For decades, declarations by perturbed relatives that a loved-one’s death was iatrogenic (induced by medical treatment), were often dismissed as anecdotal. Accounts imparted by concerned loved-ones were likely to be rejected, albeit often kindly – yet thrust aside as the demented rantings of a grieving loved-one. Placated with persuasive words, relatives often slink away, suitably chastised by the medic’s evidential superior knowledge. The rantings of the grieving widow or mother will be controlled and placated, with the vociferator patronized and often pitied as misinformed dissidents. Thus, relegated to the anecdotal tray, rather than adverse-reaction tray, the iatrogenesis will likely continue, surfacing some time later to harm another. Many feel this practice is particularly pervasive within psychiatry, where protecting the medical model seems paramount over the safeguarding of patients.
The perception of the American ‘shrink’ listening attentively, while the horizontal patient spills his innermost torment, is one that persists today. In reality, this is far from the norm, with the prescribing of psychiatric drugs taking precedence over the tedium of treating a traumatised patient. Drugs that often mask the problem with disinhibition and emotional blunting are seemingly prescribed with wild abandon, yet only the families affected can see the harms done – while medics seem oblivious. When Cochrane Scientists and expert psycho-pharmacologists, are publicly stating that antidepressants and other psychotropic drugs are causing ‘more harm than good’ and many deaths, dismissive medics who continue to recklessly prescribe are walking a fine line between acting irresponsibly and negligently. However, a vast disparity still exists between scientific findings that psychiatric drugs are the third leading cause of death in Europe (and the U.S) and psychiatry’s Key Opinion Leaders (KOLs) declaring these drugs are safe – even declaring that ‘the public should have no concerns about these drugs’.
When publicly challenged, KOLs usually retaliate with the mantra ‘correlation does not imply causation’. Pushed a bit further, their hackles will rise and they’ll state ‘these people are causing harm, by stopping people from taking life-saving medication’. Yet, even a utilitarian argument that these drugs provide ‘the greatest good for the greatest number’ has been debunked by Peter Gøtzsche (scientist and co-founder of the Cochrane Collaboration). He stated recently, to no small uproar, that these drugs are ‘doing more harm than good’ and that almost all psychotropic drug use could be stopped without deleterious effect (due to withdrawal, discontinuing is not advisable without medical supervision).
However, the problems run deeper than the KOLs defence of psychiatric drugs. An interesting article on MIA (Mad in America) tells the sorry tale of a dad who recently discovered that the American drug regulator (FDA) is ‘hiding reports linking psychiatric drugs to homicides’. It will be interesting to see what happens next within the FDA.
Furthermore, the statement that ‘the public should have no concerns about these drugs’ was made following an inquest in Ireland, where concerns were raised by the deceased’s family about a recent prescription of Sertraline (Zoloft/Lustral). However, as is common practice, the family’s concerns were dismissed. They had no way of knowing that in 1998, the Irish Drug Regulator (HPRA), following reports of Sertraline-induced suicide, had requested that the drug company in question (Pfizer) search its database for similar cases. There were 594 ‘suicide events’ reported from non-clinical sources, of which causality was not investigated. Of the 252 from clinical trial cases, Pfizer’s internal report concluded that 54 were directly related to Sertraline treatment. Interestingly, 11 of the ‘suicide events’ reported (from both sources) came from Ireland, with 2 found causally related to Sertraline. The latter were from ‘confidential’ documents released through court proceedings and provided by Kim Witczak who lost her husband Woody to Sertraline.
Nevertheless, it seems that science may be catching up with the anecdotal evidence, with some interesting studies published recently. Following the Study 329 debacle (as yet unretracted), the latest study by Jureidini et al ‘The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance’ shows how Forest Labs, through greed and fraudulent practices, actively ignored the prospective likely harms to children. The study concluded:
Deconstruction of court documents revealed that protocol-specified outcome measures showed no statistically significant difference between citalopram and placebo. However, the published article concluded that citalopram was safe and significantly more efficacious than placebo for children and adolescents, with possible adverse effects on patient safety.
Another study by Selma et al ‘The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide’ expressed that a genetic predisposition to iatrogenesis can be traced back to pharmacogenetic interactions, namely the inability of some to metabolize prescribed drugs, making ordinarily ‘safe’ drugs, lethal for some. The study concluded:
“CYP450 status is an important factor that differentiates those who can tolerate a drug or combination of drugs from those who might not. Testing for cytochrome P450 identifies those at risk for such adverse drug reactions. As forensic medical and toxicology professionals become aware of the biological causes of these catastrophic side effects, they may bring justice to both perpetrators and to victims of akathisia-related violence. The medicalization of common human distress has resulted in a very large population getting medication that may do more harm than good by causing suicides, homicides and the mental states that lead up to them”.
Perhaps we will just have to wait for the hapless KOL to catch up, not only with the scientific evidence but with collective anecdotal evidence from families. It would seem that underestimating anecdotal evidence is unwise – not least as science often evolves from this very valuable source.
An article in Sunday’s Telegraph ‘could antidepressants be ruining your sex life?’ concerned the use of widely-prescribed SSRIs (Selective Serotonin Reuptake Inhibitors) and the associated loss of libido. The article rightly refers to statistics that estimate between 30-70 per cent of SSRI consumers will be affected with some form of sexual dysfunction – despite their much-argued efficacy. According to Peter Gøtzsche, Cochrane scientist, “There isn’t much happiness in the pills. Their most pronounced effect is to cause sexual disturbances…The drugs should therefore have been marketed as a formidable disrupter of your sex life, but that wouldn’t have sold many pills.”
However, the Telegraph article also conveyed common misconceptions into the psychopharmacological workings of antidepressants. In a nutshell – by increasing the levels of happy neurotransmitter serotonin, this effectively lifts overall mood but as a result of this increased serotonin level, your libido will decrease along with the ability to orgasm. It seems, despite there being no way of quantifying serotonin (at least not when alive), belief in ‘the chemical imbalance myth’ still prevails.
