NEJM: On Zoloft Homicidal Ideation Frequent In Those 17 & Under

Since I believe that people should always get credit for the hard work and contribution they make in life I want to give our thanks to Rosie Meysenburg for getting this out to us today and for her comments on it. Rosie has done so much, along with her husband Gene, in posting our years and years worth of work gathering these SSRI & SNRI cases together for the _www.ssristories.drugawareness.org_
( site.

“This Adverse Event Report, from a study appearing in the New England Journal of Medicine, shows that of 133 children 17 & under on Zoloft there were 2 who reported “Homicidal Ideation”. There were no reports of “Homicidal Ideation” in the placebo group.

[According to the Physicians Desk Reference, a Frequent adverse reaction is one that occurs in 100 people or less.  Homicidal Ideation occurred in 1 in 66 children on Zoloft aged 17  and under.]

“According to the Physicians Desk Reference, a Frequent adverse reaction is one that occurs in 100 people or less. Homicidal Ideation occurred in 1 in 66 children on Zoloft aged 17 and under.

“This Adverse Event Report was the appendix for this study in the New England Journal of Medicine.”

adverse event report1.pdf

This Adverse Event Report was the appendix for this study in the New England Journal of Medicine:

And with this new information from the New England Journal of Medicine I want to include information out of Australia which is that Pfizer, the maker of Zoloft, along with the Therapeutic Goods Administration (TGA similar to our FDA), recommends that any SSRI antidepressant should not be prescribed to Australians under the age of 24. Funny, but I missed that warning from Pfizer for Americans under 24, didn’t you?

Next I will send that article that just came out over the weekend because it ties in so closely with this new information on Zoloft. And because there is so much to read in this article alone I am going to cut my comments at this point and let the article speak for itself.

Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
_www.drugawareness.org_ ( &
_www.ssristories.org_ (
Author of Prozac: Panacea or Pandora? – Our
Serotonin Nightmare & the audio, Help! I Can’t
Get Off My Antidepressant!!! ()

_atracyphd1@…_ (mailto:atracyphd1@…)


Published at October 30, 2008 (10.1056/NEJMoa0804633)
Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood

John T. Walkup, M.D., Anne Marie Albano, Ph.D., John Piacentini, Ph.D.,
Boris Birmaher, M.D., Scott N. Compton, Ph.D., Joel T. Sherrill, Ph.D., Golda
S. Ginsburg, Ph.D., Moira A. Rynn, M.D., James McCracken, M.D., Bruce Waslick,
M.D., Satish Iyengar, Ph.D., John S. March, M.D., M.P.H., and Philip C. Kendall, Ph.D.

Background Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy.

Methods In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at
weeks 4, 8, and 12.

Results The percentages of children who were rated as very much or much improved on the Clinician Global Impression “Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo
(23.7%). Combination therapy was superior to both monotherapies (P<0.001).

Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal
ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline.

Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate.

( number,
NCT00052078 _[]_
) .)

Anxiety disorders are common in children and cause substantial impairment in
school, in family relationships, and in social functioning._1_
( ,_2_
( Such disorders
also predict adult anxiety disorders and major depression._3_
( ,_4_
( ,_5_
( ,_6_
( Despite a high
prevalence (10 to 20%_3_
,_7_ ( ,_8_
( ) and substantial
morbidity, anxiety disorders in childhood remain underrecognized and
undertreated._1_ (


An improvement in outcomes for children with anxiety disorders would have important public health
implications.In clinical trials, separation and generalized anxiety disorders and social
phobia are often grouped together because of the high degree of overlap in
symptoms and the distinction from other anxiety disorders (e.g., obsessive compulsive disorder). Efficacious treatments for these disorders include cognitive behavioral therapy_10_
( ,_11_
( and
the use of selective serotonin-reuptake inhibitors (SSRIs)._12_
( ,_13_

However, randomized, controlled trials comparing cognitive behavioral therapy, the use of an SSRI, or the combination of both therapies with a control are lacking. The evaluation of combination therapy is particularly important because approximately 40 to 50% of children with these disorders do not have a response to short-term treatment with either monotherapy.
_14_( ,_15_

Our study, called the Child “Adolescent Anxiety Multimodal Study, was designed to address the current gaps in the treatment literature by evaluating the relative efficacy of cognitive behavioral therapy, sertraline, a combination of the two therapies, and a placebo drug. This article reports the results of short-term treatment.


Study Design and Implementation

This study was designed as a two-phase, multicenter, randomized, controlled trial for children and adolescents between the ages of 7 and 17 years who had separation or generalized anxiety disorder or social phobia. Phase 1 was a 12-week trial of short-term treatment comparing cognitive behavioral therapy, sertraline, and their combination with a placebo drug. Phase 2 is a 6-month open extension for patients who had a response in phase 1.

The authors designed the study, wrote the manuscript, and vouch for the data gathering and analysis. Pfizer provided sertraline and matching placebo free of charge but was not involved in the design or implementation of the study, the analysis or interpretation of data, the preparation or review of the manuscript, or the decision to publish the results of the study.

Study Subjects

Children between the ages of 7 and 17 years with a primary diagnosis of separation or generalized anxiety disorder or social phobia (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision
( ),
substantial impairment, and an IQ of 80 or more were eligible to participate. Children with coexisting psychiatric diagnoses of lesser severity than the three target disorders were also allowed to participate;
such diagnoses included attention deficit–hyperactivity disorder (ADHD) whilereceiving stable doses of stimulant and obsessive compulsive, post-traumatic stress, oppositional defiant, and conduct disorders. Children were excluded if they had an unstable medical condition, were refusing to attend school
because of anxiety, or had not had a response to two adequate trials of SSRIs or an adequate trial of cognitive behavioral therapy.

Girls who were pregnant or were sexually active and were not using an effective method of birth control
were also excluded. Children who were receiving psychoactive medications other than stable doses of stimulants and who had psychiatric diagnoses that made participation in the study clinically inappropriate (i.e., current majordepressive or substance-use disorder; type ADHD; or a lifetime history of bipolar, psychotic, or pervasive developmental disorders) or who presented an acute risk to themselves or others were also excluded.

Recruitment occurred from December 2002 through May 2007 at Duke University Medical Center, New York State Psychiatric Institute Columbia University Medical Center New York University, Johns Hopkins Medical Institutions, Temple University University of Pennsylvania, University of California, Los Angeles,and
Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center. The protocol was approved and monitored by institutional review boards at each center and by the data and safety monitoring board of the National Institute of Mental Health. Subjects and at least one parent provided written informed consent.


Cognitive behavioral therapy involved fourteen 60-minute sessions, which included review and ratings of the severity of subjects’ anxiety, response to treatment, and adverse events. Therapy was based on the Coping Cat program,_17_ ( ,_18_
( which was adapted for the
subjects’ age and the duration of the study._19_ (

Each subject who was assigned to receive cognitive behavioral therapy received training in anxiety-management skills, followed by behavioral exposure to anxiety-provoking situations. Parents
attended weekly check-ins and two parent-only sessions. Experienced psychotherapists, certified in the Coping Cat protocol, received regular site-level and cross-site supervision.

Pharmacotherapy involved eight sessions of 30 to 60 minutes each that included review and ratings of the severity of subjects’ anxiety, their response to treatment, and adverse events. Sertraline (Zoloft) and matching placebo were administered on a fixed flexible schedule beginning with 25 mg per day and adjusted up to 200 mg per day by week 8. Through week 8, subjects who were considered to be mildly ill or worse and who had minimal side effects were eligible for dose increases.

Psychiatrists and nurse clinicians with experience in medicating children with anxiety disorders were certified in the study pharmacotherapy protocol and received regular site-level and cross-site supervision.
Pill counts and medication diaries were used to facilitate and document adherence. Combination therapy consisted of the administration of sertraline and cognitive behavioral therapy. Whenever possible, therapy and medication sessions occurred on the same day for the convenience of subjects.

