In 1963, Hoffman la Roche launched Valium, the brand name for diazepam, a benzodiazepine. It followed hot on the heels of Librium – chlordiazepoxide – another benzodiazepine. This was like one company producing 2 SSRIs and able to get them to numbers 1 and 2 in the charts.
Arthur Sackler of Purdue and Oxycontin fame devised the marketing. This is where the money came from to create Purdue.
There are all sorts of stories about Roche patenting every possible benzodiazepine variation so no other company could get into the market but by the late 1970s Ativan – lorazepam and Xanax – alprazolam were muscling in, claiming to be shorter acting and less likely to cause dependence. This turned out to be like Paxil/Seroxat or Efexor claiming to be less likely to cause dependence than Prozac because they were shorter acting.
By the 1970s, Roche’s Valium was the best-selling drug in the world and the boss of Roche, Adolf Jann, was asked
The amount you have spent on research, especially considering the great profits you are making for example on Librium and Valium have made which you say you are spending most of it on research is giving you an immense amount of power over the direction in which pharmaceutical research around the world is going. It’s a large sum of money – don’t you think you should be accountable for that?
Jann responded: I would say no.
Interviewer: Why not?
Jann:
Because it is in my opinion absolutely logical that my task, my responsibility is to develop Hoffman La Roche. And why are we doing that? We are doing it because it is absolutely clear that the only chance for the social security or social health service is to make economies by finding new drugs.
This Adolf Jann Interview snippet is even more extraordinary when you see it. Adolf J gives a marvellous demonstration of a scene later acted out by Adolf H in the movie Downfall. (Google Hitler scene in Downfall to see what I mean).
The full story can be seen in The Antidepressant Story made 25 years ago.
In 1985, Valium went generic. Lots of companies could now make generic diazepam. Meanwhile concerns were growing about benzo dependence and the name Valium was beginning to symbolize the worst of modern pharmaceutical company marketing.
Today when generics come onstream, many branded companies opt to keep the branded drug available at a generic price as lots of people still want the branded product. In 1985, however, Roche eliminated the name Valium. It seemed to me at the time and I imagine many others as though they were trying to escape the growing dependence scandal.
What perhaps none of us realized was that the scandal was being created by other pharmaceutical companies bringing serotonergic drugs to the market – first Buspar and then the SSRIs. Company personnel went around actively telling doctors they would be sued for prescribing benzodiazepines when the new antidepressants were a much safer and more rational option and don’t cause dependence.
While Roche’s removal of Valium in 1985 seemed like a marker for the end of an era, it now looks more a dance move. Within 3 years of paroxetine’s launch in the UK there were more reports to the British regulator of dependence on it than there had been to the regulator for all benzodiazepines combined over the previous 20 years. Decades later medical bodies and regulators manage to look surprised if anyone asks whether there might be an SSRI dependence problem here.
We had not turned the corner into a more transparent and responsible era. No truth came out. Dogs barked and the Caravans moved on.
The Prozac Era
Two years later in 1987 Prozac was approved in the US. The marketing was inspired – you will lose weight on this drug, feel better than well. your inner Vincent van Gogh will blossom. People flocked to doctors to get it. Sales boomed. Even sales of a weird book Listening to Prozac telling you Prozac might cure your homosexuality boomed.
Prozac was the new Valium. This was always the plan. It was not much of antidepressant. It was useless for severe mood disorders But Lilly didn’t mind that. There was very little money in severe mood disorders. The money was in treating the nervous problems, the anxieties of everyday life, that the benzodiazepines had captured. The money was in converting cases of Valium into cases of Prozac. See Let Them Eat Prozac.
Joined by GSK marketing Paxil/Seroxat and Pfizer marketing Zoloft, the transformation took place with astonishing rapidity. Rather like no-one having heard of the RSV virus 2 or 3 years ago and now everyone knowing it is among the greatest threats to humanity and every mother needs to get herself and her baby immunized – see It is Hard for Thee to Kick against the Pricks.