Nevertheless, leaving aside the legend of the chemical imbalance, the article also discusses another ‘libido-friendly’ alternative to SSRIs, GlaxoSmithKline’s Bupropion/Wellbrutin. The author seemingly expounds the virtues of this drug, marketed in the U.S. as Wellbutrin (an antidepressant) and Zyban (an anti-smoking drug) in the U.S. and Europe. Excerpt:
“It seems that instead of dampening desire, Wellbutrin can increase libido and suppress appetite, earning it the nickname of the ‘happy, sexy, skinny pill’.
Sounds like the perfect pill, if it actually worked. In case anyone was contemplating doing a bit of self-diagnosing and self-medicating via the internet (as the article reports many U.K. women are doing), there are other factors that just might put you off. In fact, some crucial Wellbutrin-related adverse effects were omitted from the article, f0r example, some very serious psychological effects: unusual thoughts and behaviors, increased risk of suicidal behaviour, aggression, delusions, seizures, hallucinations, paranoia, confusion and manic episodes.
In reality, this so-called ‘happy, sexy, skinny pill’ has been plagued with problems. Following significant incidences of seizures, Wellbutrin was taken off the market shortly after its initial approval – but re-introduced a few years later at a lower dose. In 2009, following numerous suicides, the FDA (US Medicine’s Regulator) was so concerned about the psychological effects of Wellbrutin/Zyban in smokers, that they ordered a further black-box warning to be attached. The following year (2010), a study by Moore et al ‘Prescription Drugs Associated with Reports of Violence Towards Others’ found Wellbutrin to be one of the 31 drugs disproportunately associated with violence.
Furthermore, as for being nickednamed the ‘happy, sexy, skinny pill’ there is one main reason for this – money. In fact, GSK actively promoted Wellbutrin as ‘the happy, horny, skinny pill’ and paid handsomely for promoting the drug for unapproved uses. In an action taken by the U.S. justice department, allegations included a myriad of wrongdoings, including that GSK hired PR firms to promote off-label use, paid doctors, organised sham advisory boards, sham ‘independent’ medical education events and provided samples to pediatric psychiatrists for unapproved use in children (despite knowing it increased the risk of suicide in this age group).
On one particular radio show, well-known tv-doc, Drew Pinsky, said it was possible that Wellbrutin could have caused a female caller’s ’60 orgasms a night’ (Sure, you’d be worn out – and I’m not entirely sure why this wouldn’t be conceived as a downright affliction). Anyway, dear Dr Drew never clarified this or mentioned that he was paid, very, very handsomely, for his services to GSK. In the months before the radio show, GSK indirectly paid him $275,000 – a fact not disclosed to the listeners. Thus, an internal GSK report determined that the media campaigns pushing Welbutrin’s ‘happy, horny, skinny’ effects, reached a total audience of 387 million. It would be surprising if anyone hasn’t heard of it, even on ths side of the Atlantic.
In case you need further convincing, in 2012, GSK was fined 3 billion dollars for these illegal and dubious practices, including for the off-label and harmful promotion of Wellbutrin in children and adults. Nevertheless, as the sales for Wellbutrin during that same period, were reportedly $5.9 billion, GSK made a tidy profit. The collateral damage of harmed kids and unsuspecting consumers went seemingly unnoticed.
So, I would be very careful of that so-called miracle cure – you just might get more than you bargained for. ‘Sickness’ is a very lucrative business and all pharmaceuticals companies are corporate entities, ones that are totally reliant on sickness, not health. GSK just so happens to be bigger than most and one that has shown itself time and again to use greater bullying tactics.
There has been much publicity recently on the alcohol industry and their sponsorship of sporting events. I won’t rehash the numerous arguments here but suffice to say, most agree that it’s an unethical alliance. An article by Dr John Scally, TCD (and RCSI) lecturer in Ethics and Theology, expressed the view that there are particular ethical issues involved when accepting sponsorship from the alcohol industry. He stated “No drug has caused more damage to Irish families than alcohol. Of course, the Guinness sponsorship of the hurling championship did not force young people to drink alcohol. Yet it would be naive in the extreme to think that executives of alcohol companies would fork out huge sums of money on sports sponsorship unless there was some boost to their sales in return”.
To be honest, I’m not really sure what all the fuss is about – there’s no subterfuge, it’s a self-explanatory and transparent relationship. It seems to me that there are far worse examples of industry-funded events, ones that are far from transparent. What of Pharma-funded awareness programmes, companies that just so happen to have a drug that might (or might not) help the same condition they’re creating awareness for? A recent article in Spain’s El País Newspaper (unwittingly) provides an insight into the unethical subterfuge that can often exist behind ‘awareness’ programmes. The article ‘Three-quarters of at-risk drinkers in Spain unaware of dangers of alcohol’ gives a stark warning to Spanish drinkers who ‘consume worrying amounts of booze’. The article comes on the back of a survey done by Danish pharmaceutical company Lundbeck, which was presented by a panel of experts to a symposium in Madrid last week. Following the study on alcohol consumption, the panel of experts called for legislation to regulate alcohol intake, limit access to alcohol and control alcohol-industry advertising. The El País article ends with the line “Each day, the industry spends a million euros promoting alcoholic drinks. This is not ethical.” Okay so far – many would agree that spending a fortune in promoting alcohol products is an unethical practice.
What the article doesn’t say, is that –
Lundbeck, the Pharmaceutical company behind the survey, (coincidentally) manufactures a drug for alcohol dependence, Nalmefene.
Each expert from the panel has many conflicts of interest, including receiving numerous ‘honoraria’ from Lundbeck – all have a vested (and potentially very lucrative) interest in their submissions. Honoraria (plural of honorarium), a confusing word, meaning cash for services rendered.
The Panel of experts –
Julio Bobes, president of Socidrogalcohol, a research organization into alcohol and drug dependence. His conflicts of interest includes receiving honoraria from Lundbeck and being part of the ESENSE 2 Study, a randomized controlled 6-month study of ‘as-needed Nalmefene’, sponsored by Lundbeck.
