Antidepressants may cause depression and suicidality

Suicide Response News and Notes
April 2004, Volume 3, 4th Edition

Table of Contents

Section 1: Update on Suicide Response Initiative in Region 3

In this business year the following objectives have been identified as those we will
work towards achieving:

1. Utilization of the Hope and Healing booklet to increase awareness of
suicide and strengthen community networks.
2. Maintain and strengthen linkages with aboriginal community on suicide
3. Increase research and interest in research in the area of suicide.
4. Initiate the development of postvention protocols for the Calgary Health

All four objectives include giving a greater role to survivors of suicide to move the
Suicide Response Initiative forward.

Please note, The Joint Suicide Response Steering Committee will be asked to set
objectives for the coming year at the next meeting set for June.
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Utilization of the Hope and Healing booklet to increase awareness of suicide and
strengthen community networks.
Distribution of the booklet has been steady, with over 200 being distributed since March. A plan
for a formal evaluation of the booklet will begin over the summer months and be implemented in
the Fall of 2004. To date almost 11,000 booklets have been distributed.
Maintain and strengthen linkages with aboriginal community on suicide issue.
The II PAA TAA PII (Formerly Calgary Urban Aboriginal Suicide Prevention) committee
has delivered one ASIST (Applied Suicide Intervention Skills Training) workshop and will
host 19 more over the next three years. The committee is also working on improving
linkages with other groups doing similar work in Calgary and Alberta. One task that will
be completed in the coming months is a community mapping. This project will document
who is doing what in the field of suicide prevention/postvention, injury prevention,
community development, etc. in order to assist in developing the appropriate linkages.

Increase research and interest in research in the area of suicide.
Consultation with Survivors of Suicide
Several completed questionnaires were submitted in the month of April. The data
reported in these questionnaires will be combined with other results. The report will be
circulated to focus group participants to ensure their thoughts and recommendations
have been reported accurately.
Evaluation of News and Notes
The evaluation of Suicide Response News and Notes has been completed. Results will
be shared at the next Joint Suicide Response Steering Committee meeting to be held in
June. The results will also be published in the June edition of News and Notes.
Recommendations arising from the Steering committee meeting will be reported in the
June or July newsletter.
Initiate the development of postvention protocols for the Calgary Health Region
Feedback and direction for the process of developing protocols was received at the last
Joint Suicide Response Steering Committee meeting held in March. The consultation
with health care professionals is proceeding. Several interviews have been completed.
Thus far, formal procedures for supporting survivors after suicide have not been found
within the health system. Work will continue on this phase of the consultation.

Increasing Awareness

CFCN TV Series
CFCN, a CTV affiliate in Calgary developed and aired a three part series on suicide April
26-28 during the six o’clock news hour. Members of the Suicide Response Initiative were
involved in the initial development of the series. The series looked at three aspects of
suicide – the first part included a ride along with the Mobile Response Unit as they did a
call out with a woman in crisis. When someone experiences significant stressors or other
life crisis, thoughts of suicide can occur. Many individuals can have suicidal thoughts in
such scenarios – anyone can be affected. The second part showed a family impacted by
the suicide of a young teenager. It talked about the devastation felt by those left behind
after a completed suicide. The third part of the series included an interview with a
woman who had experienced severe depression, had seriously contemplated suicide but
chose life. Information about how to get help was included during the broadcast as well
as made available on the CFCN web site.
News Articles
Safer Calgary recently released its first edition of the newsletter “ Safety in the Home”.
The publication contains articles related to keeping Calgarians safe at home (including
articles on Fire safety, emergency preparedness, domestic violence and suicide
prevention). The publication is free of charge where ever city publications are made
available, or it can be do. Scroll down
to Downloads (located on Right hand side of screen) and click on Safety in the Home.
Alternatively click on the link below.

