This post features in a series of posts on the Politics of Care Forum. It sits alongside Can Politicians Save Us, Can Politicians Save the World as well as What’s a Life Worth, Once We Were Warriors and Do Not Forsake Me Oh My Doctor. There will be a follow-up post next week.
The letter below (without the images) was sent to Eluned Morgan, Minister for Mental Health in Wales a week ago. It followed her response to a letter to her from Tania and Ian Morgan following an inquest on the death of their son Samuel in December 2020.
August 9th 2021
Eluned Morgan AS/MS
Minister for Mental Health
Welsh Assembly Government
eluned.morgan@wales.gov.
Dear Ms. Morgan
I am writing after seeing your correspondence with Ian and Tania Morgan. Over 200 drugs can trigger suicide. If a family member of yours kills themselves (or others) as a result of one of these, what happened to the family of Samuel Morgan recently will happen you also.
There will be an inquest.
The doctor who prescribed for your son, daughter or parent may be asked to be present or to prepare a report. S/he will check with their medical insurer beforehand. The insurer will advise against conceding the drug caused the problem. At the inquest or in their report, the doctor will say s/he can’t rule out the mental disorder being treated or the one that must have been there if the suicide happens after taking an antibiotic like doxycycline or isotretinoin given for acne.
Medical insurers in this case de facto shield the pharmaceutical industry rather than support a doctor to act in the best interest of the patient’s family at a moment that calls for humanity and courage. The barrister for Dr Adams, Samuel’s prescribing doctor, pushed for an outright suicide verdict rather than an open or narrative verdict.
Dr Adams seems to be a decent man. Samuel’s case was open and shut – citalopram caused his suicide. There is no other reasonable explanation for what happened.
Dr Adams knows comparatively little about these drugs and almost nothing about Samuel, having met him perhaps only once for maybe 15 minutes. Samuel had a family and close girlfriend who knew him far better than Dr Adams could possibly ever have hoped to.
At his inquest, Samuel had input from an expert who probably knows more about these drugs than anyone else in Britain and vastly more than Dr Adams and the barrister speaking for him.
Coroners are unable to say the drug caused the suicide for two reasons. First, there is no box on their forms for this that they can tick. Second, they are semi-obliged to go by what the doctor says – s/he after all is a medical professional and coroners aren’t.
The coroner may believe however that suicide is the wrong verdict and strictly speaking if a drug triggered the death, the death cannot be suicide. In this case a coroner may return an Open Verdict, or Death by Misadventure, or a Narrative Verdict. This often feels important to a family who welcome an escape from the stigma of suicide.
If it seems obvious to the coroner that a drug caused the death of someone like Samuel Morgan or Alana Cutland whose inquest was held a year ago, who had been taking doxycycline (Appendix 1), s/he may report to the medicines’ regulator (the MHRA), as Mr. Philips did in this case and Mr. Osborne in the Cutland case.
A referral to a regulator sounds good to most people, and likely to you, but regulators are bureaucrats who never go out on a limb and say a drug has caused a problem.
- The regulator will invariably tell the coroner in the case of antidepressants for instance they have done all they can to keep people safe. This is how MHRA responded in the Morgan case and right back to the first Welsh SSRI inquest report I did in 1999.
- In the case of drugs like doxycycline, the regulator will say the evidence about harms is not conclusive enough to support warnings or that they don’t want to deter people from seeking treatment, as MHRA responded in the Cutland case – when every sane person looking at the case saw a horrific drug induced suicide in a 19-year-old woman.
MHRA
Even when informed close to explicitly by a coroner of a death that looks triggered by a drug, as in Cutland case, the regulator will not agree a drug has caused or can cause a problem.
MHRA are de facto incapable of deciding if a drug has caused a problem. They are also tangled up in a web that pharmaceutical companies have spun for them.
When doctors report a problem to regulators, the regulator removes the patient’s name (usually pleading a concern about confidentiality). Once this happens no-one can establish whether a drug has caused a problem. Establishing whether a drug can cause a problem cannot be done without investigating in detail the case of the person who has been harmed. If the harm is death this means interviewing relatives. MHRA have not investigated Samuel Morgan’s death.
The doctor’s view at an inquest that a drug did not cause the problem, or failure to say it did cause the problem, is a get-out-of-jail-free card for companies and regulators. For most people, the view of a doctor who killed your family member trumps everything else.
