When she sent Margaret’s Story to us, M had already written to Britain’s Suicide Czar, Louis Appleby. She got the following response:
Dear Mrs
Thank you for taking the trouble to contact me. I am so sorry to hear about the death of your son. Those of us who work in suicide prevention are always aware of the individual tragedies that lie behind our figures.
The problem of agitation in the early period of treatment with SSRIs has been known for several years, at least to psychiatrists. I think you are commenting on front-line A&E staff and if so, I suspect you are right, that many will be unfamiliar with the side-effects of SSRIs as they are not specialists in mental health. I have forwarded your note to my Department of Health colleagues who are preparing the final suicide prevention strategy – analysing the consultation responses has taken a lot of time and they are still working on this. I will also raise it when I meet the College of Emergency Medicine shortly.
As you will appreciate, one of our biggest concerns in preventing suicide is still the under-treatment of depression in primary care. One reason for this has been the reluctance of many depressed patients to take antidepressants. SSRIs have helped here because in general their side-effect profile is more acceptable than that of the older tricyclic drugs, and because taking them is usually a matter of only one tablet a day. However, SSRIs are not without their own risks.
Thank you again for writing.
With best wishes
Louis Appleby
But there is no evidence that suicide rates would be reduced
The argument that we can’t warn because it will deter others from seeking help first surfaced at FDA hearings on Prozac and suicide in 1991 (See Pharmageddon). If there were any evidence that anyone’s life was being saved this might be one thing, but there is no evidence that suicide rates would be reduced if we got everyone who could be treated with SSRIs and related antidepressants onto them.
The data shows a net harm, even when FDA stripped the suicides and suicidal acts linked to withdrawal out of the picture in 2006. Adding withdrawal suicides back in makes the risk of treatment look even worse.
It’s difficult to see how Dr Appleby or others expect to get many more people on antidepressants than we now have. We have had 20 years of perhaps the most successful marketing campaign in history, a campaign that has even managed to persuade parents and doctors that pre-school children are depressed and in need of antidepressants. The vast majority of these and of anyone else who might be likely to end up on antidepressants are at a vanishingly small or no risk of suicide.
The biggest single reason people might not end up on an antidepressant in recent years is down to pharmaceutical company marketing of bipolar disorder and efforts to persuade doctors to prescribe anticonvulsants or antipsychotics rather than antidepressants.
What is an antidepressant?
Let’s step back and ask what an antidepressant is. An antidepressant is a drug that gets through current testing procedures put in place by regulators like FDA. The current testing procedures are such that if two glasses of good red wine per day were put through the kinds of trials in the kind of patients that brought SSRIs on the market, the wine would show up as being just as “antidepressant” as SSRIs do. There might even be less evidence of suicide risk with wine compared to SSRIs, but whether less than or the same as SSRIs, if the argument were put forward that we must avoid warning about the risks of alcohol because we don’t want to deter others from getting started on it, what would we think was going on?
A covert vaccination program..?
If there was a good reason to think that SSRIs could somehow reduce rates of suicide, despite the evidence, the failure to warn about the risks in order to increase the numbers likely to be put on the drugs comes close to a covert vaccination program. All will be treated in the expectation that more will be saved than lost as a result.
A curious vaccination program in that with a vaccine while some lose everyone stands to gain but in this case a majority of those being vaccinated have little or no conceivable gain. A curious vaccination program in that doctors aren’t actively on board with it. They are as much in the dark as to what is going on as everyone else, maybe even more so. They haven’t been told there is a good case to warn but we aren’t going to warn for fear of deterring you from putting as many people on pills as you can.
This under the radar “policy” appears to have come out of meetings between a few bureaucrats in FDA and company people in Lilly, over 20 years ago.