Poster development
Several members of the Suicide response Initiative are involved in the development of a
‘postvention’ poster. The main message is to support survivors of suicide and raise
awareness of societal stigma towards suicide and the impact of suicide. It will also
promote options for help-seeking.
World Suicide Prevention Day – Friday, September 10, 2004
After its successful launch in 2003, World Suicide Prevention Day will be held on
September 10, 2004 around the world. On this day numerous events, conferences,
campaigns and local activities will call public attention to one of the world’s largest
threats to health and well being – SUICIDE. The International Association for Suicide
Prevention, in collaboration with the World Health Organization call for action and
involvement by governments, governments agencies, NGOs international and national
associations, local communities, clinicians, researchers and volunteers to conduct
activities on this day to promote increased awareness about the problem of suicide and
the many ways which can reduce suicide rates and decrease suicidal behaviors.
Once again several organizations have come together to form a coalition to plan events
to recognize this day in the Calgary area. This coalition includes the Calgary Health
Region, the Centre for Suicide Prevention, The Canadian Mental Health Association –
Suicide Services, and the City of Calgary. The coalition is expected to grow as we get
closer to September. Initial plans include a resource fair at City Hall. Other plans will be
announced in next month’s newsletter.
Section 2.0: Articles of Interest
Section 2.1 Articles Related to Mental Health, Mental Health Promotion and
Suicide
ANTIDEPRESSANTS MAY CAUSE DEPRESSION AND SUICIDALITY
Yael Waknine
March 22, 2004 — The U.S. Food and Drug Administration (FDA) has asked
manufacturers of the several antidepressant drugs to include in their labeling a warning
statement that recommends close observation of adult and pediatric patients treated with
their agents for worsening depression or the emergence of suicidality.
The antidepressant drugs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil),
fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), buproprion
(Wellbutrin), venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron).
Several of these drugs are approved for the treatment of obsessive-compulsive disorder
in pediatric patients (sertraline, fluoxetine, fluvoxamine). Only fluoxetine is approved for
use in children with major depressive disorder. None of these drugs are approved as
monotherapy in treating bipolar depression, either in adults or children, and fluvoxamine
is not approved as an antidepressant in the U.S.

ANXIETY SYMPTOMS AND TREATING DEPRESSION
Posted
Michael R. Liebowitz, MD
Introduction
Over the past 10-15 years, the pharmacologic treatment of depression has been greatly
advanced, with the introduction of many new medications that have achieved much
wider use. However, a variety of problems continue to exist. Many patients do not
respond to first-choice treatments, which are usually selective serotonin reuptake
inhibitors (SSRIs), and there are no clear guidelines as to what to do next for such
patients. Further, substantial portions of the patients who do benefit from the SSRIs do
not achieve full remission, and here also guidelines are lacking as to what to do next.
Finally, many depressed patients manifest substantial anxiety symptoms as well; here
again, guidelines are lacking as to how these anxiety features should influence treatment
selection.
To get access to the complete article go to:

TREATMENT OF DEPRESSION IN PATIENTS WITH ALCOHOL OR OTHER DRUG
DEPENDENCE
A Meta-analysis
Edward V. Nunes, MD; Frances R. Levin, MD
JAMA. 2004;291:1887-1896.
Context Depression and substance abuse are common and costly disorders that
frequently co-occur, but controversy about effective treatment for patients with both
disorders persists.
Objective To conduct a systematic review and meta-analysis to quantify the efficacy of
antidepressant medications for treatment of combined depression and substance use
disorders.
Conclusions Antidepressant medication exerts a modest beneficial effect for patients
with combined depressive- and substance-use disorders. It is not a stand-alone
treatment, and concurrent therapy directly targeting the addiction is also indicated. More
research is needed to understand variations in the strength of the effect, but the data
suggest that care be exercised in the diagnosis of depression–either by observing
depression to persist during at least a brief period of abstinence or through efforts by
clinical history to screen out substance-related depressive symptoms.
To read the complete abstract or obtain paid access to the full article, go to:

TALKING POINTS ABOUT ANTIDEPRESSANTS AND SUICIDE
Posted 04/14/2004
Thomas A. M. Kramer, MD
Introduction
Many people have asked me for advice about how to respond to questions from patients
and the lay public about the recent press, and ultimately US Food and Drug
Administration (FDA) warnings, about suicidality and antidepressants. I thought it might
be helpful to the readership to present some talking points about this issue which may
be used in responding to these questions.