Unlike regulators, when problems are reported on their drug pharmaceutical companies are legally obliged to investigate them. This usually means contacting the doctor who prescribed the drug and asking for the person’s medical records.
You may be surprised to know that even if the doctor has explicitly said a drug did not cause a problem, companies who work through a person’s medical records may decide their drug did cause it. This happens often in clinical trials but these conclusions are never reported in the up to 50 almost entirely ghostwritten articles that may appear in the clinical trial literature reporting the results of a single trial – articles on which NICE base their Guidelines.
How do companies come to conclusions like this? They use common sense – the problem wasn’t there before the drug was given, emerges after the drug is started or when the dose is raised, and clears if there has been a chance to stop the drug.
But in public, at court cases or inquests, the company will continue to deny a link to their drug and say that unless a randomized clinical trial (RCT) shows the problem being caused by the drug there is no proper evidence that it has been. No trials are ever done to look at a hazard and the data from the trials that are done remain inaccessible.
This speaks to the web that companies have trapped regulators in. Companies have persuaded regulators that RCTs offer gold standard evidence on what drugs do but also that a positive finding on an RCT means that the benefit-risk ratio for a drug is favourable and that warning about risks might deter people from getting that benefit.
Regulators appear incapable or unwilling to see the flaws in this argument, perhaps because it offers them a box to tick – an alibi in the event of a scandal.
RCTs can only properly investigate one of the more than 100 effects a drug has. The effect chosen is called the primary endpoint. Most people assume this is the commonest effect of the drug and other events are rare or happen if you have been the drug for a long time. This view underpins the risk-benefit argument above.
In company trials, the primary endpoint is an effect of commercial interest rather than the most common effect. In the case of SSRIs, the commonest effect is on sexual functioning. Sexual effects happen in pretty well everyone who takes these drugs, within 30 minutes of a first dose, whereas a convincing mood effect can take months to appear and is less common. Because trials are designed to focus on primary endpoints, these sexual effects of SSRIs are missed – even though companies knew they were happening from healthy volunteer trials.
In terms of risk-benefit, when companies and regulators talk about a benefit against which risks can be set, in the case of SSRIs they mean a change on depression rating scale scores. There is a minimal difference between SSRI and placebo rating scale changes that perhaps means these drugs offer a ‘X’ in the case of one person in ten who takes them.
What does offer an ‘X’ mean. No-one knows. X is a rating scale score. It does not mean get back to work or general functioning. It does not mean lives saved; more lives are lost on SSRIs than on placebo.
These drugs are now taken by roughly one in six people in Wales – not because X is a benefit but because they cause dependence and people can’t get off them. Some may think the drugs are saving their lives because they feel so bad when they miss a dose and feel so much better if they get their pills again.
In the case of women, any X there might be is likely to be wiped out by the fact they cannot function sexually, and their libido vanishes. Up to a quarter of couples in some Welsh towns are likely not making love the way they might wish.
There has been a good deal of talk about miscarriages in the UK media lately. If a woman gets pregnant, while on an SSRI, her risk of a miscarriage is doubled. If she gives birth, the risk of a birth defect is doubled, as is the risk of her child will have behavioural problems. This is all likely contributing to Welsh birth rates falling below the replacement rate.
The idea that these drugs have a positive risk-benefit balance that warrants not warning properly about their hazards is ludicrous regulatory humbug.
Warnings
Your letter to the Morgan family notes the increased risk of suicide in mental illness. Samuel Morgan was not at an increased risk of suicide from any condition he had, if he had any at all. Minor nervous conditions may even protect against suicide (Appendix 2). The suicide rate in the most severe mental illness was close to zero before the introduction of psychotropic medicines in 1955 (Appendix 3).
As you should know because of studies conducted in Wales, healthy volunteers can become suicidal, engage in suicidal acts, or commit suicide linked to their intake of these drugs. I’ve invited Vaughan Gething and Frank Atherton to look into this, but it looks like neither has or, perhaps just not passed the information on to whoever wrote the letter in your name.
Another factor in Samuel’s case is that in the United States these drugs come with a Black Box Warning. Why a warning, you might ask, when regulators and companies do not want to deter people from seeking treatment?
This is not a matter of Black Box Warnings being a thing we don’t do in Britain. The FDA took the step they did because there was no benefit to the drugs for those 25 years old and under – as Samuel was. The lack of benefit in this age group came to light after GlaxoSmithKline was charged with fraud for claiming paroxetine was effective and safe in minors, and later fined $3 billion. (Many of the paroxetine healthy volunteer studies prior to its launch were done in Wales).
