photo: Ryan McGuire / Pixabay
As in America, Australia suffers from corporate lobbying. The team writes that many opinion leaders receive funding from pharmaceutical companies; it makes sense that these figures will tout the benefits of antidepressants while downplaying potential harm. They also note that governing bodies are likely relying on outdated evidence of risk, which translates into a lack of consumer awareness.
They also write that general practitioners account for 90.4 percent of antidepressant prescriptions in Australia. Since mental health is not their area of expertise, they often repeat what psychiatrists initially prescribed.
Correlation is not causation, a limitation the researchers acknowledge. They list another cocktail, this one labelled "drivers of mental health distress." Smartphone addiction, online bullying, lack of meaningful relationships, climate change, and debt top the list. Antidepressants are not the cause of mental distress. What we need to know is whether they help alleviate it or add to the burden.
This forces us to confront a longstanding question: Why are we treating the symptoms of mental health problems with pills while never addressing their actual cause? Put another way, why does the psychiatry industry rely on pills with a long list of side effects instead of addressing the environmental and social issues that are at the foundation of mental distress? And why are we putting increasingly higher numbers of teenagers on drugs that negatively impact their brains while their prefrontal cortex is still in development? This seems to set them up for a lifetime of dependence, which is a great profit model but a terrible health care solution.
The psychiatry industry faced an existential crisis in the nineteen-seventies when the public grew weary of their growing reliance on drugs. The industry's response was to double down on pharmacology. Thanks for a massive PR campaign around Prozac, that move worked. You cannot both have increasing numbers of prescriptions and increasing mental health problems and pretend that this intervention is working.
While more work needs to be done, the researchers are confident in their assertion between increased self-harm with antidepressant usage.
"These results are consistent with the hypothesis that antidepressants increase the risk of suicidality and self-harm in young people. Furthermore, they provide compelling evidence that the antidepressants prescribed to children and adolescents are frequently the means of self-harm."
These children deserve more from us at a pivotal time in their development. The psychiatry industry needs to come through this existential crisis with better solutions.
Higher education faces challenges that are unlike any other industry. What path will ASU, and universities like ASU, take in a post-COVID world?
- Everywhere you turn, the idea that coronavirus has brought on a "new normal" is present and true. But for higher education, COVID-19 exposes a long list of pernicious old problems more than it presents new problems.
- It was widely known, yet ignored, that digital instruction must be embraced. When combined with traditional, in-person teaching, it can enhance student learning outcomes at scale.
- COVID-19 has forced institutions to understand that far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted.
What conditions of the new normal were already appreciated widely?<p>First, we understand that higher education is unique among industries. Some industries are governed by markets. Others are run by governments. Most operate under the influence of both markets and governments. And then there's higher education. Higher education as an "industry" involves public, private, and for-profit universities operating at small, medium, large, and now massive scales. Some higher education industry actors are intense specialists; others are adept generalists. Some are fantastically wealthy; others are tragically poor. Some are embedded in large cities; others are carefully situated near farms and frontiers.</p> <p>These differences demonstrate just some of the complexities that shape higher education. Still, we understand that change in the industry is underway, and we must be active in directing it. Yet because of higher education's unique (and sometimes vexing) operational and structural conditions, many of the lessons from change management and the science of industrial transformation are only applicable in limited or highly modified ways. For evidence of this, one can look at various perspectives, including those that we have offered, on such topics as <a href="https://www.insidehighered.com/digital-learning/blogs/rethinking-higher-education/lessons-disruption" target="_blank">disruption</a>, <a href="https://www.nytimes.com/2020/02/20/education/learning/education-technology.html" target="_blank">technology management</a>, and so-called "<a href="https://www.insidehighered.com/sites/default/server_files/media/Excerpt_IHESpecialReport_Growing-Role-of-Mergers-in-Higher-Ed.pdf" target="_blank">mergers and acquisitions</a>" in higher education. In each of these spaces, the "market forces" and "market rules" for higher education are different than they are in business, or even in government. This has always been the case and it is made more obvious by COVID-19.</p> <p>Second, with so much excitement about innovation in higher education, we sometimes lose sight of the fact that students are—and should remain—the core cause for innovation. Higher education's capacity to absorb new ideas is strong. But the ideas that endure are those designed to benefit students, and therefore society. This is important to remember because not all innovations are designed with students in mind. The recent history of innovation in higher education includes several cautionary tales of what can happen when institutional interests—or worse, <a href="https://www.insidehighered.com/news/2016/02/09/apollos-new-owners-seek-fresh-start-beleaguered-company" target="_blank">shareholder</a> interests—are placed above student well-being.</p>