Antoni Gual, of Barcelona’s Hospital Clinic. His conflicts of interest include- AG has received honoraria, research grants and travel grants from Lundbeck. He wrote numerous Nalmefene papers, including this one he co-wrote with employees of Lundbeck – ‘A randomised, double-blind, placebo-controlled, efficacy study of nalmefene, as-needed use, in patients with alcohol dependence’. Lundbeck was involved in the study design, data collection, data analysis, and interpretation of the data. AG was also on the advisory board of Socidrogalcohol.
José Ángel Arbesú of the Spanish Association of Primary Care Medics. His conflicts of interest include being an advisor to Lundbeck and obtaining Lundbeck funding for research, publications and training. He took part in the following study ‘SEMERGEN positioning for the treatment of alcohol disorders in primary care’ with Julio Bobes and Antoni Gual – a study that recommended Lundbeck’s Nalmefene for reducing alcohol consumption.
Javier Zarco of the Spanish Society for Family and Community Medicine, has consulted and obtained funding for advice, research, publications and training activities from Lundbeck.
In 2014 the college of psychiatrists of Ireland called for a ban on Alcohol advertising and sponsorship; it seems ironic that they do not see the glaringly obvious similarities between the latter and the pharmaceutical industry’s funding of academia and of the very studys that medics rely on for basic education. One wonders why the college would focus on sponsorship by the alcohol industry and ignore their own professions alliance with, and allegiance to, the pharmaceutical industry.
Jeez – here we go again. Yesterday’s BMJ article that found antidepressants double the risk of suicide and aggression in young people, made headlines worldwide. From America, Australia to india, caution was advised when prescribing in this age bracket. Not so in Ireland. The one newspaper article referring to the BMJ article can be found in today’s Irish Examiner here, entitled ‘Drug link to child suicide queried by expert’. So did it warn prescribers of the suicide and aggression risks, advise stricter guidelines or just advise caution when prescribing to children? None of the latter. Instead the Irish Examiner published an article allowing Professor Patricia Casey to question the findings of the Nordic Cochrane Centre.
Coincidentally, Professor Casey was also in the newspapers yesterday, having brought a High Court action against the Irish Times for alleged defamatory comments made by the public online. The anonymous online comments stated that Professor Casey was an unprofessional psychiatrist who was unfit to treat suicidal pregnant women and further, that she misrepresented psychiatric research in order to promote a Catholic agenda. The Times kowtowed apologised and the action was settled between the parties; therefore, no legal precedent was established. Professor Casey’s legal letters are legendary and many, including me, have been on the receiving end. Whatever happened to ‘truth’ and ‘honest opinion’ being defences to defamation?
Furthermore, regarding the comment that Professor Casey is pushing a Catholic agenda. Similar to defending antidepressant use in children, she’s certainly not pushing a Catholic agenda when she says antidepressants can be life-saving in pregnancy, while keeping quiet about the harms SSRIs can cause to the foetus, an issue that she’s well aware of. Another scientist (and psycho-pharmacologist) David Healy, has brought to her attention that these drugs can increase the rate of abortion, miscarriage and birth defects – but Professor Casey chose not to explore the data. May God forgive us all..
As for the BMJ article, far be it for me to contradict Professor Casey, so I asked the scientist at the centre of the study, Peter Gøtzsche, what his thoughts were on her Examiner article. See his detailed reply (in blue) below –
Prof Casey, however, said the jury was still out on the risks and benefits of prescribing the antidepressants, commonly known as SSRIs.
She believed psychiatrists dealing with children and adolescents should decide on a case-by-case basis.
“If a child is depressed and is not responding to evidence based treatment on offer, like talking therapies or some other anti-depressant, the psychiatrist might only then go and prescribe the SSRIs,” she said.
I consider it bad medicine to use antidepressants in children. They don’t work, according to the children themselves when asked in placebo controlled trials, and they double the risk of suicide and treble the risk of aggression.
“I am not a child or adolescent psychiatrist — I deal with adults. But I know from speaking to colleagues that there are differing views on prescribing SSRIs. Some say no, SSRIs should not be prescribed while others say, yes, we should, otherwise there will a greater risk of dying by suicide.”
Psychiatrists who claim that antidepressants protect children from committing suicide should not be allowed to practice; they are too dangerous to have around.
Prof Casey said it was found in the US and in the Netherlands that the suicide rate in children and adolescents increased after members of that group stopped being prescribed SSRIs.
All such studies have been found to be seriously misleading. I explain why in my recent book, Deadly Psychiatry and Organised Denial. The randomised trials provide far more reliable evidence and they show that the suicide risk doubles when children get antidepressants, which is why the drug agencies warn about using these drugs in children.
This was noticed particularly in the Netherlands, where the drugs carry a ‘black box’ warning.
Critics quickly pointed out the dishonest science that Gibbons had employed to make this case. He reported that SSRI prescriptions to youth declined by 22% in the U.S. from 2003 to 2005, and that suicide rates in youth rose 14% between 2003 and 2004. But since he had only the suicide rates for the U.S. through 2004, he should have focused on prescribing rates during that same period of time.
In fact, there had only been a very small decrease in the prescribing of SSRIs to youth between 2003 and 2004, when the number of suicides rose. It was between 2004 and 2005 that the there was a significant decrease in the prescribing of SSRIs to youth, and–as the critics noted–once the suicide data for that period became available, it showed that during that time, the number of suicides for persons ages 5 to 24 declined.
In other words, the data showed that as the number of prescriptions to children and youth declined, the number of suicides in this age group declined too. But Gibbons reported that the opposite was true. He did so by matching the increase in suicides in 2003-2004 to the decline in prescribing in 2004-2005. This is not the sort of error a scientist “accidentally makes.” This is the sort of presentation of data one makes when he or she is trying to deliberately tell a story that fits a preconceived end.