Company propaganda is now so good they could take someone figuring on voting Harris or Trump today and by tomorrow have them converted to the opposite side with almost no memory they had ever thought otherwise.
Prozac came with great marketing and great shenanigans in the management of regulators. The shenanigans have led to a state of affairs where the greatest concentration of Fake News on earth centres on the drugs – any of the drugs – our doctor might prescribe for us.
The shenanigans mean that any warnings on clear phenomena like SSRIs making people suicidal or homicidal are viewed as tokenistic – May Contain Nuts labels – regulators and companies covering their backs rather than something to take seriously. See Doctors Disclosures and The Seductive Charm of Pharmacology.
The new Big Pharma had CEOs and legal firms that overlapped and interchanged with Big Oil or Big Tobacco . It used the same Doubt is our Product strategy to manage adverse events invented by Big Tobacco. Any hint of an academic article suggesting there might be a hint of an adverse event linked to an SSRI gets met with counter-blasts from experts claiming there is no risk here – not for suicide, homicide, withdrawal, birth defects, sexual dysfunction, alcoholism or anything else.
Because they are unavoidably hazardous, drugs like Prozac are on prescription-only. Your doctor is supposed to be the Risk Manager for these hazards. But doctors prescribing the drugs from Prozac onwards have been told their perceptions of what might be happening their patients are essentially anecdotal and irrelevant. This leaves them in a position where they don’t know what to tell patients and so they tell them nothing.
This all happens because pharma have persuaded regulators to become Risk Communicators. Risk Communication is the up to date term for being Economical with the Truth – a phrase that originated with Robert Armstrong, a British official, in the Spycatcher trial, in 1986 – the year between Valium and Prozac.
Risk Communication is all about lies scented with an only-in-the-public’s interests fragrance. Who decides the public’s interests? Bureaucrats who have a job brief that includes partnering with pharma. In its modern form Risk Communication took root with Prozac – it was a way to manage the suicide crisis.
Never concede our drug is causing a problem. When a suicide and antidepressant controversy blew up in 1991, the regulators crafted language saying that the treatment of depression can lead to an emergence of suicidality. This leaves regulators able to say – look we warned.
But doctors have been trapped into seeing any worsening as a worsening of the illness and they double the dose of the drug if things seem to be getting riskier – doctors no longer have any weapons other than drugs with which to combat risks. Taking someone off their drugs has become close to unthinkable.
Partnering with Pharma would be fine if the bureaucrats also partnered with Medicine. But they can’t – medicine is missing in action. The Prozac and suicide controversy branded doctors and patients views about what was happening on a drug to the patient in front of them as anecdotes. The BMJ played a major part in facilitating this.
No BMJ, NEJM or any medical journal editor ever since has had to guts to come out and say we made a terrible mistake – see Vampire Medicines and Silencing Doctors, Silencing Safety.
As a result, doctors have lost the confidence to claim that We, not the drugs, Save Lives. Almost no trials of any drugs submitted to regulators in the last 30 years show lives saved.
When a second suicide and antidepressants controversy blew up in 2004, the American Psychiatric Association rushed out a statement that APA believes antidepressants save lives. This is a suicide note. It should have said APA believes Psychiatrists Save Lives. See Suicide Note.
Because of BMJ, APA, RCP. NICE and other guidelines makers, along with FDA and other regulators, we now are at greater risk from good doctors than old-style cowboys. Doctors are now viewed as good because they adhere to guidelines etc. When these guidelines are based on a ghostwritten literature with no access to clinical trial data and when the CEO of NICE says we know that but what can we do about it – The NICE before Xmas – we have an extraordinary situation.
Between this and the treating of risk factors rather than illnesses, clinical medicine is now as dysfunctional as the Soviet Union was at the time of its collapse. See Embracing Healthcare’s Opportunities.
Thirty years ago the idea that a large proportion of negative company studies could be reported as positive in the very best journals with no regulators, journals or anyone having access to the data behind them would have been unbelievable.
