Pharmacosis: terminator algorithm

The single commonest question to Rxisk.org has been about dependence on and withdrawal from treatments, such as anticonvulsants, statins, diuretics and others. We often think that it is only drugs of abuse that can cause dependence and withdrawal but in fact an astonishing number, perhaps most medicines, can cause problems (see Medicine Induced Stress Syndromes, Dependence and Withdrawal, Halting Antidepressants).

Rxisk.org is the only website that attempts to establish whether you might have become dependent on or have a withdrawal problem from your treatment. Neither controlled trials nor epidemiological studies conducted when the drug is given to treat an illness reliably give us this kind of information.

Studies in healthy volunteers are much more informative and in the case of some SSRIs had given convincing evidence of problems 25 years or more before companies conceded there was a problem. But the data from these studies is buried.

Even though antidepressant withdrawal was first described in 1961 and even though some companies have since gone as close as they can to openly telling doctors that competitor drugs may come with serious withdrawal problems, most doctors still don’t realize that all antidepressants can cause withdrawal.

Withdrawal effects can come in the shape of rebound syndromes, stress syndromes, legacy and other syndromes. Few doctors ever consider some of these possibilities.

These are the questions we ask you on Rxisk, that are of the type an expert would ask if they were attempting to link your treatment to dependence and withdrawal but they focus on rebound and stress syndromes rather than legacy and other effects.

Rxisk Terminator Algorithm

    1. Are there previous reports of withdrawal effects from this drug in the Rxisk or FDA database, or on Google?
    2. If you reduced the dose of the drug did the problem start before or after reducing?
    3. Was the problem different to your original condition?
    4. If you stopped the drug, did the problem start after stopping?
    5. If you restarted the drug, did the problem clear up?
    6. If you increased the dose of the drug, did the problem improve?
    7. How soon after restarting the drug or increasing the dose did the problem improve?
    8. If you tried a related drug did the problem clear up?
    9. Have you ever had withdrawal effects before on another drug? Was it on the same type of drug?
    10. Have you had other drugs of the same type? Did you have a similar withdrawal effect on them?
    11. Could anything else be causing this event?

 Rxisk Score

Rxisk Score
 9+  points strongly to a linkage – take this timeline to your doctor/pharmacist
 4-8  points to a linkage – take this timeline to your doctor/pharmacist for input
 1-4  not enough information to confirm a linkage – take to your doctor/pharmacist
 0  at present unlikely to be a withdrawal effect

 

Other Beasts in the Jungle:

Drugs for osteoporosis alter the bone architecture of women taking them. These changes to bones may last for years after stopping the drug and put the women at risk of breaking long bones such as her femur. A fracture that happens 6 months after a drug is stopped is not likely to be linked to an earlier treatment.

In just the same way, there are almost certainly a number of other conditions that a treatment may trigger that only show up months or perhaps years later. For this reason on Rxisk we ask you about drugs you may have stopped months previously.

Any drug that has been released since 1990 should be considered a possible candidate for problems that appear months after it has been stopped. This is likely to be even more true for the biologic group of drugs now being used widely for a range of conditions.

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Pharmageddon

Pharmaceutical companies have hijacked healthcare in America, and the results are life-threatening.

 

Dr. David Healy documents a riveting and terrifying story that affects us all.

 

University of California Press (2012)

 

Available on Amazon.com

 

Comments

  1. “Talk to your doctor” cry the ads in magazines and on TV commercials [in the US]
    “Talk to your doctor” cry the drug company patient information leaflets that accompany most prescription pills.
    “Talk to your doctor” cry the drug companies when one writes to them seeking advice on withdrawal problems.
    “Talk to your doctor” cry the medicine regulators when one seeks advice from them on drug withdrawal.

    The doctor has become the prescriber and withdrawal expert overnight it seems when in actual fact the only advice given to doctors by drug companies is that these drugs, although not recommended for certain populations, are widely prescribed by many doctors. It’s promotion by proxy and buck-passing of the highest order… it’s also fraud.

  2. dearieme says:

    Statins? So as well as giving no benefit to several categories of patients, and doing harm to many patients, they can cause withdrawal problems too? The scandal gets worse.

  3. @ dearieme, I have read some of the accompanying material that Professor Healy has provided on this subject. From my understanding an example of a Statin withdrawal effect would be a rebound effect such as an increase in clotting.

    http://davidhealy.org/wp-content/uploads/2012/06/DBM-Paper-Medicine-Induced-Stress-Syndromes.pdf

  4. I was destroyed by Cipro, stole a year of my life. Misprescribed for sports training injury which arose from a rare bone condition discovered a few months after severe ADR. That condition I was advised required major surgery and bone drugs ie bisphosphenates. Refused both, almost 18 months on I have no problems with the bone I was told would break but still have side effects from the Fluoroquinolone. Pharma is seriously under regulated and Doctors ignorant of harm drugs they prescribe are doing. Current corrupt model maintains iatrogenic disease which keeps the money rolling in.

  5. The primary problem is that psychiatrists are not councellors.
    If you get to the point whereby a psychiatrist is involved, then, yes, Irene, pills are produced to solve the problem. They seem incompetent to know any other way.

