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?
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