Study objectives were, first, to compare the relative efficacy of the three active treatments with placebo; second, to compare combination therapy with either sertraline or cognitive behavioral therapy alone; and third, to assess the safety and tolerability of sertraline, as compared with placebo. We hypothesized that all three active treatments would be superior to placebo and that combination therapy would be superior to either sertraline or cognitive behavioral therapy alone.

Outcome Assessments
We obtained demographic information, information on symptoms of anxiety, and data on coexisting disorders and psychosocial functioning using reports from both the subjects and their parents and from interviews of subjects and parents at the time of screening, at baseline, and at weeks 4, 8, and 12.

The interviews were administered by independent evaluators who were unaware of study-group assignments.
We used the Anxiety Disorders Interview Schedule for DSM-IV-TR, Child Version,_20_ ( to establish diagnostic eligibility. The categorical primary outcome was the treatment response at week 12, which was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impression Improvement scale,_21_
( which ranges from 1 to 7, with lower scores indicating more improvement, as compared with baseline. A score of 1 or 2 reflects a substantial, clinically meaningful improvement in anxiety severity and normal functioning. The dimensional primary
outcome was anxiety severity as measured on the Pediatric Anxiety Rating Scale, computed by the summation of six items assessing anxiety severity, frequency, distress, avoidance, and interference during the previous week._22_(

Total scores on this scale range from 0 to 30, with scores above 13 indicating clinically meaningful anxiety. The Children’s Global Assessment Scale_23_ ( was used to rate
overall impairment.

Scores on this scale range from 1 to 100; scores of 60 or lower are considered to indicate a need for treatment, and a score of 50 corresponds to moderate impairment that affects most life situations and is readily observable. Agreement among the raters was high for anxiety severity (r=0.85) and diagnostic
status (intraclass correlation coefficient= 0.82 to 0.88) on the basis of a videotaped review of 10% of assessments by independent evaluators that were performed at baseline and at week 12.

Adverse Events
Adverse events were defined as any unfavorable change in the subjects’ pretreatment condition, regardless of its relationship to a particular therapy. Serious adverse events were life-threatening events, hospitalization, or events leading to major incapacity. Harm-related adverse events were defined as thoughts of harm to self or others or related behaviors. All subjects were interviewed at the start of each visit by the study coordinator with the use of a standardized script. Identified adverse events and harm-related events were then evaluated and rated by each subject’s study clinician.

This report presents data on all serious adverse events, all harm-related adverse events, andmoderate and severe (i.e., functionally impairing) adverse events that occurred in 3% or more of subjects in any study group. The data and safety monitoring board of the National Institute of Mental Health performed a quarterly review
of reported adverse events. Given the greater number of study visits (and hence more reporting
opportunities) and the unblinded administration of sertraline in the combination-therapy group, the test of the adverse-event profile of sertraline focused on statistical comparisons between sertraline and placebo and sertraline and cognitive behavioral therapy.

Randomization and Masking
The randomization sequence in a 2:2:2:1 ratio was determined by a computer-generated algorithm and maintained by the central pharmacy, with stratification according to age, sex, and study center. Subjects were assigned to study groups after being deemed eligible and undergoing verbal reconsent with a study investigator. Subjects in the sertraline and placebo groups did not know whether they were receiving active therapy, nor did their clinicians. However, subjects who received combination therapy knew they were receiving active sertraline. The study protocol called for independent evaluators who completed assessments to be unaware of all treatment assignments.

Statistical Analysis
On the basis of previous studies,_10_
( ,_11_
( ,_12_
,_13_ ( ,_14_
( ,_15_
we hypothesized that 80% of children in the combination-therapy group, 60% in either the sertraline group
or the cognitive-behavioral-therapy group, and 30% in the placebo group would be considered to have had a response to treatment at week 12. We determined that we needed to enroll 136 subjects in each active-treatment group and 70 subjects in the placebo group for the study to have a power of 80% to detect a minimum difference of 17% between any two study groups in the rate of response, assuming an alpha of 0.05 and a two-tailed test with no adjustment for multiple comparisons.

Analyses were performed with the use of SAS software, version 9.1.3 (SAS Institute). For categorical outcomes (including data regarding adverse events), treatments were compared with the use of Pearson’s chi-square test, Fisher’s exact test, or logistic regression, as appropriate. Logistic-regression models included the study center as a covariate. For dimensional outcomes, linear mixed-effects models (implemented with the use of PROC MIXED) were used to determine predicted mean values at each assessment point (weeks 4, 8, and 12)
and to test the study hypotheses with respect to between-group differences at week 12.

In each linear mixed-effects model, time and study group were included as fixed effects, with linear and quadratic time and time-by-treatment group interaction terms. Each model also began with a limited number of covariates (e.g., age, sex, and race), followed by backward stepping to identify thebest-fitting and most parsimonious model. In all models, random effects included intercept and linear slope terms, and an unstructured covariance was used to account for within-subject correlation over time. All comparisons were planned and tests were two-sided. A P value of less than 0.05 was considered to indicate statistical significance. The sequential Dunnett test was used to control the overall (familywise) error rate._24_

We analyzed data from all subjects according to study group. Sensitivity analyses were performed with the last observation carried forward (LOCF) and multiple imputation assuming missingness at random. Results were similar for the two missing-data methods. We report the results of the LOCF analysis because the
response rates were lower and hence provide a more conservative estimate of outcomes.

A total of 3066 potentially eligible subjects were screened by telephone
(_Figure 1_ ( ). Of these subjects, 761 signed consent forms and completed the inclusion and exclusion evaluation, 524 were deemed to be eligible and completed the baseline assessment, and 488 underwent randomization. Eleven subjects (2.3%) stopped
treatment but were included in the assessment (treatment withdrawals); 46 subjects (9.4%) stopped both treatment and assessment (study withdrawals).

On the basis of logistic-regression analyses, pairwise comparisons indicated that subjects in the cognitive-behavioral-therapy group were significantly less likely to withdraw from treatment than were those in the sertraline group (odds ratio, 0.33; 95% confidence interval [CI], 0.13 to 0.87; P=0.03) or the placebo
group (odds ratio, 0.24; 95% CI; 0.09 to 0.67; P=0.006). Of the 488 subjects who underwent randomization, 459 (94.1%) completed at least one postbaseline assessment, 396 (81.1%) completed all four assessments, and 440 (90.2%) completed the assessment at week 12. Subjects were recruited primarily through advertisements (52.2%) or clinical referrals (44.1%).
View larger version (30K):
_[in this window]_
_[in a new window]_

Figure 1. Enrollment and Outcomes.

Subjects who are shown as having withdrawn from treatment discontinued their assigned therapy but continued to undergo study assessment. Subjects who are shown as having withdrawn from the study discontinued both therapy and assessment. CBT denotes cognitive behavioral therapy.

Of 14 possible sessions of cognitive behavioral therapy, the mean (±SD) number of sessions completed was 12.7±2.8 in the combination-therapy group and 13.2±2.0 in the cognitive-behavioral-therapy group. The mean dose of sertraline at the final visit was 133.7±59.8 mg per day (range, 25 to 200) in the combination-therapy group, 146.0±60.8 mg per day (range, 25 to 200) in the sertraline group, and 175.8±43.7 mg per day (range, 50 to 200) in the placebo group.

Demographic and Clinical Characteristics
There were no significant differences among study groups with respect to baseline demographic and clinical characteristics (_Table 1_ ( ). The mean age of participants was 10.7±2.8 years, with 74.2% under the age of 13 years.

There were nearly equal numbers of male and female subjects. Most subjects were white (78.9%), with
other racial and ethnic groups represented. Subjects came from predominantly middle-class and upper-middle-class families (74.6%) and lived with both biologic parents (70.3%). Most subjects had received the diagnosis of two or more primary anxiety disorders (78.7%) and one or more secondary disorders
(55.3%). At baseline, subjects had moderate-to-severe anxiety and impairment (_Table
2_ ( ).