Samuel was on citalopram which is equally ineffective in his age group. The first citalopram trial done in minors had one of the highest suicidal act rates. Forrest Laboratories marketing it in the US were fined nearly $400 million.
But not even Black Box Warnings make it clear that these drugs can cause suicide in healthy volunteers. There is nothing in the UK or US labels of these drugs to tell doctors what to do if a drug is causing a problem. Instead of stopping treatment, they routinely double the dose, as Dr Adams would likely have done had an agitated Samuel come back to him.
I routinely tell people that MHRA don’t see study data. MHRA say they do. We can agree they see figures – from a selected set of company trials. In addition, in the case of Eluned Morgan’s file let’s say, MHRA will see figures from an EM file but are unaware there may be up to four alternate EM files differing in length by several hundred pages in some cases (See Children of the Cure).
If someone dies in a trial or has to go to hospital because of an adverse event, companies must fill out a serious adverse event form. Or once had to. They have discovered that if investigators decide a person dropped out of the drug or vaccine study because s/he had an intercurrent illness, no report is needed.
In one paroxetine study (Study 329), four teenagers dropped out with intercurrent illness, all taking paroxetine. One of these, a 15-year-old boy, was arrested by police for brandishing a gun in a public place threatening to shoot people. He was taken to hospital. This was likely a serious paroxetine adverse event, but GSK gave him an intercurrent illness and didn’t fill any paperwork. MHRA have no idea what happened here or to the others with intercurrent illness. Access to the data really means being able to investigate what happened – that is have access to the people in a trial. MHRA have access to NONE of the data from any study they review.
There is a link between this 15-year-old boy and Samuel. There have been 45 antidepressant RCTs in supposedly depressed minors – all 45 negative, but many written up as positive. This is the greatest concentration of negative trials ever. Yet antidepressants now appear to be the second most commonly taken drugs by teenage girls and their use is fast growing.
This isn’t just a matter of doctors inappropriately pushing these drugs. Greta Thunberg’s generation have transformed our awareness of the chemicals being pumped into the environment, but they are pumping more chemicals into themselves than any previous generation. Samuel was a case in point. He pressed Dr Adams to prescribe, as do an increasing number of young people you know. Laying on therapy is not the answer because therapists routinely pressure people to get on meds.
Politics
While deferring to MHRA or NICE might look appealing, most people in Wales reading this will spot the irrelevance of MHRA, NICE, BMA or BMJ. They:
- Will be able to understand the issues and see the need for political input.
- Will be horrified that MHRA, medical insurers, and the coronial system de facto prioritize the health of the pharmaceutical industry over the health of our families and friends.
- Will be aghast at the idea that where drugs are concerned NICE guidelines are based primarily on a ghostwritten literature.
- Will be amazed that coroners can’t tick a box to indicate a drug may have played a part in a death and there is no register of drugs people were on at the time of their death.
- Will be puzzled that David Healy can continue saying these things with all the above bodies quietly agreeing with what he says, but no-one doing anything about it.
The National Health System (NHS) came from Wales. It hinged on the idea that effective treatments could be delivered for free paid for from the money saved by reducing premature mortality and disability. It cannot survive delivering ineffective and dangerous treatments.
The first mental health RCTs were done in Wales. Evidence Based Medicine was born in Cardiff. How would Linford Rees, Michael Shepherd and Archie Cochrane view the situation you now preside over?
Healthcare was once the badge of honour for progressive politicians. But the Labour party now plays into pharmaceutical company hands. It champions universal health coverage rather than universal healthcare and nowhere does this show more than with the SSRI group of drugs and what happens as a consequence to people like Samuel Morgan. Labour’s healthcare policies went out of date around 1990 when the SSRI drugs came on stream.
A year ago, the Conservative MP, Johnny Mercer, resigned from the Cabinet on a point of principle. You and I may not agree with the principle, but we can respect his view that it was a matter of honour for him. I mention Mr Mercer, as, triggered by one of his constituents, I have presented him with the same gauntlet I now present you. See What’s a Life Worth?
It’s difficult to believe there isn’t a matter of honour here for you. Can you really tolerate a total lack of access to study data and an almost complete ghostwriting of the medical literature in respect of on-patent drugs with NICE, MHRA, BMA, BMJ all saying it’s not their problem?