A standard bureaucratic dismissal
Louis Appleby’s letter to Margaret seems like a standard bureaucratic dismissal. Over 10 years ago, aware of some of the individual tragedies behind the figures and of company documents conceding the drugs caused suicide, I tried to engage with MHRA – the entire correspondence was posted on socialaudit.com and part is on healyprozac.com. I asked them to show me where I was wrong as I would feel a moral obligation to stop talking about the risks of SSRIs if there was evidence they did more good than harm. I met MHRA on several occasions but despite an open invitation to them to tell me where I was wrong was never given any information.
It makes no difference to a bureaucratic machine if Margaret and others write forever.
A Platonic Lie is when a ruler decides to keep the truth from his subjects in what he determines to be their best interests.
The bottom line is that a few of us, who are still here to tell the tale, were very close to a harrowing death from withdrawal from an ssri and all the complaints in the world to all the right people result in a total lack of understanding or even interest.
I, for one, can understand why they don’t understand.
Unless you have experienced all the terrible side-effects yourself, no-one understands and will never understand. My family didn’t understand, my gp didn’t understand, the psychiatrist didn’t understand, all the communications with the MHRA led me to believe they didn’t understand either.
SSRI withdrawal is horrific.
Cold turkey is life threatening.
If I had been told that I would spend two years virtually curled up underneath the duvet, shaking, sweating, nightmares, panic, anxiety, crying, sobbing, hysterical, paralysed with fear as to what was happening to me, exhausted and confused would I have taken the pill, not on your life.
So, I had no idea what was wrong with me because nobody told me. There was no nice, kindly doctor who could treat the ‘illness’ because they didn’t recognise the ‘illness’ as severe adverse drug reaction and because they didn’t understand, they started to become just a little bit abusive.
Having to suffer a ‘mind’ problem from ssri withdrawal and then suffer an abusive reaction as well is pretty shitty when you end up trying to kill yourself and they are still telling you, it’s all in your mind.
Yes, it is all in your mind.
Eight weeks cold turkey from Seroxat resulting in attempted suicide and two years of hell, I wouldn’t wish on anyone.
After living through all that and coming out the other end, has been the most absurd and diabolical journey and if we can all help Professor Healy, let us now do so.
Of all the dishonest defenses of the widespread prescription of antidepressants, waving the bloody shirt of suicide has got to be the most pernicious.
In the US, the suicide rate of .01% (NIMH) has been unchanged for 50 years, even throughout the heyday of antidepressants. On a large scale, the beneficial effect of antidepressants on suicide is non-existent.
Even that depression precedes completed suicides is merely a logical assumption. The debate over assisted suicide demonstrates that mental derangement is not a prerequisite for suicidal intent. Suicide has long been used as an extreme form of political protest; in some cultures, it is an appropriate response to disgrace.
Yet pharma and medicine use the horror of suicide to justify extremely questionable treatment recommendations for anything resembling “depression.”
According to the US NIMH, there are 11.3 suicide deaths per 100,000 people (.01%), or 33,900 US suicides per year. For the sake of argument, let’s say the risk of suicide is confined to those suffering Major Depressive Disorder; estimated in the US at 6.7%, or 20,100,000 people. The risk that any of one of these people will suicide is .16%.
The assumption that someone with the extreme condition of MDD will suicide yields a false positive rate exceeding 99.8%, yet experts like Louis Appleby urge that anyone with even a vaguely defined “depression” be medicated to prevent suicide.
Here, he is saying even the cost of a life due to uninformed A&E staff is worth the effort to stamp out the ever-elusive risk of suicide.
In any other field of medicine, a false positive rate exceeding 99.8% would make a doctor think twice about prophylactic medication, yet when it comes to antidepressants, the threat of suicide — dwarfed, in fact, by the risks of the medications themselves — is inevitably brought out as a rationale for indiscriminately drugging large swaths of the public and subjecting them to fairly dramatic adverse effects.
How could this possibly be called evidence-based medicine?
All the statistics you quote, do not alter our own personal experiences. The facts also speak for themselves. We should take into account the concerns of eminent clinical pharmacologist Dr Andrew Herxheimer that emphasis in research is on benefits and not harms of treatment.