VASCULAR COGNITIVE CHANGES, SUICIDE, AND SQUALOR: SELECTED
SESSIONS
From the Canadian Academy of Geriatric Psychiatry Annual Meeting
The Canadian Academy of Geriatric Psychiatry held its Annual Meeting in Halifax, Nova
Scotia, Canada on November 3, 2003. Some of the more interesting topics discussed at
their meeting include vascular cognitive changes, the relationship of medical illness to
suicide, and squalor. To read the complete article go to:

COMMUNITY-INTEGRATED HOME-BASED DEPRESSION TREATMENT IN OLDER
ADULTS
A Randomized Controlled Trial
JAMA. 2004;291:1569-1577.

Context Older adults with social isolation, medical comorbidity, and physical impairment
are more likely to be depressed but may be less able to seek appropriate care for
depression compared with older adults without these characteristics.
Objective To determine the effectiveness of a home-based program of detecting and
managing minor depression or dysthymia among older aldults.
Main Outcome Measures Assessments of depression and quality of life at 12 months
compared with baseline.
Conclusions The PEARLS program, a community-integrated, home-based treatment
for depression, significantly reduced depressive symptoms and improved health status in
chronically medically ill older adults with minor depression and dysthymia.
To read the complete abstract or for paid access to the complete article, go to:

THOUSANDS OF ELDERLY PEOPLE FACE ABUSE
says Commons report
Zosia Kmietowicz , British Medical Journal
Tighter controls need to be put in place to ensure the safety of elderly people, says a
Commons report. It estimates that as many as 500 000 elderly people in England are
currently being abused by relatives, carers, or strangers.
Although the public is more aware than ever of child abuse and the measures that have
been introduced to try to protect children, abuse of elderly people remains overlooked,
says the House of Commons Health Committee.
"Our inquiry found that much abuse of older people is not reported because many older
people are unable, frightened or embarrassed to report its presence," says the
Committee's report. To read the complete article, go to:

STIGMA FOR MENTAL DISORDERS, PSYCHOPHARMACOTHERAPEUTIC DRUG
DEVELOPMENT, AND BRIEF DYNAMIC PSYCHOTHERAPY
From the Canadian Academy of Child and Adolescent Psychiatry Meeting

The Canadian Academy of Child and Adolescent Psychiatry held its 23rd Annual
Meeting November 2-4, 2003, in Halifax, Nova Scotia, Canada. Important issues
discussed included stigma, the developing psychotherapeutic treatments for children
and adolescents, and the use of brief psychodynamic therapy for treating children and
adolescents.
To access the complete article go to
EFFICACY AND SAFETY OF ANTIDEPRESSANTS FOR CHILDREN AND
ADOLESCENTS
Jon N Jureidini, Christopher J Doecke, Peter R Mansfield, Michelle M Haby, David B
Menkes, Anne L Tonkin
How safe and effective are antidepressants in children and adolescents? The authors
of this review have found disturbing shortcomings in the methods and reporting of
trials of newer antidepressants in this patient group
To read the article go to:

Free Booklet
The Child and Adolescent Bipolar Foundation and the Depression and Bipolar
Support Alliance have collaborated on the production of a booklet for children on mood
disorders. You can order up to 5 copies of the booklet at no charge. There is also a
PDF on the Internet. The address to order the booklet is:

JOB SATISFACTION AND BURNOUT IN MENTAL HEALTH SERVICES FOR OLDER
PEOPLE
Australasian Psychiatry
Volume 12 Issue 1 Page 58 - March 2004

Objective: The objective of the present paper was to identify factors associated with
job satisfaction and burnout among staff working in mental health services for older
people.
Methods: A postal survey was distributed to staff members from eight mental
health services for older people in Western Australia. Staff focus groups identified
causes of work stress.
Results: The response rate was 33% (116/349). Teamwork, social support and
clear roles had a positive effect on job satisfaction. Community staff members had
higher job satisfaction than ward staff. Nurses reported higher burnout and lower
job satisfaction than other mental health professionals. Staff members working in
newer models of service delivery had higher job satisfaction than those working in
more traditional models.
Conclusion: Surveys and focus groups were an effective means of identifying
factors associated with job satisfaction in mental health staff members. Newer
models of service delivery with team building and supportive management may
improve the workplace for staff.
To access this abstract or to attain paid access to the complete article go


NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE
Neuroscience of Psychoactive Substance Use and Dependence provides an
authoritative summary of current knowledge of the biological basis of substance use
behaviours, including their relationship with environmental factors. The report focuses on
a wide range of psychoactive substances, including tobacco, alcohol and illicit drugs.
New developments in neuroscience research are discussed (e.g., mechanisms
governing craving, tolerance, neuroadaptation, immunotherapies and the concept of
dependence) as well the ethical implications of these developments. As the product of
consultations with and contributions from many international experts and partners, the
best available evidence is provided from the various schools of thought and areas of
research in the field of neuroscience. Neuroscience of Psychoactive Substance Use and
Dependence is targeted at individuals with more than a basic knowledge of
neuroscience, including scientists from a number of disciplines. It is expected that this
publication will be of interest to health care workers, clinicians, social workers, university
students, science teachers and informed policy makers. To download the document, go
to:
(Please Note: Document is 286 pages)
RISK FACTORS, PREVALENCE, AND TREATMENT OF ANXIETY AND
DEPRESSIVE DISORDERS IN PAKISTAN: systematic review
Ilyas Mirza, specialist registrar in adult psychiatry, Rachel Jenkins, visiting professor and
director
Objectives To assess the available evidence on the prevalence, aetiology, treatment,
and prevention of anxiety and depressive disorders in Pakistan.
Design Systematic review of published literature.
Results Factors positively associated with anxiety and depressive disorders were
female sex, middle age, low level of education, financial difficulty, being a housewife,
and relationship problems. Arguments with husbands and relational problems with in-
laws were positively associated in 3/11 studies. Those who had close confiding
relationships were less likely to have anxiety and depressive disorders. Mean overall
prevalence of anxiety and depressive disorders in the community population was 34%
(range 29-66% for women and 10-33% for men). There were no rigorously controlled
trials of treatments for these disorders.
Conclusions Available evidence suggests a major social cause for anxiety and
depressive disorders in Pakistan. This evidence is limited because of methodological
problems, so caution must be exercised in generalising this to the whole of the
population of Pakistan.
To read the complete article, go to:

COMMUNITY CAPACITY BUILDING AND MOBILIZATION IN YOUTH MENTAL
HEALTH PROMOTION: The Story of the Community of West Carleton.
How the Community Helper Program Evolved From a Community’s Experience With
Youth Suicide.
This paper explores key concepts in youth mental health promotion, demonstrating how
these concepts can and have been operationalized and implemented at the community
level. The experience of youth suicide in a rural community is used to illustrate, in
practical terms, how these concepts have real-life application. To download go to:

TALKING ABOUT MENTAL ILLNESS: TEACHER’S RESOURCE
A Guide for Developing an Awareness Program for Youth
This program, from Ontario, was developed to help bring about positive changes in
adolescents’ knowledge and attitudes toward mental illness. Everything you need to
prepare a presentation, including suggestions for activities, overhead masters, and other
resources. To view go to:


Section 2.2 Articles related to Health Services

A GUIDE TO HEALTH IMPACT ASSESSMENT: A POLICY TOOL FOR NEW
ZEALAND
This guide introduces health impact assessment as a practical way to ensure that health
is considered as part of policy development in all sectors. Central and local level policy
makers and anyone who may be affected by policy will find this guide useful. The first
section introduces health impact assessment and answers key questions such as “What
is health impact assessment?”, “Why do it?”, “Who should do it?”, and “What else do you
need to know?”. The rest of the document sets out guidance for how to do health impact
assessment. You can access this guide at
.
IT'S TIME FOR A PLAN FOR CHILDREN'S MENTAL HEALTH
Saskatchewan needs comprehensive, best practices-based plan for children's mental
health: Children's Advocate
A report released in the first week of April by the province's Children's Advocate Office
recommends that Saskatchewan Health, in consultation with stakeholders, develop and
implement a comprehensive plan to ensure that mental health services are provided to
Saskatchewan children, youth and families in a manner that is consistent with what
is known about best practices.
To read the report, go to ( Report is 94 pages with graphics/pictures - 650kb, )

