Among the greatest triumphs linked to RxISK was Anne-Marie Kelly’s discovery that SSRI antidepressants can cause alcohol misuse.
A Hero
Anne-Marie’s story was first told in Out of My Mind Driven to Drink, which featured here in March 2012. This led to a post on RxISK Driven to Drink. Between them the posts have over 450 comments, a huge proportion of which say this describes me to a T, or I stopped the drug and I stopped drinking – you’ve saved my life or my marriage.
The posts and comments led to an article on 93 Cases of SSRI induced alcohol dependence.
Besides a magnificent scientific and medical breakthrough, there were two extraordinary features to the story. First Anne-Marie is quiet and unassuming. In a group she was in, you’d be unlikely to pick her out as the person likely to make a major medical breakthrough worthy of a significant Prize.
She had to go through what most people harmed by meds and report to RxISK have to go through. Faced with doctors telling her what she claimed was impossible, she wondered was she going mad. She even wondered if she was hallucinating. It was difficult to continue believing in herself.
Ten years ago none of us were Tik-Tokkers on the web from morning till night, but Anne-Marie began to go there and found again and again that there was evidence showing these drugs could cause exactly what she thought they had caused her. There were articles about clinical trials showing the drugs made recovery worse. There were articles about clinical trials showing that pharmaceutical companies agreed with her and thought there might be a goldmine in getting something to do the opposite to an SSRI.
She had never been to university, and had to teach herself to gauge what these articles were saying, especially when they started talking about the many different serotonin receptors.
Meeting a fabulous doctor, an extraordinary man, Andrew Herxheimer helped – he believed her.
But still nothing was easy. Sure she would be cured, she persuaded her doctor to stop her paroxetine, which he did but he put her on citalopram. Unaware she was essentially still on the same drug, she had another thicket of thorns to fight her way through.
Her doctor referred her to AA who told her that her idea her drug was causing her drinking was typical alcoholic thinking and just proved she was an alcoholic.
Another Hero
On Wednesday, Evan Wood gave a webinar for Vancouver’s Therapeutics Institute on Antidepressants and Alcohol. This was recorded – scroll down to the bottom of the page on this link or below and click play.
The lecture is one of the best I’ve ever heard. Evan like Anne-Marie is not flashy. Rather like her, he plays himself down. His talk began with all the wrong things he used to think and say to patients who came to him for help.
He describes himself as a Evidence Based Medicine nerd. So he was looking at the controlled trial literature rather than hanging everything on a case like Anne-Marie’s. He found, like Anne-Marie had, that there was a surprising amount of stuff out there pointing to more harms than benefits from giving serotonergic antidepressants to people with alcohol use disorders.
His talk wonderfully picks through his prior beliefs one by one and shows they were all wrong. For someone working in substance abuse, addictive disorders, this was quite something. It’s a world of good drugs and bad drugs and you don’t question the good drugs.
He took the story beyond where Anne-Marie and RxISK have taken it, implicating antidepressants in substance use other than alcohol and where we have tended to assume things go back to normal when you stop, he has found many cases where this is not true – once an antidepressant has established a disorder for some people that can persist after you stop the treatment.
This point should resonate with everyone who has PSSD, Visual Snow or the growing number of problems that can persist after treatment with these drugs stops.
Many of the details of his talk, including some slides, are here in this Therapeutics Initiative Newsletter – Antidepressants and Substance Abuse Disorders.
Evan disarmingly tells us how he disabused himself of some myths. What he doesn’t tell us is how he managed to persuade the rest of Canadian Addiction Medicine to accept a new set of Canadian Guidelines aimed at telling you and doctors what you can hear in this talk.
I think the only answer is that he and the evidence is compellingly persuasive. Still it has been an extraordinary achievement to get Guidelines like this in place when no regulators anywhere in the world have seen fit to say your drug may make you drink. They still tell people – Oh yes you can take these drugs and drink.
