Testing for Antisuicidal Effects of Lithium Treatment (2024)

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November 17, 2021

Not 'antisuicidal'

Carolyn Quadrio, MD | School of Psychiatry, University of New South Wales, NSW, Australia

While i have no quarrel with the substance of this article, I take issue
with the use of the term, 'antisuicidal'. Suicide is a complex behaviour
that must be understood, at the very least, in terms of individual
cognition, motivation, affect, and attachment relationships, and in terms of
much broader philosophical and existential concerns. If it is proposed that
a single chemical can reverse the outcome of this complex interaction, then
a model must be presented for how that comes about. There does not seem to
be such a model.

The use of the 'anti' prefix has

CONFLICT OF INTEREST: None Reported

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November 30, 2021

Response to Carolyn Quadrio

Andrew Tuck |

I'm afraid I disagree with Carolyn Quadrio's comment here. The idea that our use of the prefix "anti" in psychiatry is pharmaceutical propaganda is far-fetched. So is the assertion that using "anti" in the name of a class of drugs implies that we fully understand the mechanisms of action of those drugs. There is nothing about that prefix that implies such a thing. The term "antibiotic" does not entail a specific mechanism of action either (e.g. peptidoglycan cross-linkage inhibition). "Anti" is a common prefix that is germane not only to virtually all branches of science, but even common parlance. It is not a fancy technical term. Further, we actually DO understand how antipsychotics work (all FDA-approved antipsychotics for schizophrenia block D2 receptors, and we even understand how this specifically produces an antipsychotic effect; we also know that 5HT2a blockade is common in these drugs and likely antipsychotic to some extent) and increasingly antidepressants.

But again, the prefix "anti" is not some sort of ideology-laden jargon. It literally just means "against." Antidepressants have anti-depression properties, so we call them antidepressants. Antipsychotics have anti-psychosis properties, so we call them antipsychotics.

And yes, if lithium has anti-suicidal effects, we will call these effects anti-suicidal.

CONFLICT OF INTEREST: None Reported

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January 9, 2022

The error in 'anti-suicidal.'

Niall McLaren, MBBS FRANZDP | Retired

In defending the expression “anti-suicidal,” Andrew Tuck makes a common mistake. He said we “… DO understand how antipsychotics work…” This is not true. We have some understanding of what they do but that is descriptive, and not explanatory. We could only know how they work if we had a resolution of the mind-body problem because, as every child watching a magician knows, knowing what something does is not the same as knowing how it does it. Granted, reductionist biological psychiatry believes laboratory science will tell us all we need to know of the human condition but that is an unproven ontological claim, not scientific.
He also said “Anti… is not a fancy technical term.” True, but psychiatry uses it in the common sense just because we don't know how these drugs work on the mind. However, psychiatrists then try to imply that we are using it in a strict scientific sense, akin to understanding how, for example, modern antivirals work, which is certainly not true. Finally, the term “anti-psychotic” actually did come from drug companies. In the 1970s, they were known as major tranquillisers. “Antipsychotic” came much later, as Joanna Moncrieff showed.

CONFLICT OF INTEREST: None Reported

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