INAPPROPRIATE ADMISSION OF YOUNG PEOPLE WITH MENTAL DISORDER TO
ADULT PSYCHIATRIC WARDS AND PAEDIATRIC WARDS: CROSS SECTIONAL
STUDY OF SIX MONTHS' ACTIVITY
Adrian Worrall, Anne O'Herlihy, Sube Banerjee, Tony Jaffa, Paul Lelliott,
Peter Hill, Angela Scott, Helen Brook

COMMUNITY BASED TEAMS CAN TRANSFORM MENTAL HEALTH SERVICES
BMJ 2004;328:790 (3 April) Debashis Singh
Community based mental health teams are having far reaching effects on mental health
services across the country, a new report says. But it warns that the teams need to be
set up over a realistic period of time and be adequately resourced.
The report is the result of a two year study by the charity the Sainsbury Centre for
Mental Health and the National Institute for Mental Health in England. It is a guide to
establishing assertive outreach teams and crisis resolution teams based on the lessons
learnt from new and existing teams across England.
Assertive outreach teams originated in the United States in the late 1970s and target
people with severe mental illness living in the community, with whom conventional
mental health services find it difficult to engage. Apart from improving engagement, they
also aim to reduce the number of hospital admissions and offer a wide range of help—
from assistance with medication and doing everyday tasks to guidance on education and
employment.
To read this article go to:
MENTAL HEALTH SERVICES FRAMEWORK WELCOMED
Annabel Ferriman , BMJ
The first national service framework for mental health, announced last week by the
health secretary, Frank Dobson, has been welcomed by a wide range of organisations,
including the Royal College of Psychiatrists, the NHS Confederation, the Sainsbury
Centre for Mental Health, the King's Fund, and the NHS Executive for London.
The framework sets national standards for mental health services, based on clinical
evidence, and sets out best practice for promoting mental health and treating mental
illness. Along with the government's allocation of an extra £700m ($1120m) to
psychiatric services over three years, it aims to iron out unacceptable variations around
the country.

HUMANIZING THE HOSPITAL
Quality health care
Open medical records, open visitations and home-like surroundings are part of the
Planetree (Derby, Connecticut, USA) quest to make health care more comfortable for
patients, their families, and staff. Among Planetree’s key concepts:
Emphasizing human interactions
Providing information and education for patients and families
Encouraging support from family and friends
Giving attention to spiritual issues
Providing massage
Fostering positive distractions through arts and entertainment
Creating suitable architecture and interior designs for medical
buildings
Offering nurturing food
A clinical study published in 1990, which demonstrated that the approach brought
dramatically better patient satisfaction levels, received a great deal of attention.
Planetree now partners with 90 hospitals, says president Susan Frampton.
To read this article, go to:


QUALITY OF HEALTH CARE FOR CHILDREN AND ADOLESCENTS: A
CHARTBOOK
Up to three-quarters of children and adolescents don't get appropriate care

Despite a number of noted successes, American children largely don't get the quality of
health care they should, with up to three-quarters of children and adolescents not
receiving care scientifically proven or recommended, according to a new overview of
children's health care released today by The Commonwealth Fund.
The review, shows a number of clear advances in children's health care and improved
outcomes on a series of measures. But it also notes that one-third of children with
asthma don't get appropriate controller medications and three-fourths of children with
severe mental health problems don't get evaluation or treatment. In addition, it illustrates
ongoing racial disparities in care and inadequate attention to widely effective preventive
measures.
To download the report (1.76 MB) go to