And a growing number of lives are destroyed as a result/ Lives that could be saved if it was easier to find something that gave someone who was once in a state like Anne Marie a hint that she might be right to think the way was thinking.
In between the lines of this fabulous lecture is something about more than antidepressants and alcohol. It’s about how to help people stand up to their doctors and to the system on all kinds of problems. What is stopping us all being Anne-Maries?
What is stopping more doctors from being like Evan?
I saw the video just need to watch it a few more times to absorb everything.
Evan is amazing. His is a breath of fresh air to be taking this subject seriously. It was sad to hear that alcohol and drug addiction has had little attention in the past. Maybe the powers that be don’t see alcohol or drug addiction as a priority so we are left on the scrap heap. He’s right though when he says they have had at least 20 years of genetic knowledge so should have at least seen some sort of connection with treatment. This is what I couldn’t understand either, why is no-one seeing the connection. Well hopefully they will now because its there for all to see and they can’t deny it forever.
It’s really cool and such a huge relief to have someone like Evan, a drug and alcohol specialist, take this weight on.
We all who have suffered in the past and others who are still suffering today cannot thank all of you enough. Your all amazing people every single last one of you.
I am just coming across this information and story. I drank to blackout all the time while on these drugs, I was functional. This was a 33 year deal for me, about 6 months ago, I tapered off all psych meds. And I no longer drink. It was not hard to quit without drugs on board. Now I am beginning to understand why.
I Was just thinking about the time I was sentenced to an “Enhanced thinking Skills” programme with probation. I was in withdrawal from Citalopram and was suffering terrible withdrawal effects, panic attacks being one. I was sat next to a drug addict who was very sympathetic as he said he knew how bad clucking was and legal drugs were the worst. He couldn’t understand how we were made to do an Enhanced thinking skills course either because like he said when you’re in a drug induced state you don’t think properly at all because you can’t think straight. He said what chance of understanding can any of us get from the system when the system can’t even see it in prescriptive drugs. The Probation officer let me go home and skip the course because I was suffering withdrawal to badly to attend.
The Judge needed the Enhanced thinking skills course.
I just googled “Enhanced thinking skills programme and it took me straight away to the government probation Enhanced thinking skills programme. Scroll down to see snippet.
It teaches problem solving, perspective taking, empathy, impulse control and critical reasoning. Ssris and alcohol take away all of those effects leaving you unable to partake in these courses. This is how dumb probation are. You try telling them but they either ignore you or dismiss you. This is what the drug addict was trying to tell them when you are on drugs you can’t experience these things. Your addiction is preventing you.
What is the enhanced thinking skills program?
The ETS is a 40-hour cognitive behavioural offending behaviour programme which teaches problem solving, perspective taking, empathy, impulse control and critical reasoning. It is targeted at medium- and high- risk offenders who must have the thinking deficits targeted by the programme.
Mind-boggling, Anne-Marie
You’re on a roll, so don’t want to interrupt you, as what you are saying is so interesting, from the patient perspective.
I have listened to Dr. Wood’s analysis twice now. He is a specialist physician and has pretty much done an exhaustive investigation in to why Antidepressants (and Benzos) are such a bad choice for AUD.
Including Study 329
Why it is important?
The Echo Chambers.
Publication Bias.
He rattles along and has done an outstanding job; he should know, he works in this field and clearly has done his research. His arguments are well-made, and clearly understandable. Very impressive to impact the CUD Guidelines.
Out of my Mind Driven to Drink, 2012, completely awesome.
Please do continue to add your thoughts, Anne-Marie, for sure, you have done an outstanding job.
Thank you for the opportunity to listen to this outstanding lecture. Expert content, outstanding delivery.
“If anything, I think there is an overwhelming bias towards trying to show these medications are effective”.
“I do not want to pull out my prescription pad that’s going to lead someone to drink more”.
Prescribers need negative trials to be published in order to ensure safe and thoughtful prescribing/non-prescribing.