Photo: Getty Images<p>Third, it is abundantly apparent that universities must leverage technology to increase educational quality and access. The rapid shift to delivering an education that complies with social distancing guidelines speaks volumes about the adaptability of higher education institutions, but this transition has also posed unique difficulties for colleges and universities that had been slow to adopt digital education. The last decade has shown that online education, implemented effectively, can meet or even surpass the quality of in-person <a href="https://link-springer-com.ezproxy1.lib.asu.edu/article/10.1007/s10639-019-10027-z" target="_blank">instruction</a>.</p><p>Digital instruction, broadly defined, leverages online capabilities and integrates adaptive learning methodologies, predictive analytics, and innovations in instructional design to enable increased student engagement, personalized learning experiences, and improved learning outcomes. The ability of these technologies to transcend geographic barriers and to shrink the marginal cost of educating additional students makes them essential for delivering education at scale.</p><p>As a bonus, and it is no small thing given that they are the core cause for innovation, students embrace and enjoy digital instruction. It is their preference to learn in a format that leverages technology. This should not be a surprise; it is now how we live in all facets of life.</p><p>Still, we have only barely begun to conceive of the impact digital education will have. For example, emerging virtual and augmented reality technologies that facilitate interactive, hands-on learning will transform the way that learners acquire and apply new knowledge. Technology-enabled learning cannot replace the traditional college experience or ensure the survival of any specific college, but it can enhance student learning outcomes at scale. This has always been the case, and it is made more obvious by COVID-19.</p>
What conditions of the new normal were emerging suspicions?<p>Our collective thinking about the role of institutional or university-to-university collaboration and networking has benefitted from a new clarity in light of COVID-19. We now recognize more than ever that colleges and universities must work together to ensure that the American higher education system is resilient and sufficiently robust to meet the needs of students and their families.</p> <p>In recent weeks, various commentators have suggested that higher education will face a wave of institutional <a href="https://www.businessinsider.com/scott-galloway-predicts-colleges-will-close-due-to-pandemic-2020-5" target="_blank">closures</a> and consolidations and that large institutions with significant online instruction capacity will become dominant.</p> <p>While ASU is the largest public university in the United States by enrollment and among the most well-equipped in online education, we strongly oppose "let them fail" mindsets. The strength of American higher education relies on its institutional diversity, and on the ability of colleges and universities to meet the needs of their local communities and educate local students. The needs of learners are highly individualized, demanding a wide range of options to accommodate the aspirations and learning styles of every kind of student. Education will become less relevant and meaningful to students, and less responsive to local needs, if institutions of higher learning are allowed to fail. </p> <p>Preventing this outcome demands that colleges and universities work together to establish greater capacity for remote, distributed education. This will help institutions with fewer resources adapt to our new normal and continue to fulfill their mission of serving students, their families, and their communities. Many had suspected that collaboration and networking were preferable over letting vulnerable colleges fail. COVID-19's new normal seems to be confirming this.</p>
President Barack Obama delivers the commencement address during the Arizona State University graduation ceremony at Sun Devil Stadium May 13, 2009 in Tempe, Arizona. Over 65,000 people attended the graduation.
Photo by Joshua Lott/Getty Images<p>A second condition of the new normal that many had suspected to be true in recent years is the limited role that any one university or type of university can play as an exemplar to universities more broadly. For decades, the evolution of higher education has been shaped by the widespread imitation of a small number of elite universities. Most public research universities could benefit from replicating Berkeley or Michigan. Most small private colleges did well by replicating Williams or Swarthmore. And all universities paid close attention to Harvard, Princeton, MIT, Stanford, and Yale. It is not an exaggeration to say that the logic of replication has guided the evolution of higher education for centuries, both in the US and abroad.</p><p>Only recently have we been able to move beyond replication to new strategies of change, and COVID-19 has confirmed the legitimacy of doing so. For example, cases such as <a href="https://www.washingtonpost.com/education/2020/03/10/harvard-moves-classes-online-advises-students-stay-home-after-spring-break-response-covid-19/" target="_blank">Harvard's</a> eviction of students over the course of less than one week or <a href="https://www.nhregister.com/news/coronavirus/article/Mayor-New-Haven-asks-for-coronavirus-help-Yale-15162606.php" target="_blank">Yale's apparent reluctance</a> to work with the city of New Haven, highlight that even higher education's legacy gold standards have limits and weaknesses. We are hopeful that the new normal will include a more active and earnest recognition that we need many types of universities. We think the new normal invites us to rethink the very nature of "gold standards" for higher education.</p>
A graduate student protests MIT's rejection of some evacuation exemption requests.