FIRST NATIONS IN ALBERTA: A FOCUS ON HEALTH SERVICE USE
Alberta Health and Wellness Report
This report describes the pattern of health services utilization of First Nations People in
Alberta. It is intended to:
• aid policy makers in making sensitive evidence-based decisions on issues affecting the health of First Nations people; • empower health care administrators and professionals to create or enhance programs and services that lead to positive health and social change; • inform First Nations communities about the health issues they face and empower them to meet the health service delivery challenges; and • encourage academics and researchers to engage in research in the field of You can access this report at:
.
Section 2.3 Articles Related to Policy
AUTO ACTION LEARNING: A TOOL FOR POLICY CHANGE
Building capacity across the developing regional system to improve health in the North
East of England
This paper traces developments in the North East of England from the perspective of an
advocate for developing a systemic and systematic approach using a World Health
Organization Investment for Health guideline. It provides a tool (Auto Action Learning)
for implementation of a policy change through capacity building focussed on developing
a systemic approach to the improvement of health by helping existing systems to work
together. The paper explains the approach in four stages – the context and tools used;
the data gathered; reflections on the data; and learning from the process. To access
go to:
Section 2.4 Articles Related to Community Development
Urban Nexus, a monthly e-bulletin of policy research, news and events on cities and
communities launched by Canadian Policy Research Networks (CPRN) in October 2002.
Urban Nexus is for policy makers, researchers and interested members of the public
seeking up-to-date information, from Canadian and non-Canadian sources, about new
research on cities.

This month’s issue of Urban Nexus highlights leading research and policy analysis on
the creative city, and the role of the arts and culture in building healthy, vibrant, and
inclusive cities.
Creative cities are dynamic locales of experimentation and innovation, where new ideas
flourish and people from all walks of life come together to make their communities better
places to live, work, and play. They engage different kinds of knowledge, and encourage
widespread public participation to deal imaginatively with complex issues.
Beyond Garrets and Silos: Concepts, Trends and Developments in Cultural Planning.
Municipal Cultural Planning Project. Baeker, Greg. 2002.

The Creative City. London: Demos.
Landry, Charles, and Franco Bianchini. 1995.

Arts Council England. 2003. Local Performance Indicators for the Arts.

To view archived Urban Nexus summaries on the CPRN Web site, go to:


Section 3.0 Web Sites to Bookmark

An interesting web site based on the work of Robert Fuller and his work on rankism. The
introduction reads:
“An undiagnosed disorder is loose in the world. It afflicts individuals, groups, and
nations. It distorts our personal relationships, erodes our will to learn, taxes our
economic productivity, stokes ethnic hatred, and incites nations to war. It is the cause of
dysfunctionality, and sometimes even violence, in families, schools, and the
workplace.”
Site contains links to many other interesting web sites.

Section 4.0 Funding Alert

Killam Research Fellowships Program

Canada Council for the Arts

Killam Research Fellowships are intended for established scholars who have
demonstrated outstanding research ability and who have published the results of this
research through substantial publications in their field over a period of several years.
The intent is to provide release time from teaching and administrative duties to an
individual scholar who wishes to pursue individual research. These fellowships are
offered in the fields of Humanities, Social Sciences, Natural Sciences, Health Sciences,
Engineering, and studies linking any of the disciplines within these broad fields. The
deadline for application is May 17, 2004. For more information go to


Section 5.0 Upcoming Events

HEALTH RESEARCH TRANSFER NETWORK OF ALBERTA – WATER COOLER
SESSION – LESSONS FROM THE CHSRF KNOWLEDGE BROKERING
CONFERENCE
Monday, May 3, 2004 – 9:00 a.m. to 10:30 a.m.
(Continental breakfast and networking at 8:30 a.m.)
In this session, the six RTNA members who attended the CHSRF Knowledge Brokering
Conference in Montreal last October will discuss what they learned at the conference
and how they are applying these lessons in the workplace. Locations are as follows:
Edmonton
Joseph Dvorkin Centre, University of Alberta Hospital Lethbridge
Lethbridge Regional Hospital, Room 2K163 Red Deer Hospital, Conference Room 1120a University of Calgary, Health Sciences Centre Room G382
Links to other sites may be arranged. Please ask if you are interested. RSVP to
y April 27, 2004.

If you wish to provide feedback on the above information or submit information of
interest please reply to this email or contact Catherine Davis at (403) 943-8136,

Source: http://nb.cmha.ca/files/2012/04/SuicideResponseNewsApril2004.pdf