I will post my letters to Mr. Mercer and to you online next week. I enclose a series of links to posts that include the prior correspondence to NICE, Welsh Government and others and you are welcome to show this letter to anyone you wish to show it to.
Yours Sincerely
David Healy MD FRCPsych
Essential Resource:
Click on an entry to reveal more detail.
https://study329.org/timelines/
Click
2006 – More lawsuits are filed based on tragedies resulting from prescriptions of Paxil to young people. Conflicted apologists defend the drug under the guise of research, arguing the net benefit of SSRIs. GSK warns healthcare professionals that Paxil adds suicide risk for young adults.
Each Click will bring up important information relevant to each heading
The burden to the people when you are dead falls on them to analyse and investigate their case as best they can and to may be bring on an expert –
The Works Below far Exceed the Mealy Mouths of NICE, MHRA, BMA or BMJ :
https://ssristories.org/
https://www.antidepressantrisks.org/
https://www.missd.co/
https://www.facebook.com/stephenoneillsvoice/
and many Others in the Prescribed Harm Community who work so hard
Allen Frances
@AllenFrancesMD
·
14 Aug
I try to make self-blaming depressed patients feel guilty about #suicide: “The burden you are to others alive is nothing compared the burden if you are dead. People who care about you will be haunted by your death for the rest of their lives. You must stay alive to save them.” twitter.com/MarkLRuffalo/s…
Using ‘Guilt’ in any professional circumstance is not helpful; particularly those deaths from psychotropic drugs which should have been averted long before they happened ….
Allen Frances
@AllenFrancesMD
· 19h
Replying to @SameiHuda, @CoyneoftheRealm and @Rosewind2007
What Peter Goetszche doesn’t know about psychiatry is almost everything- but that’s never stopped him from irresponsibly scaring patients off meds they need.
Garbage in, Garbage out: The Newest Cochrane Meta-Analysis of Depression Pills in Children
By
Peter C. Gøtzsche, MD
August 19, 2021
https://www.madinamerica.com/2021/08/garbage-cochrane-depression-pills/
“The Cochrane authors miss the forest by looking at one tree at a time, and it gets worse”:
Auntie Psychiatry August 20, 2021 at 12:52 pm
The Cipriani meta-analysis (Apr 2018) did indeed get “colossal media attention” – that’s because it was a marketing exercise to promote depression pills as “safe and effective”, and it worked a treat. I illustrated how the conspirators pulled this off in my cartoon “Anatomy of a Confidence Trick.” https://www.madinamerica.com/2018/08/anatomy-confidence-trick/
The quality of the research didn’t matter a jot, all that mattered was that the public picked up the “safe and effective” message from trusted sources. Same trick being pulled now, on a global scale – works every time.
In case you missed it
https://www.madinamerica.com/2018/08/anatomy-confidence-trick/
– works every time.
This is to Eluned Morgan, Minister for Mental Health in Wales
The general public are along way from grasping the significance, depth and incredible seriousness of all this. They just can not accept that licensed drugs called medications can, in some people, turn them into potential and actual violent killers of themselves, others or both. They can and do. I’ve experience emotional lability one of the aspects of akathisia from Sertraline and then into full-on akathisia/toxic psychosis due to being pumped full of more toxic drugs. I slashed my wrist quite badly, tried to hang myself a number of times to escape the horrific horror. And I tell you from that experience David Healy is totally correct. And I tell you, if you experienced just 10 mins of what I went through for almost a year it would be blindingly clear that a major crime against humanity under cover of ‘mental illness’ is well under way.
I suggest you read: Children of the Cure, it details how all this has come about. If you have experienced emotional lability, akathisia, toxic psychosis it takes on a meaning well beyond just reading the words, the truth is extremely sickening and to know many more unsuspecting and health care trusting people suffering some low level depression, anxiety, insomnia are going to experience this horrific horror, while you will probably pass the letter to someone else, takes it to another level.
I’ve been following you, Dr. David Healy, for a long time and I’m thankful for your relentless work.
I experienced drug induced suicidal ideation and the difference from the real suicide ideation is easy, for me now looking back, to describe.
I was prescribed these drugs even though I was not depressed.
Not only SSRIs is on the list I was prescribed.
A lot of drugs.