How much safer would prescribing become if all Vocational Trainees in General Practice, and their trainers, watched this video lecture?
I was compelled by its excellence to watch it twice.
The lecture was remarkable for the breadth or breath-taking amount of evidence based content and brilliant presentation . It seems just as remarkable that Evan Wood could hold a position in the group which sets up guidelines which now gives at least some protection for prescribers to go against current accepted guidelines without being sanctioned Guidelines are just that though so some will still not change practice probably or even not be aware of updated evidence How can they keep up to date with massive amounts of updated research without it being specifically presented to them And of course those who wish to decline what is being prescribed have an opportunity, if they get hold of this information somehow, to have better consultations and information to put on their own medical records. The lecture would need some concentrated picking through though . Maybe there are extracts or precis of parts of the content which could be useful if done by members of the group and not picked up and scewed by less trusted parties. .
The co-operation is remarkable Do the guidelines now apply all over Canada or just Vancouver.
The Therapeutics Initiative (TI) was established in 1994 by the Department of Pharmacology and Therapeutics in cooperation with the Department of Family Practice at The University of British Columbia with its mission to provide physicians, nurse practitioners, pharmacists, allied health professionals & the public with up-to-date, independent, evidence-based, practical information on healthcare interventions.
To reduce bias as much as possible the TI is an independent organization, separate from government, pharmaceutical industry and other vested interest groups.
The Guidelines were published in the Canadian Medical Journal over 15 months ago – see A Medical Triumph – a post on RxISK in October 2023. https://rxisk.org/a-medical-triumph-that-took-a-decade/
Even though they have been sitting there for 15 months there is no budging from MHRA about this risk or from the NHS in Britain who are or were conducting a survey last year on possible Guidance for the management of Alcohol Use disorders. NHS are/were exploring what anyone who wanted to make a submission – semi-advocating for more of – thought about exploring prior maybe even past life traumas in people who were resistant to recovery. There was no mention of a possible role for the meds people were on.
As far as I am aware there was no movement among folk on RxISK – apart from the 3/4 people affected besides Anne-Marie to draw this to wider attention.
Katinka Newman had a Daily Mail article about SSSRs and alcohol some months ago which led to the usual reactions – lots of comments that it was people’s depression that needed treating that was causing the problem and don’t be ridiculous – how could an antidepressant cause this.
This story is an extraordinary triumph for the message that The Motivation of ordinary folk is often worth more than Medical Expertise but none of the harmed community is celebrating it – none are marching on Downing St, Washington or Ottawa.
Rather than asking what’s wrong with doctors – maybe we should ask what is wrong with us
D
I think people in general especially daily mail readers see anything to do with alcohol or illegal drugs as self-inflicted injuries and think people are just using any excuse to excuse their behaviour. They don’t understand the workings of the drugs and how it affects people and some readers are not interested either. I see their sarcastic comments on many articles on different subjects.
I noticed better comments on the Australian article so I think the Australian readership are better educated and more sympathetic and outspoken people.
Personally I feel more people need to speak up rather than leaving it down to just one or two people. Like the pssd or the withdrawal group it would make a huge difference I think.
I also feel some people feel ashamed and blame themselves even when they feel it is the drug causing it or they fear people not believing them. I also think people fear speaking out may back fire on them and cause them more problems like that lady in Canada wanted to remain anonymous because she has a business that could be affected by telling her story. Which I also understand. Some people may have kids and are afraid of social services e.t.c so many reasons why people won’t speak out which I understand as well. Other side effects are maybe easier to speak out about than the alcohol one.
It’s a really hard one to deal with.
Hi Anne-Marie. There are a few in our group who would love to share their stories with you in person. To that end, I have sent you an email earlier this afternoon – hope you received it! Keep sharing – it’s the only way forwards.
“I think people in general especially daily mail readers see anything to do with alcohol or illegal drugs as self-inflicted injuries and think people are just using any excuse to excuse their behaviour. They don’t understand the workings of the drugs and how it affects people and some readers are not interested either. I see their sarcastic comments on many articles on different subjects.”