Given the geographic diversity among study centers, there were significant differences among sites on several baseline demographic variables (e.g., race and socioeconomic status). Overall, these variables were equally distributed among study groups within each center; however, three centers had one instance each of
unequal distribution for sex, race, or socioeconomic status.

View this table:
_[in this window]_
_[in a new window]_
Table 1. Baseline Characteristics of the Subjects and Recruitment According
to Study Center.

View this table:
_[in this window]_
_[in a new window]_
Table 2. Key Outcomes at 12 Weeks.

Clinical Response
In the intention-to-treat analysis, the percentages of children who were rated as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression–Improvement scale at 12 weeks were 80.7% (95% CI, 73.3 to 86.4) in the combination-therapy group, 59.7% (95% CI, 51.4 to 67.5) in the cognitive-behavioral-therapy group, 54.9% (95% CI, 46.4 to 63.1) in the sertraline group, and
23.7% (95% CI, 15.5 to 34.5) in the placebo group (_Table 2_ ( ).

With the study center as a covariate, planned pairwise comparisons from a logistic-regression model showed
that each active treatment was superior to placebo as follows: combination therapy versus placebo, P<0.001 (odds ratio, 13.6; 95% CI, 6.9 to 26.8); cognitive behavioral therapy versus placebo, P<0.001 (odds ratio, 4.8; 95% CI, 2.6 to 9.0); and sertraline versus placebo, P<0.001 (odds ratio, 3.9; 95% CI, 2.1 to 7.4). Similar pairwise comparisons revealed that combination therapy was superior to either sertraline alone (odds ratio, 3.4; 95% CI, 2.0 to 5.9; P<0.001) or cognitive behavioral therapy alone (odds ratio, 2.8; 95% CI, 1.6 to 4.8; P=0.001). However, there was no significant difference between sertraline and cognitive behavioral therapy (P=0.41).

There was no main effect for center (P=0.69); however, a comparison among centers according to study group revealed a significant difference in response to combination therapy but no differences with respect to the response to sertraline alone (P=0.15) or cognitive behavioral therapy alone (P=0.25).

Further evaluation of response rates revealed that the average response rate for combination therapy at one center was significantly lower than at the other centers (P=0.002). A sensitivity analysis of site response rates showed that when data from the one site were removed, the average response rate of the other sites was consistent with that of the full sample.

The mixed-effects model for the Pediatric Anxiety Rating Scale revealed a significant quadratic effect for time (P<0.001) and a significant quadratic time-by-treatment interaction for cognitive behavioral therapy versus placebo (P=0.01) but not for either combination therapy or sertraline versus placebo. In other words, as compared with placebo, cognitive behavioral therapy had a linear mean trajectory (_Figure 2_
( ). Planned pairwise comparisons of the expected mean scores on the Pediatric Anxiety Rating Scale at week 12 revealed a similar ordering of
outcomes, with all active treatments superior to placebo, according to the following comparisons: combination therapy versus placebo, t=–5.94 (P<0.001); cognitive behavioral therapy versus placebo, t=–2.11 (P=0.04); and sertraline versus placebo, t=–3.15 (P=0.002). In addition, combination therapy was
superior to both sertraline alone (t=–3.26, P=0.001) and cognitive behavioral therapy alone (t=–4.73, P<0.001). No significant difference was found between sertraline and cognitive behavioral therapy (t=1.32, P=0.19). The same magnitude and pattern of outcome was found for the Clinical Global Impressio Severity
scale and the Children’s Global Assessment Scale.
View larger version (21K):
_[in this window]_
_[in a new window]_
Figure 2. Scores on the Pediatric Anxiety Rating Scale during the 12-Week

Scores on the Pediatric Anxiety Rating Scale range from 0 to 30, with scores higher than 13 consistent with moderate levels of anxiety and a diagnosis of an anxiety disorder. The expected mean score is the mean of the sampling distribution of the mean.

Estimates of the effect size (Hedges’ g) and the number needed to treatbetween the active-treatment groups and the placebo group were calculated. Effect sizes are based on the expected mean scores on the Pediatric Anxiety
Rating Scale, derived from the mixed-effects model. The number needed to treat is based on the dichotomized, end-of-treatment scores on the Clinical Global Impression–Improvement scale with the use of LOCF. The effect size was 0.86 (95% CI, 0.56 to 1.15) for combination therapy, 0.45 (95% CI, 0.17 to 0.74) for
sertraline, and 0.31 (95% CI, 0.02 to 0.59) for cognitive behavioral treatment.

The number needed to treat was 1.7 (95% CI, 1.7 to 1.9) for combination therapy, 3.2 (95% CI, 3.2 to 3.5) for sertraline, and 2.8 (95% CI, 2.7 to 3.0) for cognitive behavioral therapy. Treatment and Study Withdrawals
Most treatment and study withdrawals were attributed to reasons other than adverse events (43 of 57, 75.4%) (_Table 3_
( ).

Of the 14 withdrawals that were attributed to an adverse event, 11 (78.6%) were in the groups receiving either sertraline alone or placebo and consisted of 3 physical events (headache, stomach pains, and tremor) and 8 psychiatric adverse events (worsening of symptoms, 3 subjects; agitation or disinhibition, 3; hyperactivity, 1; and nonsuicidal self-harm and homicidal ideation, 1).
View this table:
_[in this window]_
_[in a new window]_
Table 3. Subjects Who Withdrew from Treatment or the Study.

Serious Adverse Events
Three subjects had serious adverse events during the study period. One child in the sertraline group had a worsening of behavior that was attributed to the parents’ increased limit setting on avoidance behavior; the event was considered to be possibly related to sertraline. A child in the combination-therapy
group had a worsening of preexisting oppositional defiant behavior that resulted in psychiatric hospitalization; this event was considered to be unrelated to a study treatment. The third subject was hospitalized for a tonsillectomy, which was also considered to be unrelated to a study treatment
4_ ( ).
View this table:
_[in this window]_
_[in a new window]_
Table 4. Moderate-to-Severe Adverse Events at 12 Weeks.

Adverse Events
Subjects in the combination-therapy group had a greater number of study visits and therefore significantly more opportunities for elicitation of adverse events than did those in the other study groups, with a mean of 12.8±4.0 opportunities (range, 1 to 22) in the combination-therapy group, as compared with 9.9±3.6 (range, 1 to 14) in the sertraline group, 10.6±2.0 (range, 1 to 14) in the cognitive-behavioral-therapy group, and 9.7±4.2 (range, 1 to 14) in the placebo group (P<0.001 for all comparisons). Rates of adverse events,
including suicidal and homicidal ideation, were not significantly greater in the sertraline group than in the placebo group. No child in the study attempted suicide. Among children in the cognitive-behavioral-therapy group, there were fewer reports of insomnia, fatigue, sedation, and restlessness or fidgeting than in the sertraline group (P<0.05 for all comparisons). For a list of mild adverse events that were not associated with functional impairment, as well as moderate and severe events, see the _Supplementary Appendix_
( ,

available with the full text of this article at

Our study examined therapies that many clinicians consider to be the most promising treatments for childhood anxiety disorders. Our findings indicate that as compared with placebo, the three active therapies combination therapy with both cognitive behavioral therapy and sertraline, cognitive behavioral therapy alone, and sertraline alone — are effective short-term treatments for children with separation and generalized anxiety disorders and social phobia, with combination treatment having superior response rates. No physical,psychiatric, or harm-related adverse events were reported more frequently in the sertraline group than in the placebo group, a finding similar to that for SSRIs, as identified in previous studies of anxious children._12_
( ,_13_
( ,_25_

Few withdrawals from either treatment or the study were attributed to adverse events. Suicidal ideation and homicidal ideation were uncommon. No child attempted suicide during the study period. Since they were recruited at multiple centers and locations, the study subjects were racially and ethnically diverse. However, despite intense outreach, the sample did not include the most socioeconomically disadvantaged children.
Subjects were predominantly younger children and included those with ADHD and other anxiety disorders, factors that allow for generalization of the results to these populations.