I’m Brazilian and there’s nothing in Portuguese explaining what’s really happening.
David Healy and others were the source of understanding that made me aware of what happened to me.
These drugs took years of my life and I still take three of them. But I can say I’m lucky for I had no cognitive impairment and didn’t take my life the two times I was drug induced suicidal and prepared to “go home” while tapering Effexor.
Now I’m balanced with these three drugs my body can’t get rid off.
I wrote a book in my language but I have to remain silent. Not even close friends understand and don’t feel like listening.
Maybe I’ll upload to the bookb somewhere after revising and telling things I didn’t know when I finished it in 2008. Or translate it to English. Dunno.
For those of you who are new in this journey:
trust your instincts, research, pay attention to your feelings for sometimes it’s hard to understand what is side effect, withdrawal symptoms or a mere sadness caused by the oddness of life – these drugs turns an explainable sad reaction into a nightmare.
It’s hell.
Fight fight and fight to get better.
The journey is lonely and long depending on numerous factors.
We are all in this together. You’re not alone.
Search for those who are fighting the same battle. Usually there are forums, blogs or other sites you’ll have like minded people.
Love 💕
My email justana9@gmail.com
The one on the blog I left I no longer have and I don’t visit this blog of mine for a long time.
I’ll deactivate the comments.
Ana
Several people – mostly women – have been saying exactly the same thing to me in the last 24 hours. One talked about The Little Mermaid – you can have a place at the table provided we take your voice away.
This fits with research that shows that its effective for men to get angry but people perceive women and people of colour who get angry as being less effective. Power determines who can speak.
David
Dear Dr Healy,
Thank you for the article and understanding how women are not heard. Your interdisciplinary approach is remarkable!
One of the reasons I admire you.
It’s getting harder and harder to find physicians and scientists who have it or, at least, the average cultural knowledge to come up to their own practice.
Medicine, as you explained relentlessly, became a religion, a cult with a very dogmatic bible.
Like the monarchs they rule from the will of God.
In your article:
“…when they try stopping the drug, feel absolutely terrible and even suicidal, and feel so much better when they restart. The drug does save their life from the dependence the drug has caused. …”
This is so empowering coming from you! I came up to this conclusion “empirically” while withdrawing and noticing that when I got back to the dose I was taking withdrawal symptoms disappeared.
Side effects were a bless!
“… Pill-Shaming. Its when they mention hazards, they are treated like a threat to society – as blasphemers, slanderers, or treasonous. …”
I’ve learned to take these ad hominem as compliments and medals! 🙂
“Are you calling me crazy? You have no idea the level of my madness! If I were you I would not be next to me in any way, shape or form! You’ve better go!”
“…This reaction has nothing to do with PSSD being strange. …”
The condition entered in Wikipedia but was deleted.
I’ve seen it but I didn’t saved.
I remember the first video done by a British man explaining.
Although they will deny, deny and deny this is appalling:
Stuart Shipko MD admits that SSRIs cause sexual dysfunctions and are being used to treat sex-offenders
“…These effects have been used by medical scientists. these drugs have been promoted in same cases as treatment for premature ejaculation. Martin Kafka, a Harvard psychiatrist, has promoted the use of these drugs to reduce sexual impulsivity in sexual offenders.”…
https://justana-justana.blogspot.com/search?q=sexual+offenders
Quite an evidence for me but who cares? Circunstancial evidence.
What’s most strange about it is that not only biologically we’re affected. Fantasies become less vivid.
There are numerous heinous changes we want explanations.
What triggers the suicidal ideation and violent behavior?
” …The greatest support is likely to come from women. The mothers of children, …”
Unfortunately some family members whether women or not are not that supportive.
One of the examples I have is Tracy Johnson, a health 19 woman who hanged herself in Elli-Lilly’s facilities.
Not a word from her family and it seems their silence is due to a certain amount of money.
It’s not proven.
http://justana-justana.blogspot.com/2014/02/10th-anniversary-of-cymbaltas-victim.html?m=1
However, we always have to consider that:
“Antidepressants saved my life.”
“These drugs save millions of lives.”
For those who are new on this road study, research and use of sense of humor. It’s a great tool.