In the Netherlands, Dutch academics were incensed with Gibbons and his statistical antics. In the Dutch Drug Bulletin, they noted that the increase in suicides in the Netherlands was so small that it was “not statistically significant.” They described his conclusions as “astonishing” and “misleading,” and stated that Gibbons and his co-authors had been “reckless” to publish such claims.
“Child psychiatrists should not be eliminating SSRIs totally from their armory but using them when other treatments don’t work because there is now clear evidence of an increase in suicide in young people that appears to approximate to the time when the reduction in their prescription occurred,” said Prof Casey.
This is total nonsense. There are no reliable studies that have shown this. And interestingly, when the usage of SSRIs went up in the UK in youth, suicides in youth also went up, but no one has felt compelled to publish a paper about this, as far as I know. Selective reporting is certainly an issue here.
However, the research led a British expert to call for stricter prescribing rules.
Professor of evidence-based psychological therapies at University of Reading, Shirley Reynolds said only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
No. No one should prescribe antidepressant medication to children and young people. I consider this a medical error. They don’t work and they are harmful.
“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.
They need not think hard. They should just say no. This will save many lives.
“But do the results mean that children and young people should never be prescribed antidepressant medication? No.
Yes! It should be forbidden to use these drugs in children and young people. We also need to face the fact that these drugs can cause suicide at any age, and they can also cause homicide.
I’ve been neglecting my blog recently and must say, I’ve missed it. I find blogging very therapeutic but have had to forego the rantings in order to study for a masters. Whose bright idea was that? While some people find it relaxing to visit the spa, go jogging (requires too much effort) or veg on the couch with the latest ‘Top Gear’ and a Tesco’s bag stuffed with chocolate and jellys (the poor unfortunate husband) – I like nothing more than having a few hours hunched over the computer (blissfully oblivious to the lads running amok in the background), ranting about what occasionally interests or annoys me. The thing about becoming a mature(ish) student is that there are always essays to be submitted. Timely and well-researched masterpieces take time and effort, I’ll have you know! Having finished my first assignment and mastered (kind-of) the intricacies of Endnote (no mean feat), my time is my own for a few days. I’m still not quite over the shock that this quare one from Sallynoggin was accepted into The Royal College of Surgeons. I kept telling the husband that Sallynoggin people are superior beings but he never believed me, although, I keep expecting the professor to barge through the door and say so sorry Ms Fennell, we got the rejected pile of applicants mixed up with the deserving scholars and you’ll just have to go. Anyway, he hasn’t as yet and I have to say, it’s an awesome place.
So considering I’ve left the triathlons to my much fitter sisters and there’s only so many re-runs of Jeremy Clarkson that a person can watch without wanting to harm the Hammond guy – what did I find of interest today? Well now, seen as you asked, this morning a study was published in the British Medical Journal (BMJ) entitled ‘Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports’ (Sharma et al., 2016). The objective of the study was to study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). Now, as I can feel your eyes glazing over (just as mine did), there’s an article in the Telegraph that provides a simplified account of the study findings – an article which incidentally gives a well-deserved mention to my lovely friend Mr AntiDepAware.
Excerpt from the Telegraph article ..
“Antidepressants can raise the risk of suicide, the biggest ever review has found, as pharmaceutical companies were accused of failing to report side-effects and even deaths linked to the drugs. An analysis of 70 trials of the most common antidepressants – involving more than 18,000 people – found they doubled the risk of suicide and aggressive behaviour in under 18s. Although a similarly stark link was not seen in adults, the authors said misreporting of trial data could have led to a serious under-estimation of the harms.”
While the study found no increased risk in adults, the Telegraph provides a quote from Professor Peter Gøtzsche, lead author of the study, who said “What I get out of this colossal underreporting of suicides is that SSRIs likely increase suicides in all ages”.
In a related BMJ editorial today, psychiatrist and author Joanna Moncrieff expressed concerns that many adverse events are being misrepresented – Several deaths were misclassified, and more than half the instances of suicide attempts and suicidal ideation were coded as ‘emotional lability’ or ‘worsening of depression’.
There are two hugely important findings in this study.
the safety of Fluoxetine (Prozac), psychiatry’s main drug of choice for children suffering with mental trauma, was widely misrepresented by Lilly.
antidepressants double the risk of suicidality and aggression in children and adolescents.
The study authors recommend – minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant.
Considering Lilly’s consistent hiding of the harms of Fluoxetine and the recent inquests in the Dublin Coroner’s Court where this drug was implicated, access to the data is crucial in order to stop further unnecessary deaths. A mammoth task but not an impossible one, as shown recently by Le Noury et al (with Paroxetine and Study 329). My brain is frying at the thought of it; although a PharmaHealyGotzsche triathlon actually sounds quite fun.
SHARMA, T., GUSKI, L. S., FREUND, N. & GØTZSCHE, P. C. 2016. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ, 352.
LE NOURY, J., NARDO, J. M., HEALY, D., JUREIDINI, J., RAVEN, M., TUFANARU, C. & ABI-JAOUDE, E. 2015. Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ, 351.
My attention was drawn recently to an Irish Catholic article involving Professor Patricia Casey, well known Irish psychiatrist and IONA Institute patron (conservative Catholic advocacy group). The article ‘Simplistic therapy approach to suicide criticised in new study’ was published in the ‘Irish Catholic’ and centers on a study published in the Irish Journal of Psychological Medicine. The study Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings is based on toxicology tests done post mortem and expresses the opinion that people dying by suicide were not adhering to their treatment (drug regime). The journal itself is the official journal of the ‘College of Psychiatry of Ireland’ – the same college which I have previously shown to engage in some dubious practices. While sending an ‘internal’ college e-mail to its members (regarding my son’s death where an antidepressant was implicated), it also forwarded the same literature to the drug company in question. While I have queried the ethicality of the latter with the college of psychiatry, no satisfactory answers have ever been forthcoming.