Photo: Maddie Meyer/Getty Images<p>Finally, and perhaps most importantly, we had started to suspect and now understand that America's colleges and universities are among the many institutions of democracy and civil society that are, by their very design, incapable of being sufficiently responsive to the full spectrum of modern challenges and opportunities they face. Far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted. And without new designs, we can expect postsecondary success for these same students to be as elusive in the new normal, as it was in the <a href="http://pellinstitute.org/indicators/reports_2019.shtml" target="_blank">old normal</a>. This is not just because some universities fail to sufficiently recognize and engage the promise of diversity, this is because few universities have been designed from the outset to effectively serve the unique needs of lower-income students, first-generation students and students of color.</p>
Where can the new normal take us?<p>As colleges and universities face the difficult realities of adapting to COVID-19, they also face an opportunity to rethink their operations and designs in order to respond to social needs with greater agility, adopt technology that enables education to be delivered at scale, and collaborate with each other in order to maintain the dynamism and resilience of the American higher education system.</p> <p>COVID-19 raises questions about the relevance, the quality, and the accessibility of higher education—and these are the same challenges higher education has been grappling with for years. </p> <p>ASU has been able to rapidly adapt to the present circumstances because we have spent nearly two decades not just anticipating but <em>driving</em> innovation in higher education. We have adopted a <a href="https://www.asu.edu/about/charter-mission-and-values" target="_blank">charter</a> that formalizes our definition of success in terms of "who we include and how they succeed" rather than "<a href="https://www.washingtonpost.com/opinions/2019/10/17/forget-varsity-blues-madness-lets-talk-about-students-who-cant-afford-college/" target="_blank">who we exclude</a>." We adopted an entrepreneurial <a href="https://president.asu.edu/read/higher-logic" target="_blank">operating model</a> that moves at the speed of technological and social change. We have launched initiatives such as <a href="https://www.instride.com/how-it-works/" target="_blank">InStride</a>, a platform for delivering continuing education to learners already in the workforce. We developed our own robust technological capabilities in ASU <a href="https://edplus.asu.edu/" target="_blank">EdPlus</a>, a hub for research and development in digital learning that, even before the current crisis, allowed us to serve more than 45,000 fully online students. We have also created partnerships with other forward-thinking institutions in order to mutually strengthen our capabilities for educational accessibility and quality; this includes our role in co-founding the <a href="https://theuia.org/" target="_blank">University Innovation Alliance</a>, a consortium of 11 public research universities that share data and resources to serve students at scale. </p> <p>For ASU, and universities like ASU, the "new normal" of a post-COVID world looks surprisingly like the world we already knew was necessary. Our record breaking summer 2020 <a href="https://asunow.asu.edu/20200519-sun-devil-life-summer-enrollment-sets-asu-record" target="_blank">enrollment</a> speaks to this. What COVID demonstrates is that we were already headed in the right direction and necessitates that we continue forward with new intensity and, we hope, with more partners. In fact, rather than "new normal" we might just say, it's "go time." </p>
Russian astrophysicists propose the Casimir Effect causes the universe's expansion to accelerate.
- Astrophysicists from Russia propose a theory that says dark energy doesn't exist.
- Instead, the scientists think the Casimir Effect creates repulsion.
- This effect causes the expansion of the universe to accelerate.
Gravity Should Slow the Expanding Universe, but Dark Energy Is Speeding It ...<div class="rm-shortcode" data-media_id="TXFqpm0M" data-player_id="FvQKszTI" data-rm-shortcode-id="e242a06f4b4464e0cffae45d5142d2ea"> <div id="botr_TXFqpm0M_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/TXFqpm0M-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/TXFqpm0M-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/TXFqpm0M-FvQKszTI.js"></script> </div>
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Hollywood has created an idea of aliens that doesn't match the science.
- Ask someone what they think aliens look like and you'll probably get a description heavily informed by films and pop culture. The existence of life beyond our planet has yet to be confirmed, but there are clues as to the biology of extraterrestrials in science.
- "Don't give them claws," says biologist E.O. Wilson. "Claws are for carnivores and you've got to be an omnivore to be an E.T. There just isn't enough energy available in the next trophic level down to maintain big populations and stable populations that can evolve civilization."
- In this compilation, Wilson, theoretical physicist Michio Kaku, Bill Nye, and evolutionary biologist Jonathan B. Losos explain why aliens don't look like us and why Hollywood depictions are mostly inaccurate.
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