    The gp who pushed me into this direction, was Indian, he was quite honest, in telling me that he had no idea how to address my problems. He suggested the psychiatrist who as you rightly say, has no idea how to address the problems either so starts the pill-popping scenario.

    How I craved a woman to talk to, just someone to listen and understand and help me make a few choices.

    But the direction I ended up in, with pills, pills and more pills made me a humungous wreck and that is pretty much unforgiveable.

  6. One step forward, two steps back. The better news is that the New York Times has just published a lengthy article on the dangers of the PPIs that should have been obvious to anyone years ago. One cannot change a part of the body meant to be acidic to relatively acid free without multiple negative results. P.P.I.’s like Prilosec, Prevacid and Nexium to reduce stomach acid are the third highest-selling class of drugs in the United States, after antipsychotics and statins, with more than 100 million prescriptions and $13.9 billion in sales in 2010, in addition to over-the-counter sales. The adverse effects include anemia, osteoporosis leading to fractures of the hip and femur, increased susceptibility to pneumonia in the elderly, high risk of claustridium difficile, impaired absorption of magnesium, calcium and B12. And what do we hear yet again? “Studies have shown that once you’re on them, it’s hard to stop taking them,” said Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston. “It’s almost like an addiction.” Hmmmm.

    Next, we find Simonoff et al “Randomized controlled double-blind trial of optimal dose methylphenidate in children and adolescents with severe attention deficit hyperactivity disorder and intellectual disability.” This article starts with the astonishing statement that “Attention deficit hyperactivity disorder is increased in children with intellectual disability”. Let’s compare that with several articles stating, as a given, that depression is common in persons with dementia. The term “dementia” has, unfortunately, become regarded as synonymous with Alzheimer disease, ignoring the fact that there are several types of dementing illness often confused with delirium, adverse drug reactions, hyperthyroidism, mini-strokes, low B12 (PPIs anyone?) and a host of other conditions. But look at what is being claimed. Two groups, the developmentally and cognitively impaired young and the equally impaired older person most, if not all of whom, are unable to communicate effectively are judged, on the basis of their behaviour, to have conditions deemed to require medications. My question has always been, and remains “How do you know?” How do you know whether or not these individuals are in pain, just hopelessly miserable because of life circumstances, behaving in ways caused by underlying pathology and so on. What arrogance to assume the presence of disorders that cannot be verified. Of course, the market for drugs grows exponentially larger and isn’t that what it’s all about?.

  7. My day got worse after the above comment. I was reminded of something my elderly patients used to tell me all the time: “Don’t grow old my dear, or, if you do, don’s do it alone.” A new article brought on this particular cri de coeur:
    Antidepressant Prescribing in Older Primary Care Patients in Community and Care Home Settings in England and Wales
    Harris T; Carey IM; Shah SM; DeWilde S; Cook DG. JAMDA 13 (2012) 41e47
    It is remarkable for a number of issues but, in particular, the following:
    “Most antidepressant prescriptions in both community and care home settings were for SSRIs, recommended because they have fewer side effects.”.
    “Twenty-eight percent of community patients prescribed antidepressants in the last 3 months had no record of a diagnosis of or recent symptoms of depression or anxiety, consistent with another UK study. The higher proportion with no recorded indication in care homes (43%) could be because of inappropriate antidepressant prescribing without a clear indication, or could be explained by several other factors: the higher dementia prevalence making depression assessments more difficult and therefore making depression less likely to be recorded as an indication; the fact that most UK general practitioners visiting care homes will record details on the practice computer system later on with potential for incomplete data entry; and the possibility that more care home antidepressant prescribing could have been initiated by secondary care.”
    I am beginning to suspect that should I ever be so unfortunate as to be incarcerated in a nursing home I would be the “troublesome patient” who, after forming Hell’s Grannies with scythes on my wheelchair and rivets on my gauntlets, would be “sedated” with mega doses of antidepressants, antipsychotics and whatever else came to hand having been diagnosed as demented/psychotic/depressed or some such combination. Scares the daylights out of me.

  8. Most of us may be incarcerated in a care home at some awful point in the future, but we have our armour, Irene, ‘the knowledge’. As with taxi drivers who have ‘the knowledge’ in London and take an exam for it, us oldies will refuse all medication because’ we now know’ the A to Z of the ‘drug’ map’ and we, could also pass an exam on it.

    That is worth a million bucks and will keep us safe and protected and so, so, knowledgeable, compared to all those surrounding us, drugged up to the eyeballs.

  9. The Plea Agreement between GSK and the US government for $3billion for fraud is as interesting for what it doesn’t contain as for what it does. The agreement names three drugs by brand name: Wellbutrin, Paxil and Avandia and orders “Restitution to any victims of the offense.” The case includes selling Paxil for children and Wellbutrin for weight loss. It also identifies Flovent, Lamictal, Zofran and others. I predict that the actual facts of this case will escape the notice of both the general public and a majority of physicians. The fraud is for promotion of these drugs for “off-label use” i.e. prescription for conditions that were never included in the original trials and marketing of the drugs. Also, note that nowhere does it identify Zyban which is, of course, Wellbutrin by another name. People taking it for smoking cessation are, for the most part, unaware of its real nature and also notice that it causes weight loss. If this isn’t a form of “off-label use” what is it? And how did that one get past the court?

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