Leaving aside my possible subjectivity on the college’s questionable ethics, the article itself raises other relevant issues. Toxicology results post mortem are notoriously unreliable (Drummer et al 2004) and should not, as yet, be relied upon to conclude drug concentrations before death. I personally know of mothers who have lost their sons to antidepressant-induced deaths where the antidepressant escaped detection in toxicology tests. Two of these mothers vehemently objected and insisted on a re-test – in both cases the drug was eventually detected, once on the second time and once on the third time.
Firstly, as the basis of the study relies on toxicology results, the reliability of toxicology tests post mortem was not addressed in the study.
Secondly, even if these toxicology tests were 100% reliable, it raises other important questions – how is it that 1/3 of the people who died by suicide were taking their medication? Were the drugs at best ineffective or at worst a causal factor in these deaths? It is noteworthy that the suicidality warnings included in antidepressant PILs (patient information leaflets), were put there, not by any well-meaning intentions of the drug industry, but by order of the FDA (American Drug Regulator) and EMA (European Medicines Agency) following lengthy investigations.
Lastly, again in the case of the toxicology being 100% effective, how many of the victims were in withdrawal from these highly toxic drugs? Treatment-induced (and withdrawal-induced) suicide has been discussed in another study (Healy et al 2006). This possibility has led regulatory authorities to warn doctors about the risk of suicide in the early stages of treatment, at times of changing dosage, and during the withdrawal phase of treatment. Was ‘withdrawal’ a simple oversight on behalf of the original study authors?
It seems to me that the Irish Catholic and the IONA institute have bigger fish to fry – treatment of the living for example. Considering the current abortion debate raging in Ireland, it strikes me as strange that the pro-life IONA patrons have not addressed the issue of the widespread treatment with antidepressants in pregnancy. Speaking last year on the problem of assessing suicidal pregnant women, Professor Casey said “Who will offer her the first-line treatments (antidepressants and/or cognitive therapy) she so desperate needs?” That antidepressants save lives is not evidence based(Healy 2006) and problematic in pregnancy according to Adam Urato (personal communication, June 29, 2015), expert in Obstetrics & Gynecology and Assistant Professor at Tufts University School of Medicine. He stated –
“The antidepressants freely cross over the placenta and into the developing fetus (baby) throughout the pregnancy. They have significant harmful effects for moms and babies including miscarriage, birth defects, preterm birth, preeclampsia, newborn complications, and long-term neurobehavioral problems. These chemical compounds—what we call antidepressants—are made in chemical factories and they go from these factories, into the pregnant moms, and then into the developing babies (fetuses). Nowadays, with 5 to 10% of all pregnancies being exposed to these drugs, what we are basically witnessing is a large scale human experiment. The track record of what happens when we expose developing babies to foreign chemical compounds is not good. Chemicals have consequences for developing babies.”
Rather than focusing on dead people, the IONA Institute need to address treatment-induced fetal harm or it could be left wide open to accusations of hypocrisy. Suffer little children – a thorough investigation by the ‘Irish Catholic’ might be a good place to start.
Drummer O, Forrest ARW, Goldberger B, Karch SB, International Toxicology Advisory Group. Forensic science in the dock: Postmortem measurements of drug concentration in blood have little meaning. BMJ : British Medical Journal. 2004;329(7467):636-637
Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Medicine. 2006;3(9):e372.
Healy D, The antidepressant tale: figures signifying nothing? Advances in Psychiatric Treatment. 2006,12 (5) 320-327
Strange to be writing about someone who’s alive, but a nice change all the same. A survivor, who knew? Sorry, sarcasm – you can take the girl outta Sallynoggin…
Gareth O’Callaghan is a well known Irish author, radio presenter and mental health activist. He has written numerous books on depression, including the popular A Day Called Hope: A Journey Beyond Depression. Recently, he has spoken out about his experience on the SSRI Citalopram (aka Cipramil/Celexa), the same drug my son Shane was on for 17 days before his death. Why he has decided to bare all now, I don’t know, but I’m just glad that he has. Gareth said that he followed Shane’s case avidly “..not only because of the huge media coverage it received, but also because I too took citalopram many years ago. I can identify with the Akathisia (restless, aggressive inner anxiety) that Shane suffered as a result of the drug. I could really frighten people here if I was to explain in detail what Akathisia does to the mind. Thankfully I had a chance to stop taking the tablets. Shane didn’t”.
I should say that this is not news to me – I spoke to Gareth some years back; he’s a nice, friendly and very honest guy, who pulls no punches. He can be heard on 4FM every weekday afternoon here.
Akathisia (from the Greek for inability to sit) is a widely misunderstood and underestimated adverse effect of taking a drug, usually an SSRI antidepressant or a benzodiazepine. Coded in Patient Information Leaflets (PILs) as ‘inner restlessness’ and ‘restless leg syndrome’, it has been described by some survivors as the ‘worst experience ever’, a feeling of ‘inner torment’ where ‘death would be a welcome release’ and seems ‘the only, very welcome option’.
Wendy Dolin, who I had the pleasure of meeting in Copenhagen, described how her husband Stewart died while suffering with akathisia – 6 days after he was prescribed Paxil/Seroxat. She has set up MISSD, a blog specifically to warn of the dangers of akathisia –
“On July 15, 2010, (six days after beginning the medication), following a regular lunch with a business associate, Stewart left his office and walked to a nearby train platform. A registered nurse who was also on the platform later reported seeing Stewart pacing back and forth and looking very agitated. As a train approached, Stewart took his own life. This happy, funny, loving, wealthy, dedicated husband and father who loved life left no note and no logical reason why he would suddenly want to end it all. Neither Paxil nor the generic version listed suicidal behavior as a potential side effect for men of Stewart’s age.”
A recent post on MISSD reports a personal experience similar to Gareths here. David Healy also explained akathisia in his coroner’s report for Shane’s inquest here. Short excerpt below –
There is good evidence that akathisia can exacerbate psychopathology in general, and a consensus that it can be linked to both suicide and violence. A link between akathisia and violence, including homicide, following psychotropic drug use has previously been reported.