Regulators are supposed to police company adverts. The consumers in this case are doctors who consume by putting medicines in our mouths. The adverts aimed at them are what look like peer-reviewed publications of clinical trials appearing in our most prestigious medical journals. Thirty years ago the idea that adverts (trials) regulators knew to be misleading, even fraudulent (negative studies) might be run in our journals without some part of the regulatory apparatus complaining would have been beyond belief.
It is probably worth mentioning in passing that on all sides people claim that the US and New Zealand are the only countries with Direct to Consumer Advertising (DTCA). Many people point to this as a feature of exactly what needs to be put right. From industry’s point of view – this is marvellous as it gets their critics looking at the wrong thing. The entire world has DTCA locked in place. The glossy, sometimes clever, retro copies of old-style adverts that can be seen in medical journals are a kitsch irrelevance, other than to divert the critics from spotting the new look adverts.
Thanks to medical spinelessness, this is now the norm.
Prozac Stepping Down
Last week Focus Taiwan carried a Society page article saying that Lilly was withdrawing Prozac – globally. Taiwanese regulators, doctors and generic companies had been told of this in June and that supplies of Prozac (branded fluoxetine – fluoxetine would continue) would stop in November taking availability up to the end of the year. But supplies stopped in September and doctors have been told to stop prescribing it. No time to organize a leaving do.
Just in Taiwan? It may not be the same elsewhere. The Asian market was much smaller. It would be good to hear from anyone anywhere getting fluoxetine as a Prozac branded generic.
An Era Ending move or a Dance move? Will the Caravans moving on pay any heed to the mongrels left barking for years, maybe even decades to come?
annie says
The ‘Anodyne’ Adolphs…
The Scotsman – Are we completely clear about the Strategy?
Are the Pros and Cons remaining muddled and disinformative?
Politics
Exclusive:’Shocking’ antidepressant figures revealed as Scotland accused of ‘getting it wrong’ on mental health
https://www.scotsman.com/news/politics/over-reliance-on-antidepressants-in-scotland-change-mental-health-4840608
New figures show the number of antidepressant prescriptions in Scotland has soared in recent years.
Scotland has been accused of “getting it wrong” in tackling the mental health crisis as “shocking” figures have revealed the number of antidepressants prescribed has soared by more than 200,000 in the past year.
Figures published by Public Health Scotland show there were 8,275,583 antidepressants issued in 2023/24 – an increase of 222,801 on the previous year.
It is also an increase of 758,891 on the 7,516,692 antidepressants prescribed in 2020/21 when the Covid pandemic and two nationwide lockdowns hit Scotland.
The figures have sparked calls for Scottish ministers to “take stock” of the use of the drugs, with demands for a cultural shift away from pills towards other forms of treatment for mental health problems.
Nick Ward, chief executive of Change Mental Health, described the figures as “shocking”, but said they reflected the “significant increase” in people seeking support for their mental health.
He said: “A lot of people go to the GP and the easiest thing for the GP to do is prescribe antidepressants, and it is really sad. Lots of the people who are prescribed antidepressants will be working-class people, because it is cheaper, easier and they can’t advocate for themselves.
“Someone who has a mental illness needs really complex support like therapy and counselling in the community, but GPs don’t always prescribe that – they just give people pills and hope it gets better.
“It is an indictment that we are not getting it right in this country.”
Mr Ward added: “We absolutely as a society have an over-reliance on antidepressants. They can be transformative in allowing people to function, but it is not treating the cause and that cause will come back if it is not treated.
“It is a very short-sighted way to address a significant underlying problem.”
In its 2007 election manifesto, the SNP pledged to “reduce over-prescribing of antidepressants”. And once the party was elected to power in Holyrood that year, ministers said they wanted to cut antidepressant prescriptions by 10 per cent.
Three years later, the SNP once again pledged to cut prescriptions of these drugs after their use increased by 7 per cent.