Conversely, the exclusion of children and teens with major depression and pervasive developmental disorders may have limited the generalizability of the results to these populations.The observed advantage of combination therapy over either cognitive behavioral therapy or sertraline alone during short-term treatment (an improvement of 21 to 25%) suggests that among these effective therapies, combination therapy
provides the best chance for a positive outcome. The superiority of combination therapy might be due to additive or synergistic effects of the two therapies. However, additional contact time in the combination-therapy group, which was unblinded, and expectancy effects on the part of both subjects and
clinicians cannot be ruled out as alternative explanations.

Nonetheless, the magnitude of the treatment effect in the combination-therapy group (with two
subjects as the number needed to treat to prevent one additional event) suggests that children with anxiety disorders who receive quality combination therapy can consistently expect a substantial reduction in the severity of anxiety. An increased number of visits in the combination-therapy group resulted in increased opportunities for elicitation of adverse events. Consequently, the potential for expectancies among subjects, parents, and clinicians regarding the side effects of medications in the context of more visits may have increased the rate of some adverse events in the combination-therapy group and may limit conclusions that can be drawn regarding the rates of adverse events in combination therapy.

The positive benefit of cognitive behavioral therapy, as compared with placebo, adds new information to the existing literature._26_ (
The number needed to treat for cognitive behavioral therapy in this study (three subjects) is the same as that
identified in a meta-analysis of studies comparing subjects who were assigned to cognitive behavioral therapy with those assigned to a waiting list for therapy or to sessions without active therapy._14_

Our study’s test of cognitive behavioral therapy included children with moderate-to-severe anxiety and addresses criticism of previous trials that included children with only mild-to-moderate
anxiety._14_ (
Before our study, cognitive behavioral therapy for childhood anxiety was considered to be
“probably efficacious.”_26_

This evaluation of cognitive behavioral therapy and other recent studies_27_ (
,_28_ ( suggests that
such therapy for childhood anxiety is a well-established, evidenced-based treatment._29_ (

Given that the risk of some adverse events was lower in the behavioral-therapy group than in the sertraline group, some parents and their children may consider choosing cognitive behavioral therapy as their initial treatment.

The results of our study confirm the short-term efficacy of sertraline for children with generalized anxiety disorder_25_ ( and show that
sertraline is effective for children with separation anxiety disorder and social phobia. The number needed
to treat for sertraline in our study (three subjects) was the same as that previously identified in a meta-analysis_15_ ( of six
randomized, placebo-controlled trials of SSRIs for childhood anxiety disorders._12_
( ,_13_
( ,_25_
,_30_ ( ,_31_

These studies and others_27_ (
suggest that SSRIs, as a class, are the medication of choice for these conditions. The titration schedule that we used, which emphasized upward dose adjustment in the absence of response and adverse events, suggests that the average end-point dose of sertraline in this study is the highest dose consistent with good outcome and tolerability. No adverse events were observed more frequently in the sertraline group than in the placebo group. In contrast to the apparent risk of suicidal ideation and behavior in studies of depression in children and
adolescents,_15_ ( our study did not demonstrate any increased risk for suicidal behavior in the sertraline group. Given the benefit of sertraline alone or in combination with cognitive behavioral therapy and the limited risk of adverse events associated with the drug in our study, the well-monitored use of sertraline and other SSRIs in the treatment of childhood anxiety disorders is indicated.

Cognitive behavioral therapy and sertraline either in combination or as monotherapies appear to be effective treatments for these commonly occurring childhood anxiety disorders. Results confirm those of previous studies of SSRIs and cognitive behavioral therapy and, most important, show that combination
therapy offers children the best chance for a positive outcome. Our findings indicate that all three of the treatment options may be recommended, taking into consideration the family’s treatment preferences, treatment availability, cost, and time burden. To inform more prescriptive selection of patients for
treatment, further analysis of predictors and moderators of treatment response may identify who is most likely to respond to which_32_
( of these
effective alternatives.
Supported by grants (U01 MH064089, to Dr. Walkup; U01 MH64092, to Dr.
Albano; U01 MH64003, to Dr. Birmaher; U01 MH63747, to Dr. Kendall; U01 MH64107,
to Dr. March; U01 MH64088, to Dr. Piacentini; and U01 MH064003, to Dr. Compton)
from the National Institute of Mental Health (NIMH).

Sertraline and matching placebo were supplied free of charge by Pfizer. Dr. Walkup reports receiving consulting fees from Eli Lilly and Jazz Pharmaceuticals and fees for legal consultation to defense counsel and
submission of written reports in litigation involving GlaxoSmithKline, receiving lecture fees from CMP Media, Medical Education Reviews, McMahon Group, and DiMedix, and receiving support in the form of free medication and matching placebo from Eli Lilly and free medication from Abbott for clinical trials funded by the NIMH; Dr. Albano, receiving royalties from Oxford University Press for the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions, but not for interviews used in this study, and royalties from the Guilford Press; Dr. Piacentini, receiving royalties from Oxford University Press for treatmentmanuals on childhood obsessive compulsive disorder and tic disorders and from the Guilford Press and APA Books for other books on child mental health and receiving lecture fees from Janssen-Cilag; Dr. Birmaher, receiving consulting fees from Jazz Pharmaceuticals, Solvay Pharmaceuticals, and Abcomm, lecture fees from Solvay, and royalties from Random House for a book on children with bipolar disorder; Dr. Rynn, receiving grant support from Neuropharm, BoehringerIngelheim Pharmaceuticals, and Wyeth Pharmaceuticals, consulting fees from Wyeth, and royalties from APPI for a book chapter on pediatric anxiety disorders; Dr. McCracken, receiving consulting fees from Sanofi-Aventis and Wyeth, lecture fees from Shire and UCB, and grant support from Aspect, Johnson & Johnson, Bristol-Myers Squibb, and Eli Lilly; Dr. Waslick, receiving grant support from Baystate Health, Somerset Pharmaceuticals, and GlaxoSmithKline; Dr. Iyengar, receiving consulting fees from Westinghouse for statistical consultation; Dr. March, receiving study medications from Eli Lilly for an NIMH-funded clinical trial and receiving royalties from Pearson for being the author of the Multidimensional Anxiety Scale for Children, receiving consulting fees from Eli Lilly, Pfizer, Wyeth, and GlaxoSmithKline, having an equity interest in MedAvante, and serving on an advisory board for AstraZeneca and Johnson & Johnson; and Dr. Kendall, receiving royalties from Workbook Publishing for anxiety-treatment materials.

No other potential conflict of interest relevant to this article was reported.

The views expressed in this article are those of the authors and do not necessarily represent the official views of the NIMH, the National Institutes of Health, or the Department of Health and Human Services.
We thank the children and their families who made this study possible; and J. Chisar, J. Fried, R. Klein, E. Menvielle, S. Olin, J. Severe, D. Almirall, and members of NIMH’s data and safety monitoring board.
* The study investigators are listed in the Appendix.