What surprises me with Gareth’s post, is that while he is telling of his awful experience and has many supporters, some people have taken offence where there is none intended. There are quite a few ‘how dare yous’. It seems that while it’s perfectly acceptable to be MedicatedAndMighty, it’s not okay to be UnMedicatedAndMighty and talk of a bad personal experience with prescription drugs. Surely his story is equally important? A selection of the comments below:
you’re doing more damage by labelling those who need help
I am going to unfollow u I have had enough of your one sided beliefs
Please don’t make people feel bad If they need it after bereavement etc.
Giving drugs for bereavement is surely part of psychiatry’s problem but one I won’t go into here (See works of David Healy, Robert Whitaker, Peter Gotzsche, Peter Breggin, etc). It should be noted that akathisia is not always fatal but monitoring is crucial. If it occurs in the early stages of taking a prescription drug, it can occasionally wear off (but not always). If it develops later, it’s less likely to wear off.
Read Gareth O’Callaghan’s post on akathisia below; It’s well worth a read..
This is a true story. It is called personal experience. It happened to me. In hindsight it relates to probably the most terrifying month of my life and I would like to write about it here for the first time. It happened 16 years ago.
If you would prefer not to read how an antidepressant can destroy a human mind, and even kill, then I suggest you stop here. Otherwise please read on. It’s also worth remembering while you’re reading this that there have been hundreds of suicides in Ireland so far this year. Many of these people could still be alive if they had been told the truth about these drugs before they had been prescribed.
I have written here on a few occasions about a condition – a body and mind reaction – called ‘Akathisia’, which is directly caused by antidepressant medications. I would like to explain more about this dangerous reaction this evening and what it really is, as very few people have ever heard of it. And it is one of the most dangerous and severe side-effects of these drugs.
In 2000 I was diagnosed with depression and prescribed citalopram (aka celexa, cipramil), a drug that – to the best of my knowledge – arrived in 1996. It was still brand new. These days we now know it is also extremely dangerous as I will explain in a moment. Despite all the damaged lives it has caused and the many deaths it has been responsible for, it is still one of the most frequently prescribed antidepressants from a range of drugs known as SSRIs (selective serotonin re-uptake inhibitors). Why, if this drug can induce death, is it still widely available?
Back then we knew nothing about what this toxic drug was capable of doing because it was basically still being tested. 16 years ago most of us might agree that our education about mind-altering drugs was scant and strongly influenced by the medical profession. Consequently very few of us were prepared to share our experiences like we are today because we knew no better. We were led to believe this was ‘the cure’.
The SSRIs have for years been marketed around a shocking blatant lie, namely that a chemical brain imbalance causes depression. Back then, 16 years ago, I thought (as a result of buying into this myth) that this drug would rebalance my brain chemicals and cure my depression. If only I had known back then what I know now.
I was told that the drug would take between three and five weeks (maybe six) to really ‘kick in’. I was told to be patient. So I reminded myself each day through this anxious misery and baseline unhappiness that I was feeling that I would eventually see the sun again and appreciate the life I had forgotten existed. I waited. And waited. And then after about seven days my life changed. Something truly shocking and off-the-scale of understanding started to happen.
I started to feel more anxious, in a stomach-knotted nauseous kind of way. My heart started to beat faster and I felt like I was losing my grip on reality. My first panic attack happened in a packed shopping centre on a busy Saturday afternoon. I lost the plot. I felt like I was having some sort of seizure so deep inside me I couldn’t control my rational self.
I told my two young daughters that we needed to get back home as quickly as possible. They couldn’t understand why I couldn’t explain why we needed to go home. I was cracking inside very quickly, sweating, trembling, palpitating, even crying. I was losing all sense of reality in a way that was terrifying me. How I managed to drive home that day is still something I can’t bear to think about.
Once home I went upstairs to a room which I had converted into a small office years before, closed the door and started to cry. The crying became a full-scale panic attack and I ended up lying on the floor hugging my knees trying to stop the awful sensation of severe agitation that was tearing me apart inside.
Eventually it eased; but then the pain in my knees became so bad I had to get up and walk around. It wasn’t normal walking; it was pacing. I paced around the house, often sitting down to rub the pain out of my knees, and then standing and pacing while scratching my face and squeezing my abdomen to stop the horrendous agitation that was tearing at my gut. It was so deep inside me it was tearing at my gut with a hidden pain I couldn’t reach.
In the days that followed, the aggression I felt would play horrible games with my mind. I couldn’t be around sharp instruments, or walk near water. I found it increasingly difficult to cross busy roads, or to be in a crowded place for more than a few seconds. Panic struck me randomly. I was afraid to drive my car so I stopped driving. But most of all the desire – the irrational, unwanted, terrifying need – to kill myself was never far from my mind. Death would stop this pain but I didn’t want to die, I kept thinking. My brain was in a state of meltdown. The nightmares and the sweats were truly shocking.
I lasted for three weeks on citalopram. On the 22nd day I rang my doctor. I told him I couldn’t take it anymore. I explained to him what was happening and he was shocked. I am lucky to have a very good doctor. Many people are not so lucky.
If reading about my experience here has upset you, then please let me emphasise that this was never my intention. This may not help you but I hope it might help someone who is reading this tonight and possibly going through this awful ordeal.
I made a promise to myself years ago that I would be totally honest with myself. If I can’t be honest to me, then I definitely can’t be honest with you. My writing comes from an honesty that believes in justice and support for others who are coming through what I have come through.
I know so much more these days about mental health and what heals, and also what doesn’t. I knew nothing back then. I started to educate myself when it dawned on me just how close I had come to harming myself seriously.
Unfortunately unless you have a good doctor you probably won’t be told what you need to hear and do. That is just not acceptable. If your doctor is a dickhead, get a new doctor – simple as that. If your psychiatrist is more interested in spoofing than in healing, then leave the room.