Love, another,
Ana
I’d love to read your book one day Ana. Maybe included on the list of the most honourable publishers on the planet ,Samizdat Co-operative. Many activists publish anonymously – it can be a tricky decision but it is one honourable way the truth gets out without risking repercussions. All too real as the experience of the Olympian from Belaruse revealed recently when after speaking out she was threatened with incarceration in a psychiatric insitution and had to seek refuge in Poland . There are different ways people can be coerced and controlled of course – wthholding information about adverse effects of drugs, covert suggestions of ‘involuntary’ admissions if declining drugs , warnings of being ‘difficult’ on medical notes and so on as you know. The horror is international. Really glad you posted on the blog.
Sussane,
I “finished” this book in 2008.
I have to make a lot of updates.
I’m finally enjoying life and this topic triggers a lot of sad things.
I remember walking along the streets with tears in my eyes whenever I saw a child.
I thought “I hope s/he is never prescribed any of these drugs.”
I’m changing for another house and as soon as
everything goes back to normal I’ll think about working on this project.
My experience is not mine. We feel the moral obligation to do something.
Samizdat is a great concept and remind me of my part in it.
Love
Ana
If I were still in practice as a GP in England and wanted to check out Citalopram I would head straight to the British National Formulary (BNF) published by NICE.
https://bnf.nice.org.uk/drug/citalopram.html#importantSafetyInformations
Dr June Raine (CEO of MHRA) refers to the BNF as the “GP Handbook” in her letter to the coroner.
https://davidhealy.org/wp-content/uploads/2021/02/MHRA-response-Mr-Morgan-Citalopram-suicide-warnings-coroners-report-reg-28-19-01-2021.pdf
The entry for Citalopram in the BNF highlights, in a prominent box, a potential yet very rare risk of haemorrhage after childbirth.
But on the other hand there is no mention whatsoever here about the need to monitor young adults.
Nor is there any similar recommendation in the “Patient and carer advice” section.
The preface of the current edition of the BNF states:
“The BNF aims to provide prescribers, pharmacists, and other healthcare professionals with sound up-to-date information about the use of medicines.
The BNF includes key information on the selection, prescribing, dispensing and administration of medicines….
Information on drugs is drawn from the manufacturers’ product literature, medical and pharmaceutical literature, UK health departments, regulatory authorities, and professional bodies. Advice is constructed from clinical literature and reflects, as far as possible, an evaluation of the evidence from diverse sources. The BNF also takes account of authoritative national guidelines and emerging safety concerns. In addition, the editorial team receives advice on all therapeutic areas from expert clinicians; this ensures that the BNF’s recommendations are relevant to practice.”
I don’t think the BNF includes all the key information when it comes to prescribing Citalopram to young adults.
https://davidhealy.org/wp-content/uploads/2021/08/citalopram-warning-box-1.jpg
More from Peter Selley
https://davidhealy.org/wp-content/uploads/2021/08/CITALOPRAM-_-Drug-_-BNF-content-published-by-NICE.pdf
David
How often is the BNF updated? ‘Spruce’ was doing some invetigating a while ago. If a precriber uses outdated dodgy info – and has no reliable data to access -a person is harmed -who’s responsible? Not me…not me..not me….
Thank you Peter.
During 40 years prescribing as a hospital doctor, and over 25 years of contributing to the Vocational Training Scheme in General Practice (via a full time G.P. Trainee Senior House Officer attachment to my Department) I too would have turned to the BNF for trusted and authoritative prescribing safety information. I advised our trainees to do the same.
When my treasured daughter (never, ever depressed) was ill-advisedly given escitalopram for the normal apprehension associated with a new temporary job, and an imminent exam, I had never heard of AKATHISIA. If I had, – “Inner Restlessness” – would not have begun to describe the iatrogenic, physical, emotional and psychological agony that she suffered as a common adverse drug reaction to SSRIs/SNRIs (Psychotropic and other prescription drugs). (Please see ‘Kidnapped Daughter; 1 and 2). The reality was: Writhing restlessness, astonishing increase in muscle tone and strength. overwhelming agitation, ceaseless movement, desperation to find some relief from this acute, terrifying, neurological and systemic, life-threatening toxicity.
I found nothing in the PIL or BNF to help me, a doctor, recognise what I now would see as a ‘Barn Door Obvious’ discrete ADR clinical syndrome. The next GP changed Rx to Sertraline and the AKATHISIA intensified. This lead to a misdiagnosis of “Psychotic Depression” even though ‘Psychotic depression is vanishingly rare compared with treatment induced akathisia’.