Source Information
From the Johns Hopkins Medical Institutions, Baltimore (J.T.W., G.S.G.); New York State Psychiatric Institute–Columbia University Medical Center, New York (A.M.A., M.A.R.); the University of California at Los Angeles, Los Angeles (J.P., J.M.); Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh (B.B., S.I.); Duke University Medical Center, Durham, NC (S.N.C., J.S.M.); the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD (J.T.S.); Baystate
Medical Center, Springfield, MA (B.W.); and Temple University, Philadelphia

This article (10.1056/NEJMoa0804633) was published at on
October 30, 2008. It will appear in the December 25 issue of the Journal.
Address reprint requests to Dr. Walkup at the Division of Child and
Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.
1. Benjamin RS, Costello EJ, Warren M. Anxiety disorders in a pediatric
sample. J Anxiety Disord 1990;4:293-316. _[CrossRef]_
2. Birmaher B, Yelovich AK, Renaud J. Pharmacologic treatment for
children and adolescents with anxiety disorders. Pediatr Clin North Am
1998;45:1187-1204. _[CrossRef]_
-9&link_type=DOI) _[ISI]_
) _[Medline]_
3. Achenbach TM, Howell CT, McConaughy SH, et al. Six-year predictors
of problems in a national sample of children and youth: I. Cross-informant
syndromes. J Am Acad Child Adolesc Psychiatry 1995;34:336-347. _[CrossRef]_

0&link_type=DOI) _[ISI]_
) _[Medline]_
4. Ferdinand RF, Verhulst FC. Psychopathology from adolescence into
young adulthood: an 8-year follow-up study. Am J Psychiatry 1995;152:1586-1594.
_<NOBR Full Text]_
5. Pine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for
early-adulthood anxiety and depressive disorders in adolescents with anxiety
depressive disorders. Arch Gen Psychiatry 1998;55:56-64. _<NOBR Full Text]_
6. Pine DS. Child-adult anxiety disorders. J Am Acad Child Adolesc
Psychiatry 1994;33:280-281. _[ISI]_
) _[Medline]_
7. Gurley D, Cohen P, Pine DS, Brook J. Discriminating depression and
anxiety in youth: a role for diagnostic criteria. J Affect Disord
1996;39:191-200. _[CrossRef]_
1&link_type=DOI) _[ISI]_
) _[Medline]_
8. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview
Schedule for Children Version 2.3 (DISC-2.3): description, acceptability,
prevalence rates, and performance in the MECA study. J Am Acad Child Adolesc
Psychiatry 1996;35:865-877. _[CrossRef]_
) _[ISI]_
9. Klein R. Anxiety disorders. In: Rutter M, Taylor E, Hersov L, eds.
Child and adolescent psychiatry: modern approaches. 3rd ed. London: Blackwell
Scientific, 1995:351-74.
10. Kendall PC, Treating anxiety disorders in children: results of a
randomized clinical trial. J Consult Clin Psychol 1994;62:100-111. _[CrossRef]_
link_type=DOI) _[ISI]_
) _[Medline]_
11. Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM,
Southam-Gerow M, Henin A, Warman M. Therapy for youths with anxiety disorders:
a second
randomized clinical trial. J Consult Clin Psychol 1997;65:366-380. _[CrossRef]_
6&link_type=DOI) _[ISI]_
) _[Medline]_
12. Birmaher B, Axelson DA, Monk K, et al. Fluoxetine for the treatment
of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry
2003;42:415-423. _[ISI]_
) _[Medline]_
13. The Research Unit on Pediatric Psychopharmacology Anxiety Study
Group. Fluvoxamine for the treatment of anxiety disorders in children and
adolescents. N Engl J Med 2001;344:1279-1285. _<NOBR Full Text]_
14. James A, Soler A, Weatherall R. Cognitive behavioural therapy for
anxiety disorders in children and adolescents. Cochrane Database Syst Rev
2005;4:CD004690-CD004690. _[Medline]_
15. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk
for reported suicidal ideation and suicide attempts in pediatric
antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA
2007;297:1683-1696. _<NOBR Full Text]_
16. Diagnostic and statistical manual of mental disorders, 4th ed., text
rev.: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
17. Kendall PC, Hedtke KA. Cognitive-behavioral therapy for anxious
children: therapist manual. 3rd ed. Ardmore, PA: Workbook Publishing, 2006.
18. Idem. Coping Cat workbook. 2nd ed.. Ardmore, PA: Workbook
Publishing, 2006.
19. Kendall PC, Gosch E, Furr JM, Sood E. Flexibility within fidelity. J
Am Acad Child Adolesc Psychiatry 2008;47:987-993. _[CrossRef]_

OI) _[Medline]_
20. Albano AM, Silverman WK. The anxiety disorders interview schedule
for DSM-IV, child version: clinician manual. New York: Oxford University Press,
21. Guy W, Bonato R, eds. CGI: Clinical Global Impressions. Chevy Chase,
MD: National Institute of Mental Health, 1970.
22. The Pediatric Anxiety Rating Scale (PARS): development and
psychometric properties. J Am Acad Child Adolesc Psychiatry 2002;41:1061-1069.
) _[ISI]_
) _[Medline]_
23. Shaffer D, Gould MS, Brasic J, et al. A Children’s Global Assessment
Scale (CGAS). Arch Gen Psychiatry 1983;40:1228-1231. _[ISI]_

24. Miller RG. Simultaneous statistical inference. New York:
McGraw-Hill, 1966.
25. Rynn MA, Siqueland L, Rickels K. Placebo-controlled trial of
sertraline in the treatment of children with generalized anxiety disorder. Am J
Psychiatry 2001;158:2008-2014. _<NOBR Full Text]_
26. Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial
treatments for phobic and anxiety disorders in children and adolescents. J Clin
Child Adolesc Psychol 2008;37:105-130. _[Medline]_
27. Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S.
SET-C versus fluoxetine in the treatment of childhood social phobia. J Am Acad
Child Adolesc Psychiatry 2007;46:1622-1632. _[ISI]_
) _[Medline]_
28. Kendall PC, Hudson JL, Gosch E, Flannery-Schroeder E, Suveg C.
Cognitive-behavioral therapy for anxiety disordered youth: a randomized
trial evaluating child and family modalities. J Consult Clin Psychol
2008;76:282-297. _[CrossRef]_
) _[ISI]_
) _[Medline]_
29. Chambless DL, Hollon SD. Defining empirically supported therapies. J
Consult Clin Psychol 1998;66:7-18. _[CrossRef]_ (http://content
30. Wagner KD, Berard R, Stein MB, et al. A multicenter, randomized,
double-blind, placebo-controlled trial of paroxetine in children and
with social anxiety disorder. Arch Gen Psychiatry 2004;61:1153-1162. _<NOBR
Full Text]_
31. March JS, Entusah AR, Rynn M, Albano AM, Tourian KA. A randomized
controlled trial of venlafaxine ER versus placebo in pediatric social anxiety
disorder. Biol Psychiatry 2007;62:1149-1154. _[CrossRef]_
) _[Medline]_
32. Kiesler DJ. Some myths of psychotherapy research and the search for
a paradigm. Psychol Bull 1966;65:110-136. _[CrossRef]_
) _[ISI]_
The following investigators participated in this study: Steering Committee:
J. Walkup (chair), A. Albano (cochair); Statistics–Experimental Design: S.
Compton, S. Iyengar, J. March; Cognitive Behavioral Therapy: P. Kendall, G.
Ginsburg; Pharmacotherapy: M. Rynn, J. McCracken; Assessment: J. Piacentini,
A. Albano; Study Coordinators: C. Keeton, H. Koo, S. Aschenbrand, L. Bardsley,
R. Beidas, J. Catena, K. Dever, K. Drake, R. Dublin, E. Fontaine, J. Furr, A.
Gonzalez, K. Hedtke, L. Hunt, M. Keller, J. Kingery, A. Krain, K. Miller, J.
Podell, P. Rentas, M. Rozenmann, C. Suveg, C. Weiner, M. Wilson, T. Zoulas;
Data Center: M. Fletcher, K. Sullivan; Cognitive Behavior Therapists: E.
Gosch, C. Alfano, A. Angelosante, S. Aschenbrand, A. Barmish, L. Bergman, S.
Best, J. Comer, S. Compton, W. Copeland, M. Cwik, M. Desari, K. Drake, E.
Fontaine, J. Furr, P. Gammon, C. Gaze, R. Grover, H. Harmon, A. Hughes, K.
Hutchinson, J. Jones, C. Keeton, H. Kepley, J. Kingery, A. Krain, A. Langley,
J. Lee, J. Levitt, J. Manetti-Cusa, E. Martin, C. Mauro, K. McKnight, T. Peris, K.
Poling, L. Preuss, A. Puliafico, J. Robin, T. Roblek, J. Samson, M.
Schlossberg, M. Sweeney, C. Suveg, O. Velting, T. Verduin; Pharmacotherapists:
M. Rynn, J. McCracken, A. Adegbola, P. Ambrosini, D. Axelson, S. Barnett, A. Baskina,
B. Birmaher, C. Cagande, A. Chrisman, B. Chung, H. Courvoisie, B. Dave, A.
Desai, K. Dever, M. Gazzola, E. Harris, G. Hirsh, V. Howells, L. Hsu, I.
Hypolite, F. Kampmeier, S. Khalid-Khan, B. Kim, D. Kondo, L. Kotler, M.
Krushelnycky, J. Larson, J. Lee, P. Lee, C. Lopez, L. Maayan, J. McCracken, R.
Means,L. Miller, A. Parr, C. Pataki, C. Peterson, P. Pilania, R. Pizarro, H. Ravi,
S. Reinblatt, M. Riddle, M. Rodowski, D. Sakolsky, A. Scharko, R. Suddath, C.
Suarez, J. Walkup, B. Waslick; Independent Evaluators: A. Albano, G.
Ginsburg, B. Asche, A. Barmish, M. Beaudry, S. Chang, M. Choudhury, B. Chu, S.
Crawley, J. Curry, G. Danner, N. Deily, R. Dingfelder, D. Fitzgerald, P.
Gammon, S. Hofflich, E. Kastelic, J. Keener, T. Lipani, K. Lukin, M. Masarik, T.
Peris, T. Piacentini, S. Pimentel, A. Puliafico, T. Roblek, M. Schlossberg, E.
Sood, S. Tiwari, J. Trachtenberg, P. van de Velde; Pharmacy: K. Truelove, H.
Kim; Research Assistants: S. Allard, S. Avny, D. Beckmann, C. Brice, B.
Buzzella, E. Capelli, A. Chiu, M. Coles, J. Freeman, M. Gringle, S. Hefton, D.
Hood, M. Jacoby, J. King, A. Kolos, B. Lourea-Wadell, L. Lu, J. Lusky, R. Maid, C.
Merolli, Y. Ojo, A. Pearlman, J. Regan, S. Rock, M. Rooney, N. Simone, S.
Tiwari, S. Yeager.