Akathisia, we are told, is usually a ‘mild reaction’ to SSRIs. Let’s be honest here. Mild is an understatement. For many people who start these drugs, akathisia is a life-threatening condition that needs to be more fully understand by both patient and doctor.
Most psychiatrists play it down because they know that three of the most popular drugs that they claim to be suitable and ‘safe’ to take for depression, that they increasingly peddle as a cure (the same drugs they include in many of their speculative, dodgy concoctions) cause akathisia: FACT.
These three drugs are Prozac (fluoxetine), Seroxat (paroxetine), and Cipramil (citalopram/celexa).
These drugs are believed to play havoc with the brain neurotransmitter norepinephrine, which under normal conditions is secreted in response to stress. It is associated with levels of insomnia, anxiety (panic), and aggression (and violence).
Research has shown that these drugs make people ‘more prone’ to suicide (and aggression) during the first few weeks of starting to take them. So many people suffer silently from akathisia. Ask any of these people if they were experiencing these awful side-effects before taking the drugs and they will tell you most likely they were not.
A deep sense of loss of interest in life, a deep-rooted unhappiness, a feeling of morbidity … these are all feelings of depression; but unfortunately often the very drug that is taken to counteract these feelings creates a violent emotional storm that many psychiatrists (and doctors) blame on the depression – not the drug.
Psychiatry is not going to change its attitudes to SSRIs. The pharmaceutical companies who developed these drugs need psychiatrists and doctors to keep selling them. Big Pharma has too much to lose. They don’t want you to find another way of healing your life. They want you to be as depressed as you possibly can be. Otherwise their profits drop because they can’t peddle their drugs. (And that’s beginning to happen.)
If a young person dies while on their drug, they blame the so-called illness, not the toxic drug. Depression is a multi-billion euro business. The second biggest exporter out of Ireland is antidepressants.
Maybe you haven’t experienced anything like what I have just described. If so, you are one of the lucky ones. If you have any doubt or bad feeling about the medication you take, or have started to take, then go straight back to whoever prescribed it to you. Demand honest answers to your questions. You are paying a lot of money. In return you are also demanding respect.
If they tell you that you are “blowing it out of all proportion” (as one young man told me he was told by his doctor), or to “stick with it”, as others have been told, or if they tell you they know best, then change your doctor. Get someone who genuinely wants to help you. It might just save your life.
Two recent inquests again raise concerns on the widespread practice of prescribing ‘safe’ [sic] SSRI antidepressants. Both inquests involve Citalopram.
On the face of it, Dr Sylvia Margaret Tisdale (64) and Andre Mickley (36) have very little in common. Dr Tisdale, a clinical virologist, had a long and distinguished scientific career with GlaxoSmithKline, while Andre Mickley was a former chef who was his partner’s carer at the time of his death. Mr Mickley had taken heroin and cocaine and was described in one newspaper as ‘a long term drug addict’ – but it should also be noted that he was described as a ‘gentle giant’ by his partner and was actively undergoing addiction treatment at the time of his death.
On April 29th 2015, Dr Tisdale left her ‘coping with stress’ book, her glasses and her antidepressant Citalopram on her bedside table and jumped from her bedroom window; she died a short time later. While the coroner focused on the stress Dr Tisdale was under, her sister Linda raised concerns ‘about the controversial side effects of citalopram’. She said “I felt that she wasn’t depressed but was instead very anxious and stressed. I was concerned about the citalopram she was prescribed, when I looked up the side effects- I don’t think she knew how serious the side effects could be.”
The coroner Tom Osborne returned a suicide verdict, dismissing Linda’s concerns. He said “If you went online and read the side effects of almost any medicine, you would never want to take any medication at all.” Wait!! What about the doubling of suicide risk? Mr Osborne is obviously not an advocate for ‘informed consent’? Incidentally, the psychiatrist testifying at Jake McGill Lynch’s inquest last week said something similar – “The Patient Information Leaflets (PILs) are too over prescriptive and it might put people off“. It might, and then there might be less use for psychiatrists or doctors to be testifying at inquests?
Andre Mickley’s Inquest and a different Coroner:
Andre Mickley was described as a ‘long term drug abuser’ who had reportedly used heroin and cocaine on the morning of 17th Feb 2015. He collapsed later that day, having suffered a subarachnoid hemorrhage (uncommon form of stroke) and died a few days later. What he had in common with Dr Tisdale was a prescription for Citalopram; he had been prescribed it just a few days before his death. There is emerging evidence that Citalopram can cause major adverse events such as heart attack and stroke, leading to death. A 2012 study published in the journal Neurology, found Patients who take Citalopram and other SSRIs have an increased risk of bleeding in the brain and stroke.
At Mr Mickley’s inquest, the coroner Professor Robert Forrest returned a ‘Narrative’ verdict. Unlike the coroner who dismissed Citalopram concerns in Dr Tisdale’s inquest, Prof Forrest sent a Regulation 28 report (with the aim of preventing further deaths) to the MHRA Director of Pharmacovigilence. In the report he stressed that Mr Mickley had used many drugs for several years “without major ill effects” but he had concerns regarding the drug Citalopram. He said there are “clear potentially adverse pharmacokinetic interactions between cocaine and the SSRI group of drugs, besides case reports” and this is notaddressed in the PILs. He asked for action to be taken to prevent further deaths.
Tragically, the coroner presiding over the Dr Tisdale’s Inquest did not feel the need to initiate an investigation, but maybe, just maybe, Andre Mickley’s death might curtail the number of further Citalopram deaths and even provide some answers to Linda’s questions. Who knows – it’s a strange and sometimes wonderful world.
Thanks MrAntiDepAware for providing me with the coroner’s Report. RIP Margaret and Andre.
Copenhagen, 16th Sept, 2015 – ‘Psychiatric drugs do more harm than good’. Peter Gøtzsche is the director of the Nordic Cochrane Center, Copenhagen and co-founder of the Cochrane collaboration. Peter’s new book Deadly Psychiatry and Organised Denial contains our personal stories of the harm done by psychiatric drugs. See our conference speeches below:
Today I attended the inquest of Jake McGill Lynch, which concluded with the Coroner returning an open verdict. Firstly, amid all the legal argument, there was an infinitely more important factor; Jake..