Cascade iatrogenesis and enforced, unnecessary and dangerous psychotropic medication lead to a generalised ‘psychotropic malignant syndrome’ (Independent expert opinion) and multi-systems injuries. This was serially misdiagnosed as ‘S.M.I’. An enchanting young woman had her life destroyed and a whole family was devastated. No one has ever apologised.
I await the AKATHISIA ‘grey-box warning’ on the PIL that would have given me, and her GP, the chance to save her, ten long years ago.
My understanding is that material published on the G.M.C website is intended for doctors, but ‘may be of interest to the general public’. The following is based on this understanding.
The GMC guidance: Good Practice in Prescribing and Managing Medicines and Devices, was updated,5th April 2021:
Deciding if it is safe to prescribe:
20) You must consider, — whether you have enough information to prescribe safely.
27) You must only prescribe if it is safe to do so.
28) Before prescribing you must consider whether the information you have is sufficient and reliable enough to enable you to prescribe safely.
I know that our GP trainees and our staff physicians diligently applied this same philosophy, all those years ago.
I am certain that current prescribers similarly strive to prescribe safely, based on the trusted information made available to them.
Until prescribers, and those for whom they prescribe, (and their loved ones, families and flatmates) are allowed to understand, recognise, manage and prevent the tragedy of misdiagnosed AKATHISIA, how can antidepressants be prescribed safely?
Psychotropic ADRs: AKATHISIA, Disinhibition, emotional blunting, suicidal ideation, violence toward self and/or others, toxic sexual dysfunction (PSSD. PGAD) are not confined to those who are, or who have been depressed. They are consistently reported in HEALTHY VOLUNTEER TRIALS. Shouldn’t this fact should be included in our trusted information to allow us to prescribe as safely as possible?
Hello David
I quote Lucy Johnstone in her book, Users and Abusers of Psychiatry: “Astonishingly, it is an offence punishable by two years in jail to reveal any of the information on which the Medicines Control Agency bases its decisions about drug licencing in this country. In fact, both it and the Committee on Safety of Medicines carry out their work in almost complete secrecy.” (p170)
When I asked a representative of MHRA if reports by psychiatric patients of side-effects using the Yellow Card system would be noted, she made it perfectly clear, that only reports coming from GP’s would be taken seriously (even in the case of non-psychiatric drugs). Effectively, this means that most side-effects are never acknowledged.
It never fails to amaze me how similar the experiences that appear here are, wherever on the planet they come from. It’s the need for silence, the lack of compassion, noone listening etc. that always stand out. I am intrigued by your sentence “……and the difference from the real suicide ideation is easy ……..for me to describe” – maybe you could give us a further explanation of this? I’m glad that you have recorded your suffering in a book – has it been published and, if so, are many people reading it?
The fact that you remain on Effexor – and another two drugs – is interesting as it’s a very difficult one from which to withdraw I believe. Is your plan now to remain on your present dose of your three drugs or is further reductions your future aim?
Sorry about so many questions but it would be really interesting to know more about your journey Ana.
MHRA:
About as useful as an ashtray on a motorcycle.
By not following up on adverse events sent into them via their deeply flawed Yellow Card system, they are, in essence, allowing themselves to proclaim ‘correlation does not equal causation’.
Correlation will never equal causation if one doesn’t bother to investigate it.
Meantime, the bodies continue to pile up.
The buck stops with this utterly incompetent ‘regulator’ who, it appears, cover themselves in garlands every time they shut down Joe Bloggs selling unlicensed drugs from his garden shed. Backslaps all around from those that fully fund them, namely the drug companies.
I have sick in my mouth.
Another lady who knows of what she is talking. Kristina Kaiser lends a solemn tone to the death of her daughter Natalie from prescription drugs.
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TUESDAY, 17 AUGUST 2021 AT 18:00 UTC+01
Kristina Kaiser: Teen Mental Health, Speaking Our Truths, & Akathisia 101 Courses
Medicating Normal…
It would be reasonable to think the employment of pharmacists in clinics would make a difference.
There was tension initially about what role they would have so maybe they are reluctant to question or alter the GPs prescriptions although reviews of medication are part of the job as Independant Prescribers.. Where are they getting their own information from which would I would assume be in more depth than that of GPs? They must be seeing a lot of adverse effects to drugs yet there don’t seem to be pharmacists speaking out? Would the clinics confidentiality clauses prevent them doing so?. People directed to pharmacists in surgeries these days , where there is one,need to ask for information and reasons for prescribing and reviewing and changing meds rather than assume we should simply blindly trust another ‘expert’ . They should not take that as a personal criticism but will be factor to be negotiated
in the consultation for some . I know people have had meds changed by practices using pharmacists without any discussion whatsoever . Repeat prescriptions just turned up assuming no questions would be asked.