**************Plan your next getaway with AOL Travel. Check out Today’s Hot
5 Travel Deals!

[Non-text portions of this message have been removed]

540 total views, no views today

Adult on Autistic Specrum destroyed by psychiatric medications. Paxil

Adult on Autistic Specrum destroyed by psychiatric medications. Are you like me?

“I had direct suicide attacks from Paxil…and flushed it down the toilet.”

DISCLAIMER: I am not a doctor or other healthcare person, nor wish to be. My views expressed in this letter and associated papers are my opinion. I do not suggest others make healthcare decisions based on anything in my writings, but should study their own situations carefully and do their own research in making their decisions so as to be capable of being as responsible as possible.

BUT, I maintain that reality belongs to everyone, and everyone that chooses to should be allowed to be responsible for themselves and their own destiny as much as their ability allows them. I believe this can be much greater than our society generally acknowledges.

In the fall of 1983 I apparently received an injury to my mid back at work. The pain was delayed but then soon became massive. The Dr’s I saw were largely unable to help except through large amounts of painkillers. In the fall of 1984 a General Practitioner started me on the antidepressant Surmontil, in the hopes it would help the pain by elevating serotonin levels. It didn’t. But immediately I had and reported the symptoms of “Serotonin overload, or as I understand it Serotonin Syndrome.” The doctor did not respond this to. Also I had the onset of depression and other symptoms such as a distancing from reality, loss of emotional control etc. This of course is being blamed on the pain, or the pain being blamed on the depression etc., so increase the Surmontil etc. I also developed a bad case of “Restless Leg Syndrome,” where almost endless weird sensations in and near the skin of the legs leads to twitching etc and serious discomfort. I have learned since that this can be associated with “Akathisia,” which can result from a range of psychiatric medications and lasted the entire time I was on psychiatric medications but stopped after their refusal.

I eventually conquered the pain myself by independent means. I still needed a duodenal bypass because all the pain and arthritic medications had severely ulcerated the duodenum that it was blocked from scar tissue.

The depression etc continued and grew and I was told how much I needed the antidepressant etc.

The depression grew and with it I slowly but progressively lost cognitive and memory functions, finally by 1990 or so to a severe degree. Also obsessive-compulsive problems grew. The sensory components of the serotonin overload were bad, feelings of scalding and freezing, poor heat tolerance, nausea.

By 1993 with the added burdens of stress and politics at the job I was doing and a turn to very abusive behavior by my then wife I crashed and was ordered to a psychiatric ward in a different hospital in Saskatchewan. There medications were increased with the additions of Haldol and Ativan. Soon I had and reported the increasing symptoms of “Akathisia”, something like restless leg syndrome but much more severe such that non-activity of the legs can be intolerable. This too was reported and ignored.

But the increase in mental illness symptoms was severe including great distancing from reality, depression, massive obsessive compulsive etc. Then I also started getting the warnings that” If I ever stopped taking the medications the R.C.M.P. would bring me in and they would be forced on me.” This came from several psychiatrists as they came and went at that ward.

To shorten the story some, over the years there were many more meds, about 20 weeks of hospitalization and progressively worse mental illness of a variety of kinds. By New Years of 1996 I was totally disabled from work because of it and am still on disability.

From 1996 to 1998 things were severely bad, life becoming a second by second struggle to stay alive, fight suicide, go through the torments of a hell I utterly no ability to understand. I lost the ability to do anything productive beyond quite basic survival, and have no memory of a single thing I can date to the year 1997 etc.

In 1998 I wanted out. I knew these massive meds were causing big problems, as far as I could tell these nonsensical psychiatrists were crazier than I was. I had some of the weirdest lectures and opinions from them. But in my appeals for understanding, remember I was barely hanging on to anything at this time, my insurance company and another mental health agency I was associated with “Ganged up” on me ordering me back to psychiatric care. I gave in.

Then the trouble really got bad. I had direct suicide attacks from Paxil, which were a chore to fight but I recognised them as coming from the Paxil and flushed it down the toilet and stopped seeing the Dr. that prescribed it.

My G.P. at that time agreed to maintain me on simple benzodiazepines such as valium or Ativan until he could get me to a psychiatrist I had heard of in Saskatoon that via the grapevine sounded saner. It didn’t work; I ended up in emergency in Saskatoon that September with a different Psychiatrist that started me on Chlorpromazine, Epival and Risperdal. All of these were disasters and I ended refusing all of them in the next 3 months.

But then in November 1998 I found a very encouraging sounding psychiatrist that had just come to Lloydminster. He stated me on a cocktail as is normal and added Zyprexa. At first, until late in May 1999 the Zyprexa seemed to be helping, though things were still awfully bad. In late May 1999 they really got worse. This led to a doubling of the Zyprexa plus a constantly varying array of meds, some of which I rapidly saw were disastrous and refused and started arguing for washouts, scheduled removal of all medications to do a test. This was consistently promised but avoided. Among the problems was an involuntary movement problem spotted by a social worker and reported to the psychiatrist by her. We discussed this and then it was ignored.

Things got still much worse. This was Hell!

In September I cold turkey refused the Zyprexa and got a huge improvement. The doctor then hospitalized me and removed a sedative cold turkey (immovane), which I wanted to remove slowly. This again precipitated suicidal problems and a new round of meds to be tried and flushed as they all revealed disastrous effects.

The last round was the worst, a combination of Celexa and Tegretol. Here I lost pretty much all emotional and cognitive existence and the serotonin overload symptoms became totally immobolizing, again with no recognition by the psychiatrist. This last round of meds apparently did a lot of long-term damage, I think adding a lot of time to the recovery.

In October 1999 I flushed everything and started the recovery.