This is absolutely the case. In the setting of a psychiatric hospital it is horrendous. Those who have alcohol and street drug issues are targeted and it’s all around abuse.
Listening to the presentation I wondered about the role of B6 in people who have an alcohol disorder being as it impacts GABA and glutamate function.
Interesting this paper from the 70’s:
Vitamin B6 metabolism in chronic alcohol abuse The effect of ethanol oxidation on hepatic pyridoxal 5′-phosphate metabolism.
https://pmc.ncbi.nlm.nih.gov/articles/PMC301849/
SSRIs in some people may cause alcohol use because alcohol use can relieve akathisia. Both alcohol and P-5-P are diuretic and it looks to me like akathisia is caused by fluid retention. Both alcohol and large doses of B6 – P-5-P and SSRIs can all cause peripheral neuropathy.
D
Watching Evan Wood, a clinical scientist doing a live demo of evidence based medicine – not parroting ‘TRUISMS’ – was quite something. The drugs make the patient WORSE. QED. END OF.
It clearly isn’t though, since some of his peers, seem to be fighting back – in the time honoured style to which we’ve become accustomed – methodological nit-picking. This can be a life’s work it seems, especially for those supported by companies.
https://www.cmaj.ca/content/196/10/E346
It’s like theoreticians live on another planet – aliens disconnected from patients who know their own know. Just like Anne Marie – to whom congratulations for refusing to give into oppressive medical nonsense – you only have to look at threads on reddit – where there are real people describing similar experiences:
‘Yes, absolutely. SSRIs – Lexapro, Zoloft – made me just crave whatever. Food, alcohol, and smoking. I was only able to stop drinking after I went off. My anxiety is pretty bad though but I’m scared to try again.’
‘I’ve been on Prozac since I was 14, which was before I started drinking, but it was a low dose – I’m late 20s now. My dosage has increased over the last few years, and so has my drinking. I blackout multiple times a week and hate it – but the blacking out makes me more anxious and depressed and that’s why I need the higher dosages now’.
One was lucky and found an informed psychiatrist.
‘I went and sought out the best local psychiatrist I could find, and he was the one who told me that the inappropriately prescribed antidepressants might have played a part in nudging me toward heavy drinking.’
Others got the ‘TRUISM’ treatment.
I have spoken to my Dr about this. THEY SAID IT WOULD BE UNUSUAL FOR AN SSRI TO BE A TRIGGER FOR DRINKING AND ADVISED TO INCREASE MY ZOLOFT DOSE.’
https://www.reddit.com/r/stopdrinking/comments/113fr3s/ssri_and_alcohol_cravingstolerance/
Of course, the latest blockbuster wonder – Ozempic – seemingly an omnipurpose commercial dream – is now being billed as an antidote to AUD.
Companies spin the magic as, ‘by modifying these neural circuits, Ozempic could attenuate alcohol’s pleasurable effects, thereby reducing its attractiveness and possibly promoting abstinence.’ Well, I suppose it does interfere with satiety mechanisms- so not impossible.
https://www.healthline.com/health-news/real-housewives-ozempic-alcohol-side-effects#Why-people-using-Ozempic-have-can-have-negative-reactions-to-alcohol
But, as ever, the real scoop comes straight from patients:
‘For me, it was a total nightmare. Two glasses of wine over a long dinner made me violently ill the next day. Like a hangover times 1000. I was vomiting undigested food and then bile. It was a whole situation. I could have sworn I had food poisoning but I was the only person who got sick’.
‘They likely just advise against it because it could EXASPERATE (sic) the side affects.’
‘It depended on what I drank. One beer I was fine. A sugary cocktail made me queasy and vodka I threw up a lot. But oddly there is absolutely no craving to have any at all.’
Commonsense – based on patient experiences – suggests that SSRIs drive you to drink – whereas semaglutide makes you throw up. Not a great choice.