The bug-bear is how often doctors, psychiatrists, pharmacists don’t talk to each other when supposedly looking after the same patient. A very young new psychiatrist suggested to me that she would talk to the Hospital Pharmacist to see how I could get off Seroxat. The Pharmacist came up with the idea of liquid Paroxetine and the GP received a letter telling her to work out a plan over 12 months from 40 mg. of Seroxat.
20 mg. of Seroxat had been increased to 40 mg.of Seroxat because the psychiatrist had no idea what the GP had been prescribing and she had not told him. Following the end of this plan, another drug was then introduced.
I just wonder at the hierarchy of doctors, psychiatrists and pharmacists and how it all gets muddled-up with the patient no wiser as to who knows what.
At inquests, such as that of Stephen O’Neill, that is the time they all come together, but by then its far too late to get an honest appraisal as too often they are all covering their own backs and it is academic where the fault lay if even an expert points it out, but admissions will always be that they were acting in the patient’s best interests.
If the patient is left-in-the-dark, literally speaking, all the inquests will yield is another layer of frustration and despair at the way the ‘death’ was quite possibly avoidable.
Pharmacists could have an important part to play, but if nobody talks to each other then they are all in it together…
What you say here Annie is so true. The whole system is so disjointed that each section gets away with blaming the other with no follow-up whatsoever, or at least not beyond the “we have listened and are happy that systems are in place for the desired outcome” – which is often as far as they can be from ‘being in place’. Pharmacists, unfortunately, are just as good as the rest of the ‘system’ at passing the buck. At the pharmacy :-
“No, we haven’t had the prescription from the surgery yet sorry – you need to get in touch with them”. At the surgery :-
“They have received the prescription since 3.20pm yesterday by fax- ask them to check “. Back at the pharmacy:-
“Please check – surgery staff say it was sent through yesterday”
After roughly 10 minutes of mad shuffling through paperwork ( just slightly out of my sight!) came a muffled “Found it!”
Me:- “Did you say you found it? It was here all along then was it?”
Pharmacy staff :- “Yeah, we’ve got it but the surgery has just faxed it through again now – (with a chuckle) It hasn’t been here all along, no!”
Is that really the best that we can expect or should accept? I’m not the only one to suffer this type of disjointed working. I call at the pharmacy once a month and I can honestly say that during the majority of visits some unsuspecting patient or other is sent on a wild goose chase for a prescription that had been promised “ready for collection” at that time.
Thanks Annie -Slogan for them could be ‘lets work together and save lives’ Instead we have
Hierachies and money = mistakes, harms, , deaths and cover ups
Some snippetts
……;But Dr Peter Fellows, member of the GPC prescribing subcommittee and Gloucestershire GP, said: ‘The DoH is trying to use all sorts of means to obtain cheap GPs.
‘We are worried about this development and its threat to general practice.
‘Pharmacists do have a wide-ranging training in drugs across the board, but they don’t have the associated clinical knowledge of doctors,’ he added.
‘The government hasn’t listened to the GPC and has allowed all independent prescribers to prescribe from the British National Formulary and I think that could be dangerous.’
Practice Pharmacist Salary and Benefits
Taking into account the funding provided for primary care network pharmacists posts, this suggests that practices may need to consider contributing more than 30 per cent of a band 7 salary to secure an appropriately experienced pharmacist
And
Re ‘Responsible and Accountable’ ie Let’s all collude together if something goes wrong. However ‘experienced’ or not they are.
“A pharmacist independent prescriber is a practitioner who is responsible and accountable for the assessment of patients with diagnosed or undiagnosed conditions and for decisions about the clinical management required, including prescribing”
NICE is developing a guideline on medicines associated with dependence or withdrawal symptoms, due to be published in November 2021.
Their ‘guidelines didn’t save Stephen; Amanda ;Samuel or countless others past and in future from dying horrible deaths Unless they listen to what DH has been telling them for decades (as above and countless other places) more people will be harmed, die and leave familiies and friends greiving over the pointless loss of lives.