To date, and this is still ongoing, I have regained a great deal of my cognitive back, a lot of memory function, a fair amount of stamina, but have a highly advanced and progressive movement disorder and a bad case of Post Traumatic Stress Disorder from the experience.

And as for the symptoms of depression etc I was being treated for, they were the first parts to improve and basically leave.

I now am a licensed user of Medical Marijuana to keep the movement disorder from literally tearing me apart in short order, am also on the immovane (which the last medicating psychiatrist made me suicidal by removing in 1999), with little or no ill effect, this helps with the movements and some PTSD symptoms, I am not under psychiatric care, but get a lot of assistance from my social worker with the PTSD.

From a later psychiatrist that made little attempt to medicate me, books, and the Internet I have learned to a large degree what happened. I will try to cover this more in point form on another paper about the specific medications.

But it gets better. In the fall of 2000 I accidentally ran across a book on autism. In a hurry I discovered I have the highest functioning form, Asperser’s Syndrome, inherited from my mother. After almost 4 years of fighting the system and a great deal of research I have a solid diagnosis from a Psychologist in Edmonton experienced in Autism and with a good record with it. He has also diagnosed the Post Traumatic Stress Disorder.

Asperser’s Syndrome is the highest functioning recognised form of autism. This is believed to be largely or wholly inherited, in my case my mother and members of her family strongly show characteristics of it. The people typically are highly intelligent, creative, responsible, artistic etc, and are often highly capable within their special interests, be they computers, technical, artistic or whatever. They can be walking encyclopedias. But they tend to be clumsy and limited socially. There is data to indicate a high probability of being chemically sensitive such that in some opinions they will tend to have drug reactions similar to mine. The numbers are supposed to include Bill Gates, Albert Einstein, Sir Isaac Newton and many notable others. The most recent numbers of them I have heard for Canada and Saskatchewan are about 1/235 in the population. Almost all diagnosis and assistance for them is restricted to children, adults are generally ignored.

My movement disorder is still undiagnosed after 4 neurologists and a Neuro Psychologist that recognised it as Tardive Dyskinesia, but wouldn’t write it down. Otherwise it has been ignored totally by one neurologist or gets rapidly diagnosed by the others as something inherited, and easily disproved, and the appointment is quickly ended with no follow-up.

It seems to be a combination of tardive dyskinesia plus likely another form of Dystonia caused by at least one other medication. Health Canada accepted the diagnosis of Tardive Dyskinesia suggested by an internist on my medical marijuana application.

The movement disorder has proven to be very progressive and so at an accelerating rate. Without control, especially from the cannabis I will soon go into a “cluster” of events with it that are non stop involving powerful sudden movements of the neck, torso, upper extremities and diaphragm that get very powerful, plus spasming and violent shaking. In a cluster I could soon be unable to look after myself and likely my muscles would tear themselves apart, not to mention bone damage, plus being violently crashed into things in my environment. It also involves a progressive loss of finer motor control at all times, such that now typing is very slow and error prone, my old work of welding and much else is difficult or impossible. Walking is affected.

This also necessitates routine massages, heavy ones, to reduce the sensations involved with the disorder and at times to break movement/sensation loops that can establish that I cannot break myself and which could be fatal by themselves. I have some insurance coverage for this but not enough.

My recovery was also very tough, especially at first, has involved a huge amount of work and discipline on my part, (I get high praise from some for this), has been assisted by the social worker a great deal and sabotaged by others also greatly, including the last medicating psychiatrist and the other mental health agency I mentioned I had been involved with. It seems we do not recognize that psychiatric care causes mental illness, and the patient can be sacrificed to protect the reputation of the system.

In the course of recovery I trained myself on personal computers, had never touched one before, and have taught myself a good deal of photography and computer graphics to the point I could be doing some professional work. I have done a lot of other work too, trying to get back to who I used to be.

In my efforts to get back a life in 2002 I argued and coerced my insurance company to get me a Rehabilitation Consultant which they have, who herself proved to be great, but was constrained to the rules and protocols of the company. After being instructed to pursue several pointless approaches, such as truck driving because there is a high demand, not suitable with medical marijuana etc., I started with a rehab program with a good sounding reputation from a local agency. This resulted in a job in janitorial work that on starting I soon found impossible. I reported this to the employer, a large lumber co and builder of prefab houses, that the job was undoable as described, would require several capable people to attempt it, and needed complete reengineering to be practical.

The employer agreed with me totally, saying my assessment was: “Bang on.” I think this indicates that there was no research into the job for suitability, this employer being that agency’s best supporter for their rehab program.

He told me to reengineer it. I tackled to job and tried to assess it for this. On the first night after work I had a massive PTSD attack from it and withdrew. This ended the entire rehab approach.

The insurance co. has indicated no interest in assisting with the computer graphics approach or any form of self-employment. It has also recently refused assistance in seeking diagnosis or therapy from the psychologist in Edmonton regarding Asperser’s Syndrome and PTSD.

Presently I am broke, in debt, have sold almost everything I can sell, and spend about $200.00 a month on supplements etc to assist recovery and control the movement disorder.

Because of information from me, a few others with autism or asperser’s characteristics have been able to get away from psychiatric care and recovery, including one local woman who has gone from very disturbed and totally disabled back to finish her professional career.

There is a great deal more to say as well. The main points are however, that these medications are far more dangerous and to identifiable people than they are given credit for. The practitioners that prescribe and administer them are not adequately aware of their dangers, including known and documented ones, which they cannot separate from the illnesses they are supposed to treat, and do not pay adequate attention to the feedback from patients. The “system” does not have a reasonable means of dealing with harm caused by doctors and won’t until it is prepared to admit that harm happens in the first place. The apparent sacrificing of patients that are harmed is atrocious and I tend to describe the whole problem as a human rights issue. The task of assisting the victims falls on lesser qualified (non doctor) therapists that can seem to do a far better job but who may be put in political danger for doing so and can and likely will be overruled by doctors who seem more intent on protectionism than health care. Beyond that I have to suggest that there is little out there in mental health care and supports that seems realistic, or even works.

My future is still in severe doubt even with assists because of the progressive nature of this movement disorder, but I would like a shot at something. A greater issue is the others who obviously are and will be victimized as I was. Simple calculations from known estimates could lead to suggestions of tens of thousands or more going through what I went through right now, in Canada.

I have complained to the Saskatchewan College of Physicians and Surgeons on 2000 without realistic results. I have written reports on this to politicians and Saskatchewan’s Minister of Health, the local Health Region (and have been encouraged by healthcare people to do so) and everybody else I can think of all with similarly useless results, usually not even acknowledgement. Yet it can be seen that the carnage goes on.

Legal opinions I have sought are dismal.

I have come to the conclusion that publicity, hopefully noisy publicity, is the only recourse to finding the others so affected, or letting them find themselves as I did.

In my case I would like to see a fully independent, such as criminal, investigation done.

I hope this can be revealed so it can be dealt with.

Peter Christensen

July 9, 2004

Summary of prescription medications;
From Pharmacy records March 1995 to termination of psychiatric medication October 1999:

Note: Antidepressants were started in the fall of 1984, with Surmontil, prescribed by a General Practitioner to assist in pain relief from a mid back injury. This medication was continuous until stopped in 1993 or 1994.
Symptoms now understood to be from Serotonin overload were present almost immediately and continuously until all meds refused.

Also prior to 1995 were the medication: Haldol (neuroleptic), Atavin (benzodiazapine), Luvox (antidepressant), Restoril (benzodiazapine for sleep), and at least 2 or 3 SSRI antidepressants, one of which caused what I can only describe as mini convulsions or seizures, of short duration ending with violent vomiting after which the seizures broke.

I don’t have pharmacy records on hand to detail this.

FROM PHARM. RECORDS: names in brackets( ) are either from a Pharmacy resource or from my best recollection. Some medications in my records that were unrelated to Psychiatric care or secondary reactions have been omitted here. Medications prescribed and administered in hospital are not reflected here.

Dates of use typically are from first report in records until last time a prescription was filled, not necessarily the last time taken.