10 years of UK hospital admission statistics, show that the largest increase is due to adverse drug reactions (ADRs) which has risen by 76.8% – analysis done by Imperial College.
Iatrogenic (treatment induced) illness is a public health crisis. Professor Munir Pirmohamed’s well known study of hospital admissions, that excluded psychiatric, & paediatric admissions, showed 1 in 16 were due to ADRs.
A study in Liverpool of children who die or suffer ADRs has already found serious problems, not least of which is how unaware the parents are of the possibility of ADRs.
Awareness a drug is linked to suicide will not stop someone who needs it from taking it. However forearmed is forewarned and knowledge may reduce the number of avoidable deaths.
All kinds of medication can cause mental changes. The manufacturers are aware of this. Sadly in the UK, since the General Medical Council guidelines for medical education were changed in 1993 – to exclude Pharmacology and Therapeutics, doctors have qualified without having to prove competence to prescribe. The do not have to know about psychiatric adverse side-effects. Most have never read the data sheets produced by the manufacturers. Everyone should see these, they clearly state the psychological risks that are well known. Professor Simon Maxwell asked medical students if they felt competent to prescribe and most said ‘no’.
The British Industry web site has data sheets which are called SPCs http://www.medicines.org.uk
Today would have been my daughter Karen’s birthday. Her death in an avoidable accident was preceded by.
Pychosis and Stevens Johnson’s skin adverse reactions to a sulphonamide drug (all known adverse side effects but not always clearly indicated on patient information).
Depression following taking a drug for hormonal problem, well known to cause depression.
Akathisia – extreme agitation preceded by a headache following taking just one tablet of fluanxol an antidepressant.
She went to see the doctor but was turned away as she had no appointment. Came home and took some sleeping pills to ‘calm herself down’ …a typical reaction to akathisia is to self harm to let out the painful agitation ‘ like wanting to jump out of my skin’ one person explained.
For the rest of this list of adverse drug reactions Karen suffered, see the web site for APRIL, the charity I founded http://www.april.org.uk
Once I put up the web site – the personal stories started to come in. Shocking details of how people were adversely affected mentally by drugs.
A man wrote to me ‘ I dreamed I was hitting my wife and when I awoke, I was’. another said ‘ I tried to push my wife out of the car – I don’t know why’ . Both men had just started taking the antidepressant Seroxat.
A headmaster fell on to a motorway, he could not remember what happened, he ended up in a wheelchair.
He had been prescribed an antidepressant, Mirtazapine, not for depression but for re occurring sore throat!
The Drug Safety Research Unit did a PEM study – post marketing study – on Mirtazapine, they found serious ‘unlabeled’ adverse reactions reported by patients who were taking the drug. I asked the Director Professor Saad Shakir, why he did not insist the regulator (MHRA) took action to add the agitation, aggression etc to the patient information and he said ” I am an academic scientist and I published the paper, that is all I have to do”.
I found a similar attitude when I spoke to Professor Louis Appleby and asked why in the Suicide Prevention Strategy for England, there is no mention of medicication causing akathisia and suicidal feelings and actions. He told me he woud ” address this”. If there were warnings about the possibility that sudden changes in a person, either becoming high, manic, or very down, could be due to the treatment, lives could be saved.
I have been communicating with Professor Appleby for 10 years, to try to have the well recorded risk of suicidal feelings due to prescribed drugs or withdrawal effects, recorded in the Suicide Prevention Strategy. So far to no avail.
He admits in the letter to Margaret on this blog, that more education is needed, well he is head of mental health, so how about it Professor Appleby? Awareness among health professionals could save lives.
Apart from my daughter, I know of several instances where people feeling suicidal or agitated have been turned away by GPs or from the A & E departments instead of action being taken to care for them in this vulnerable state. One young man, a medical student, Jon Medland, had been to his GP, another, James, son of Clare Milford-Haven who told her tragic story at our last conference, had been to a walk-in clinic and then to A&E where he was graded 4 and told to wait. Tragic consequences could have been avoided.