In 2012 Jake was diagnosed with aspergers syndrome; he was just that ‘little bit different’ ye see. He was a little too intelligent; too good; too kind; too perfect to be perceived as a ‘normal’ disruptive adolescent. I often wonder why psychiatry gets to define what is ‘normal’, considering the lack of any scientific tests to determine otherwise. Are we not all individuals with traits that others would see as abnormal? Are our strange and weird traits not what makes us likable, or even unlikable? Sure, Jake liked routine and things to be in order, a place for everything and everything in its place – not a bad trait I’d say, but nowadays it’s ‘diagnosable’. This extraordinarily intelligent young man was diagnosed, labeled forever, for being just that little too perfect.
Jake was an articulate, handsome young man. He had an online girlfriend, loved to play with his Lego and like ‘normal’ 14 year olds, spent hours on his beloved Xbox. He had joined a gun club with his mam and idolized his big brother and little dog Charlie (equally). He loved his native language and was a fluent Irish speaker.
Jake was primarily a happy camper with few problems, apart from feeling a little anxious on stressful occasions. He was attending a counsellor to help with his feelings of anxiety. When the counsellor decided that Jake didn’t need any more sessions as he was “the happiest she had ever seen him”, she referred him to a psychiatrist. His mam thought that this referral was in order to sign Jake off. Inexplicably, instead of signing Jake off, the psychiatrist prescribed Jake an SSRI Fluoxetine (aka Prozac), to ‘help with his exams’. Neither his mam or dad were given a patient information leaflet (PIL) or any information on side effects – suicidality or otherwise. Therefore, they were not told that SSRIs, including Prozac, doubled the risk of suicide.
Jake’s medication was doubled after a week, without seeing the prescribing psychiatrist. He became increasingly restless and had a meltdown in school which was totally out of character. 46 days after his prescription for Prozac, Jake’s parents found him on the floor of his bedroom – he had shot himself in the head with his legally held rifle. He was rushed to hospital but declared dead a short time later.
The psychiatrist had previously testified that she prescribed Jake with Prozac ‘to help with his exams’ because he had had ‘a meltdown’ while doing an Irish exam. This off label prescribing is truly shocking, but what is worse is the fact that Jake’s ‘meltdown’ occurred 5 days AFTER he was prescribed Prozac, not before. Why would a doctor get this so wrong? Is covering their own backsides more important than revealing the true circumstances surrounding the death of a 14 year old child? Do Jake’s parents not deserve to be presented with all the facts, not a cover-up? The HSE’s barrister spends a lot of time in the Coroner’s Court – he’s obviously very good at what he does. Personally I think an apology would be far cheaper. Jake, the 14 year old child in the middle of all this, seemed to get overlooked in copious legal argument.
The Irish drug regulator, HPRA, states that ‘Prozac is not for use in children and adolescents under 18’ here. The HPRA further states that if Prozac is prescribed off-label to a child over 8 (Sweet Jesus) with ‘moderate to severe major depressive disorder’, that it should be offered only in combination with psychological therapy. JAKE DID NOT HAVE DEPRESSION! In 2005 the Committee on Human Medicinal Products, CHMP, advised that SSRIs ‘should not be used in children and adolescents except within their approved indications – not usually depression – because of the risk of suicide-related behaviour and hostility’. If prescribed off-label, the CHMP recommends that patients should ‘be monitored carefully for the appearance of suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment’. Why then was Jake’s prescription for 10mgs of Prozac doubled the following week, without even seeing the psychiatrist? I would not call that careful monitoring.
What was particularly grueling for the family, was the 13 appearances in the Coroner’s Court, mainly for legal arguments over whether the family had a right to call an expert witness (David Healy). Not surprisingly the HSE barrister was vehemently opposed to David Healy taking the stand, stating that if he was allowed to be the family’s ‘expert witness’, they (the HSE) had an ‘expert witness’ who would say the opposite. I’m sure they had! The coroner refused the family’s request, referring to the limitations of the Coroner’s Act 1962 and the case of Eastern Health Board v Farrell, but said he’d have no objection to the family having an expert to ‘advise’ them on the day. By this stage Dr Healy was in the US, so Declan Gilsenan (retired assistant state-pathologist) came to the rescue and stepped in to advise Jake’s family. He has publicly stated “Based on my experience of doing postmortems on people where anti-depressants have been started fairly recently I would have concerns about the link to suicide”.
It is of particular significance, that in May 2012 Dr Gilsenan attended Leinster House with Dr Healy, warning that these drugs were causing many deaths and asking for an investigation to be initiated. Nothing was done – NINE months later Jake was given a prescription for Prozac and the cycle continued.
What was awful today, apart from hearing the circumstances of Jake’s death, was looking into the faces of his grieving parents. That familiar look of unbearable pain etched on their faces, the unbelievable loss of their son who had so much to give – all totally avoidable. Another Irish boy lost through psychiatric drugs and another doctor being permitted to recollect ‘facts’ that just don’t add up; another mom and dad left bewildered and lost; another year, another death and still our Ministers avert their eyes and do nothing. Shame on them and the Irish Government.
The coroner, having heard arguments for the rights and wrongs of prescribing Prozac in children, said that it was “beyond his capabilities to adjudicate on Fluoxetine” but could not ‘beyond reasonable doubt’ say that Jake intended to take his own life. He then rejected a suicide verdict and returned an open verdict.
Dia leat Jake. Ní dhéanaimid dearmad ort go deo.
The last word must go to Jake. It clarifies exactly what his family have been fighting for. In an e-mail the night before his death, he said (verbatim).. “The ‘anti-anxiety’ stuff is actually an anti depressant which they didn’t tell me. Probably doesn’t make much of a difference, but I feel like I’m drugged to the point that it suppresses everything bad until it suddenly spills out.”