Scottish Conservative MSP Edward Mountain said: “Years after the SNP pledged to stop the rise in antidepressants, the figures continue to surge.
“We now have an extremely serious situation where huge numbers of Scots are being medicated for depression and anxiety. Of course, this treatment absolutely has a part to play, but we really need to get to a place where other remedies are offered.
“Many have complained that people are simply parked on medication because there’s an absence of alternatives. We urgently need ministers to take stock of this situation and come up with some solutions.”
Paul Sweeney, Scottish Labour’s mental health spokesperson, said the increase was “another reminder of the scale of need for mental health support”.
He said: “While antidepressants will always have a place in tackling mental health struggles, they should not be a substitute for lack of resources elsewhere. The reality is that under this SNP Government, the thousands stuck on psychological therapy waiting lists may feel they have no choice about the kind of treatment they receive.”
Alex Cumming, executive director of operations for Scottish Action for Mental Health (SAMH), said:
“Medication has its place, but it has to be part of a broader consideration of what’s right for the person. Depression can take many forms and be more or less severe, so a range of treatments should always be considered. Depression is often linked to significant life events, and problems in life can rarely be solved overnight.
“Antidepressants should therefore be just one piece of the puzzle in most cases, with other treatment options such as talking therapies and social prescribing to community resources such as peer support groups, conversation cafes and physical activity programmes all capable of making a significant contribution to better mental health.”
Figures published earlier this month from the 2022 census showed 617,100 Scots reported having a mental health condition– a rise from 4.4 per cent to 11.3 per cent of the population.
The jump was driven by a dramatic, six-fold increase among those aged 16 to 24, prompting critics to raise concerns over a growing mental health crisis.
The concern over the level of antidepressant prescriptions comes as the Scottish Government faces added pressure to review its free prescriptions policy amid more expected spending cuts to be unveiled in December’s Scottish Budget.
Caroline Lamb, director-general for health and social care and chief executive of NHS Scotland, said in August that “universal benefits” needed to be reviewed as Government departments looked to dramatically cut spending.
The Government said it was working hard to improve access to mental health support, and claimed taking antidepressants should not be stigmatised.
Mental Wellbeing Minister Maree Todd said: “It is important not to stigmatise the use of antidepressants or other mental health medication.
“People feel more able to come forward and talk about their mental health, which is a welcome sign that stigma is decreasing – the latest data shows. We are improving care and support for people living with depression, including appropriate access to support and treatments when they need them.
“All medicines are prescribed based on the clinical need of the patient. Decisions about the appropriateness of antidepressants are made by clinicians in discussion with the individual about what matters to them, and with reference to their medical history.
“The Scottish Government recommends that all medications, including antidepressants, be reviewed regularly to ensure that they remain the best option for the individual.”
A statement from Public Health Scotland said there were a significant number of antidepressants used for reasons other than their original licensed indication, including amitriptyline, which could be prescribed to treat pain.
“As the reason for prescribing is not available from the Prescribing Information System (PIS), it is not appropriate to assume that the use of a particular drug/drug class definitely represents use only in the original licensed indication,” the statement said.
SUICIDE DES JEUNES SOUS ANTIDÉPRESSEURS : BRISER LE SILENCE DE L’INDUSTRIE
https://www.youtube.com/watch?v=-a7uJ_qeNn4
“Suicide among young people taking antidepressants: breaking the industry’s silence
A reality for the families of Romain and Florian, who killed themselves while taking antidepressants. For their parents, this marks the start of a long search for the truth.”
Film from BLAST…
Dr Pedro says
Goodbye/Au revoir Prozac in Canada
“Business reasons”
https://www.drugshortagescanada.ca/discontinuance/238851
https://www.drugshortagescanada.ca/discontinuance/238855
David Healy says
An update from Dr Pedro who has found that Lilly has also discontinued Cymbalta – Duloxetine in Canada. There doesn’t seem to be any arrangements made for or recommendations in respect of tapering.
I can imagine a lot of wags coming up with variations on the work Hyperbolic
David