The St Bartholomew’s Day Massacre: Protestant Patients, Catholic Drugs

November, 12, 2012 | 1 Comment


  1. I thought this would be a good place to reprint a recent article from Medscape. In a very sad way, it may show the “chickens coming home to roost” with regard to the official silence on anti-psychotic drugs and suicide.

    The study it describes looked at 31,603 individuals who died by suicide – 203 of whom were physicians. The physicians were much more likely than non-physicians to die with anti-psychotics, benzodiazepines or barbiturates in their systems, but “not more likely” to have antidepressants present. Their anti-psychotic use was astronomically higher than the overall group, while benzo and barbiturate use was modestly higher.

    The spin that was put on this survey by the article was typical: Physicians are undertreated for depression; we need to increase access and reduce stigma! The “undertreatment” concept was apparently drawn from the antidepressant figures – but no numbers were given. To me, “not more likely” means the dead doctors had AD’s in their systems at “about the same” levels as dead non-physicians. What were those levels, I wonder? They could be pretty high – not only because AD’s can (fairly rarely) cause suicide but because they can (more frequently) simply fail to prevent it.

    My guess about the meaning of these figures: the doctors in question, even more so than civilians, received “Lonely Treatment”: pills only, either self-prescribed or passed along discreetly by a colleague, without any initial or followup conversation. It also looks like the doctors trusted AD’s only as much as the non-doctors did … but they trusted anti-psychotics a great deal more than the average civilian. Did they use these drugs as direct treatment for depression, or simply as industrial-strength sleeping pills? Either way, it looks like their trust was misplaced.

    Anyway, here’s a short version of the article:

    Job Stress a Major Factor in High Rates of Physician Suicide
    Caroline Cassels, Medscape Today, Nov 13, 2012

    Investigators at the University of Michigan in Ann Arbor found that among individuals who died by suicide, having a mental health disorder or a job problem was significantly associated with being a physician.

    They also found that physicians who died by suicide were much more likely than their non-physician counterparts to have antipsychotics, benzodiazepines, and barbiturates, but not antidepressants, present on toxicology testing.

    “This [study] paints a more detailed picture of external events and risk factors in a physician’s life before a suicide, rather than just looking at a death certificate,” lead author Katherine J. Gold, MD, MSW, said in a statement. The study was published online November 5 in General Hospital Psychiatry.

    Need for Change

    Among suicide victims, having a known mental illness was mildly associated with higher odds of being a physician (odds ratio [OR], 1.34; confidence interval [CI], 1.01 – 1.82; P = .045). However, among physicians, the greater likelihood of having a known mental illness was not matched by a greater likelihood of antidepressant therapy, the investigators note. Having a job problem that contributed to the suicide significantly predicted the likelihood of being a physician (OR, 3.12; CI, 2.10 – 4.63; P < .0005).

    Toxicology testing revealed that physicians were significantly more likely than nonphysicians to have antipsychotics (OR, 28.7; CI, 7.94 – 103.9; P < .0005), benzodiazepines (OR, 2.10; CI, 11.4 – 38.6; P < .0005), or barbiturates (OR, 3.95; CI, 15.8 – 99.0; P< .0005) present.

    "There needs to be greater effort to address the stigma, underdiagnosis, and treatment of depression among physicians and understand how we can reduce the stress related to work. We need to make mental health treatment more available, safe, and confidential," said Dr. Gold.

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