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Duloxetine, Lilly, and Suicide

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Duloxetine, Lilly, and Suicide

This is a story that is going to get bigger: Gregg Easterbrook rails against Lilly1^ in the New Republic, claiming that they have led to the death of a healthy 19-year-old student in Indiana. He makes some salient points, but is probably over the line, especially by his last few paragraphs — see Corante for a good analysis of the column2^. Nonetheless, I think the Easterbrook does have a point.

A number of relevant facts:

The Indianopolis Star claims that the suicide rate for patients was only 0.097 percent, whereas the rate for SSRI antidepressents is 1.5 percent. This figure is suspiciously low (it’s two magnitudes lower!) and I suspect a division error by the paper; it doesn’t match the results in the Journal of Clinical Psychiatry7^, which gives a suicide attempt rate just under 1%8^.

Financial implications. Lilly had total revenues of 12.5B in 20039^, and estimates for duloxetine ranged as high as $2 billion in 200810^. Lilly’s patent on Prozac (fluoxetine hydrochloride) is gone and they are getting quite a bit of competition from generics, so they really want a new, patented medicine in their array of drugs.

Conclusion. I think it will all boil down to one thing: Dr. Joe Glenmullen, a clinical instructor of psychiatry at Harvard Medical School, said that “patients taking antidepressants are most vulnerable to suicidal thoughts three to 10 days after they cease the medication.“11^ (also mentioned in the New York Times article12^). If this is true13^, then the question is: was Lilly conscientious in making sure that students taken off the drug were tracked? If not, look for a major negligence law suit.

[1] New Republic: Gregg Easterbrook
[2] Corante: The Cold Equations
[3] a) Indianapolis Star b) [and another] c) [and another]
[4] More information on duloxetine
[5] Yahoo Finance: LLY
[6] New York Times: Student Commits Suicide
[7] Have not been able to validate this source yet.
[8] Journal of Clinical Psychiatry 2003;64:1237-1244
[9] The study of 1,279 patients gave a rate of 1 suicide attempt per 115 patient years of experience.
[10] Surgeon General
[11] American Journal of Psychiatry


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