The first descriptions of a drug causing suicide came in 1955. A few years later in 1958 and again in 1959 the problem was described with imipramine. Treatment induced suicide became a prominent media issue in 1990 with a paper by Teicher and Cole. But it was not until 2004 that regulators and companies conceded that these drugs can cause a problem. There are now 38 drugs listed as causing suicide, including drugs for asthma, obesity and skin conditions in addition to antidepressants, anticonvulsants and antipsychotics.
The first descriptions of risk-taking behavior on l-dopa were described in 1981. Similar problems were described shortly afterward for dopamine agonists given for Parkinson’s disease. Dopamine agonists are now also given for minor conditions like restless leg syndrome. The problems were serious – judges and clergymen were arrested for gambling, prostitution and other risk seeking behaviors (see Dopamine Agonists & Parkinson’s Disease). But it was not until 2008 that regulators finally conceded that these drugs given for Parkinson’s disease could cause these risk-taking behaviors.
When it comes to side effects, doctors are flat-earthers
The moral of the story is that it can be decades from the time that a problem is first described to the point your doctor gets to hear about it and even then he may not be likely to believe it. When it comes to side effects, most doctors are Flat-Earthers, partly because it’s not a cause for concern for them in the way that it is for those they put on treatment.
There are a number of steps we take you through at RxISK.org to establish whether your drug is causing your problem – whether you are suffering from Pharmacosis or not. This will work for problems known to be caused by the drug but also for problems not yet linked to treatment. These are the steps that any expert would take you through before deciding there was a linkage. These are the steps pharmaceutical companies routinely work through, based on which they often decide their drug has caused a problem, while still denying in public that it does so.
These are the kinds of questions that need to be asked even when it is known that a drug does cause suicide, gambling, heart attacks or some other problem. Just because someone has begun to gamble or been violent and is on a drug that can cause violence or gambling does not mean the drug has caused the problem. A judgment is still needed as to whether the drug is likely to have played a part or not. Ideally this will be a team judgment – involving the person affected and as many others as possible.
Some of the steps outlined here can be found in other algorithms of which the most famous is the Naranjo algorithm but we ask more questions and score things differently.
Pharmacosis trigger algorithm
|points strongly to a link – bring to your doctor/pharmacist|
|points to a likely link – bring to your doctor/pharmacist|
|needs information or input from your doctor/pharmacist (Qs 13, 14, & 15 in particular)|
No simple score can tell whether a drug has caused a problem. It needs a team and research and judgment. The person on the drug is critical – no-one knows what is going on quite the way the person on the drug does (see Unbearable lightness of being), and as history shows people on the drugs often get it decades before the experts. But there are many side effects that need judgment calls from doctors or pharmacists or increasingly anyone armed with Google and prepared to research things (see Out of my mind).
Birth defects in general like the phocomelia caused by thalidomide cannot be tested by challenge, dechallenge or rechallenge. Babies had been born limbless and deformed like this before thalidomide but it suddenly became a lot more frequent.
Just like phocomelia on thalidomide, conditions that looked like tardive dyskinesia happened before the antipsychotics, but were a lot more common after the antipsychotics were introduced. In this case though the tardive dyskinesia that appeared on the drug cleared up if the dose of the drug was increased – could this be caused by the drug? Scoring on the Rxisk Trigger algorithm might not point to a link but scoring on the Rxisk Terminator algorithm in the next post might have helped to bring out the link.
Ultimately the more reports shared among the greatest number of people the more likely we all are to find an answer (see Unbearable lightness of being).
RxISK.org has gone live in Beta for feedback as of today June 18th.