A & E personel, GPs and medical receptionists should be trained to recognise those at risk of suicide, as being people recently prescribed SSRIs, corticosteroids or following surgery. Addiction to codeine benzoidiazepines and sleeping pills are other areas where improved medical education and availability of withdrawal protocols could prevent suffering and tragic consequences of too sudden withdrawal.
How can Louis Appleby consider it acceptable for the knowledge of SSRI risk, particularly in early weeks, to be information held chiefly by psychiatrists and mental health specialists and not spread any further!
Most people on SSRIs will be watched over by family and friends, how can there be such complacency about failing to warn them of risk? This is irresponsible and outrageous. The significant risk times are at the beginning of treatment and if altering the dosage. Not exactly a difficult message to communicate – if the will were there.
In their PILs, drug companies advise patients to look to GPs or A & E for assistance if experiencing urgent suicidal thoughts. It would seem that GPs and A & E have not been adequately instructed about how to deal with this drug company advice, and so there appears to be no recommended programme of support in place at this point of crisis.
Agreed, it is quite absurd that he minimizes the problem by saying it’s only that “front-line A&E staff…[are] unfamiliar with the side-effects of SSRIs as they are not specialists in mental health.” It’s the College of Emergency Medicine’s problem.
Who does he expect will deal with sudden and dramatic adverse effects of psychiatric medication?
Dr. Appleby’s exchanges with the College of Emergency Medicine should be closely monitored — if they occur at all.
How would Orwell have described the current situation vis-à-vis physicians and “wonder drugs.” I believe he would have described this as a state of bellyfeel, blind, enthusiastic acceptance of an idea. Any good psychiatrist should be able to internalize Pharma doctrine to the extent that it becomes a gut instinct – a feeling in the belly.
Blackwhite is equally essential. As Orwell wrote in 1984 “..this word has two mutually contradictory meanings. Applied to an opponent, it means the habit of impudently claiming that black is white, in contradiction of the plain facts. Applied to a Party member, it means a loyal willingness to say that black is white when Party discipline demands this. But it means also the ability to believe that black is white, and more, to know that black is white, and to forget that one has ever believed the contrary. This demands a continuous alteration of the past, made possible by the system of thought which really embraces all the rest, and which is known in Newspeak as doublethink.”
Blackwhite is the result of indoctrination, or repression of one’s individual critical thinking.
Those of us who contribute to this blog are guilty of Thoughtcrime. that is, thoughts that are unorthodox, or are outside the official, accepted platform.
We may also be guilty of Duckspeak meaning literally to quack like a duck or to speak without thinking. Duckspeak can be either good or “ungood” (bad), depending on who is speaking, and whether what they are saying is following the needs of Big Brother. To speak rubbish and lies may be ungood, but to speak rubbish and lies for the good of “The Party” may be good.
Louis Appleby would, therefore, be a doubleplusgood duckspeaker – like so many others.
Professor Louis Appleby is one of the authors of a recent report published by the
Journal of Epidemiology and Community Health, investigating the worrying level of suicide rates in Scotland as compared to other parts of the UK.
Between 2000 and 2006 the overall suicide rate was 79% higher than in England; that for young Scots aged 15 to 44 was 100% higher.
Significantly researchers identified the tendency to over-medicate as a factor; arising from a combination of pressure from the patient and compliance on the part of the doctor. As a result they felt that “42% of the additional suicides could be attributed to the prescription of drugs for anxiety or depression”.
Professor Appleby is in agreement and states that “the use of psychotropic medicine to treat symptoms, rather than the cause of depression or anxiety being tackled, could explain the higher suicide rates in Scotland”. The problem could lie with either inappropriate treatment seeking – or delivery.
The effects of alcohol, drugs and deprivation were identified as having impact on the situation. Future efforts will include the provision of improved access to psychology services and directed support for those presenting with depression and anxiety.