In The boy with the ponytail who played with fire, we saw Jan Akerblom struggle up the side of a mountain in his attempt to drop the Ring of Power into Mount Doom. Where others, especially doctors, are seduced by the Precious he isn’t.
Why do it – because he saw lives destroyed and wonders if we are at risk of destroying society itself. Are any contracts anyone enters into while on an SSRI valid. Far-fetched?
Imagine you are approached by someone who says his wife has been on an SSRI for several years and during this time she has changed personality. Where once she was very sensitive and caring she has become more callous and unfeeling. Where once she would be in floods of tears at a weepy movie, at the funeral of a beloved twin-brother who died in tragic circumstances she didn’t cry at all.
He contacts you because now she has left him. He concedes that maybe the marriage was heading for the rocks anyway but he is still concerned that this is not her. That if she ever stops the medication and starts feeling more like herself again she will regret what she has done – if not to him at least to her children.
There is abundant evidence SSRIs can cause exactly this kind of emotional blunting or disinhibition. The comments by Neil Gorman and Allostrata on The boy with the ponytail give detailed accounts and references. One of the first articles on the topic had a Baltimore society hostess while on fluvoxamine serving her guests wine while naked from the waist up.
Its worth thinking for a moment before reading on – if you were the doctor, what do you do?
It’s almost impossible to know. Little details can change the picture dramatically. Perhaps he is much older than her and now that she has grown up she has found herself and resents his control and the SSRI disinhibits her just enough to make it possible to do what she might in many respects be better off doing – leaving him. Would it really be better to live a safer life or a life of quiet desperation?
If you’re her doctor and he approaches you, what do you do? If you suggest reducing the dose and she insists that no this is the real her and perhaps brings friends along who vouch for the fact she is now doing what they’ve implored her to do for years, what do you do? Perhaps she tells you she will get the drug through the internet if you don’t prescribe.
Who are you to decide these important issues for someone else? You’ve had no training in matters like this. Better surely to play Pontius Pilate, continue prescribing, and let events take whatever course they will.
Except as Who Cares in Sweden makes clear you cannot wash your hands of this responsibility.
This is not Side-Effects, the movie. You’re not in the position of Jonathon Banks (Jude Law) treating Emily Hawkins (Rooney Mara), whom you’re having an affair with and whom you’ve put on a new prescription drug, who has then perhaps gone on to kill her husband – we have to wait till February to see what actually does happen.
Unbelievable though it doubtless sounds, it’s worse. You are as much a police or probation officer as the doctor with whom every patient you prescribe for might want to have an affair with. This is whether it be an infant or a 96 year old. Prescription-only was a system introduced to control opiate and cocaine addicts. Anyone who gets their drugs through you is trapped in a set of Stockholm syndrome dynamics neither you nor they asked for.
But whether you asked for it or not you make your living out of it and the buck stops with you. Every inappropriate divorce, birth defect, school shooting, suicide, or case where a woman schoolteacher molests a juvenile male pupil that comes from your practice is your responsibility. Every heart attack on Chantix, cognitive dysfunction or muscle weakening on statins or premature death on the next Avandia or Vioxx is down to you. Every love affair that might happen on a clinical trial you are running is down to you. But you can’t find out what dramatists think the implications are because The Effect is booked out.
If you have a son who is a fireman and his life depends on others in the fire crew “caring” normally, what do you do if a fireman’s wife comes in to you and says that her husband has been showing no emotions lately? Or her husband is a pilot with the airline that your family are due to fly with in a week’s time?
If you appeal to the fact that you can’t be blamed for companies withholding data, you end up in a cutthroat. Either you say that whatever the data now reveals you would have used the drug anyway in which case the company walks away with no legal liability.
Or else you say you wouldn’t have used the drug but how can you be blamed if companies withhold data. Sounds good, except we’re not talking breaking news here. The information about SSRI induced disinhibition, violence and suicide has been in the public domain for nearly 25 years. The information about significant hazards on prescription drugs in general is out there for up to 20 years on average before you and your colleagues pay heed to it.
These drugs are available on prescription only because it was once thought you were the kind of person that might be able to quarry information out of companies or would steer people away from drugs if you were worried that we weren’t being told the full truth – it’s called professionalism.
Just recently a French psychiatrist Daniele Canarelli, 58, was found guilty after a patient of hers hacked a man to death. The court decided she should have recognized the risks he posed. This was the first case of its kind and it led to extensive media coverage worldwide because of the implications for doctors in general. It followed hard on the heels of a conviction of Italian seismologists for failures to warn sufficiently of earthquake risks.
Somewhere around 90% of the school or other mass shootings that have happened in recent years in America or Europe have involved shooters on psychotropic drugs usually antidepressants. The public sympathy for the victims typically also extends to the doctor who is seen as one more victim. But the so called perpetrator is much more likely to be a victim than the doctor. He may have been turned into a guided missile by his doctor. These are people in treatment whose doctors clearly failed to recognize the risks they posed.
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