Novo-Doxepin (Sinequan) Tricyclic Antidepressant 50 mg – From: Mar. 29/95 – Aug 10/95 Tried earlier on, until about 1994, one of the least harmful antidepressants, but still not good.
Carbolith (Lithium Carbonate) 150 mg – From: Mar 29/95 – May 13/98 Now known to be associated with depression and a continuous urinary incontinence problem that was denied, that still lingers to a lesser degree.

Apo Diazepam (Valium) 5 mg – From: Mar 23/95 used periodically almost throughout, was used very briefly after termination of Psych. care at time of death of mother in 2000. By itself, similar to other benzodiazepines led to progressive loss of reality and what I call psychotic existence.

Nu – Ranit (ranitidine) 150 mg From a GP – stomach acid reducer (this was a serious problem while on Psych medications) – From: Apr 7/95 – July 15/99
Losec 20 mg (stomach acid controller) Not from a psychiatrist – May 5/95 –

Apo Metoclopramide (maxeran) 10 mg – Antinauseant – had almost constant from mild up to disabling nausea entire time of Psychiatric medication reducing steadily after termination of Psych. care, understand this involved with Serotonin overload. From: June 7/95 – last used sporadically until spring 2001 for nausea, when I discovered it was a leading cause of drug induced Dystonia, though I was always reassured as to it being very safe, after which no antinauseants have been used. This may be part of my present movement disorder.

Apo – Perphenazine 2 mg – 4 mg – Used to control side effects of other drugs – From: Sept 22/95-July 7/97 No specific recall.
Apo – Imipramine 50 mg – Antidepressant From: Sept 22/95 – until Effexor started. Associated with massive symptoms of Serotonin Overload and depression.
Restoril 15 mg – (benzodiazapine sleep med) From: Sept 22/95 – Oct 16/96 No specific recall of effects.

Apo – Oxazepam 15 mg (benzodiazapine Serax) From: Sept 22/95 – Dec 13/95

Alprazolam 0.5 mg (Xanax) From: Jan 23/96 – Oct 8/99

Effexor 37.5 mg – 75 mg (antidepressant) From: June 5/96 – June 23/98 (started in hospital Apr. or May/96) Associated with much deeper depression and anxiety, (SSRI Mania?) plus massive symptoms of serotonin overload, still being the subject of treatments for PTSD.

PMS – Clonazepam 0.5 mg – (benzodiazapine Rivitril) From: June 5/96 – June 18/99 shown independently to rapidly cause the “benzo crazies.”

Nozinan 5 mg – 50 mg From; June 5/96 – July 7/97 Heavy short lived sedation, huge appetite stimulant, loss of reality.

Nu – Loraz 1 mg 2 mg – (Lorazepam – benzodiazapine) From: Nov 25/96 – June 23/98

Nono-Ridazine 25 mg – (Thiaridazine? neuroleptic) From: July 18/97 – Dec 19/97 May have softened the anxiety from the other meds.

Effexor – XR 150 mg – (Antidepressant) May 27/98 tried very briefly, immediately caused strong depression and “going crazy.”

Paxil 20 mg – (antidepressant) From: Aug 7/98 – Aug 20/98 This included a dosage increase and was refused due to suicide attacks (now being more widely discussed internationally. Also caused specific attacks of depression and anxiety.

Novo-Poxide 25 mg – (Librium) Sept.7/98 Single dose taken resulting in severe instant anxiety attack.

Epival 500 mg – Sept 29/98. Associated with severe gastro intestinal distress, disorientation, and loss of reality until refused.

Novo – Chlorpromazine 50 mg – From: Sept 29/98 – Dec 17/98 Massive disorientation, blackouts leading to short periods of total disorientation, activity observed by others as totally bizarre but of which I have little or no recall, until medication refused.

Risperdal 1 mg From: Sept 29/98 – Oct 28/98 – Note: Associated with extreme obsessive compulsive, utter madness, and arthritic attack in several joints including hands, some symptoms of this still exist leading to surgery in one hand and cortisone injection in the other. May be due to Neuroleptic Malignant Syndrome.

Rhovane 7.5 mg (immovane – zopiclone) from Sept 10/98 Note: Am still using this med as a control for the flinch (tardive dyskinesia), it being possibly the only primarily psychoactive pharmaceutical I can tolerate. This drug was forcibly withdrawn cold turkey in hospital in 1999 leading to massive suicidal urge.

Nu-Trimipramine (Surmontil) older tricyclic antidepressant started in 1984 for back pain, caused depression etc., used until replaced in 1994 up to very high dosage. 50 mg – From: Nov 23/98 – Dec 23/98

Dom-Metoprolol-B 50 mg – From: Dec 11/98

Zyprexa 5 mg – 10 mg (Olanzapine – neuroleptic) From: Dec 23/98 – Refused Sept/99 Note: This drug is associated with the start of my flinch (tardive dyskinesia), extreme symptoms often associated with Trauma Response, psychosis, severe dietary problems possibly from pancreatic damage, many present symptoms associated with Post Traumatic Stress Disorder stemming back to here. Only the use (prescribed) of very heavy doses of immovane allowed this medication to be survivable.

Stemetil 5 mg – (anti nauseant) From: Dec 30/98 – Oct 14/99 not used continuously, some effect in treating nausea.

Serzone 100 mg – (antidepressant) From: Jan 29/99 – April 19/99 No recall.

Dixarit 0.025 mg – Feb 2/99 No recall.

Dom-Trazodone 50 mg – (Desyrel – antidepressant) July 23/99 Single prescription associated with high anxiety and massive panic attacks from inconsequential stimuli.

Apo-Amitriptyline 25 mg – (Elavil – antidepressant) From: July 30/99 – Aug 20/99 Similar to other tricyclic antidepressants, big improvement when removed.

Apo-Halopridol 1 mg – (Haldol – neuroleptic) From: Sept 15/99 – Sept 24/99 Utter nightmare, compelled to use in 1993 in hospital, associated with akathisia (severe leg etc discomfort and inability to remain still, sitting etc, walking helped) plus massive obsessive compulsive, depression, disorientation until refused, repeat performance in 1999 until refused.

PMS-Benztropine 2 mg – (Cogentin) From: Sept 15/99 – Sept 24/99 Poor recall other than improvement on refusal.

Apo- Carbamazepine 200 mg – (Tegretol) From: Sept 8/99 – Oct 8/99 plus as follows:

Celexa 20 mg (antidepressant) From: Sept 15/99 – Oct 10/99 Note: This combination of Tegretol and Celexa was the most terrible time of the entire ordeal, with massive symptoms of disabling nausea and sweating, associated with serotonin overload, utter collapse of emotional and cognitive function, overall shutdown of mental capacity in almost every regard, symptoms of which were a very long time reducing after refusal of these drugs, though the turnaround was obvious and immediate upon their refusal.

This marked my total refusal of psychiatric medications.

All benzo diazapines were stopped after last prescription of Valium April 4, 2000, which was used briefly after my mother’s death, except for a 2 day trial of a Benzodiazapine sleeping pill Starnoc, represented as the mildest of mildest which led to a 10 day run of anger and utter psychotic feeling.

Peter Christensen

583 total views, 1 views today

Prozac Made Me Want to Kill Myself

“Prozac is the scariest thing that ever happened to me.”

I am a 19 year old female. I struggled with depression for as long as I can remember, it peaking at the age of 14. When I turned 16, I couldn’t take it anymore and begged my mother to get me help. After seeking help from a psychologist and it being unsuccessful I finally agreed to try out Anti-Depressants.

I can’t remember all the kinds of A.D.’s I tried but I do remember that it took a while before I could find one that worked for me. One of the med’s my doc had me try was Prozac. Prozac is the scariest thing that ever happened to me. While before I would sleep all the time to “get away from the world” Prozac gave me insomnia. At night I would curl up in a ball and cry my eyes out uncontrollably. Thoughts of suicide emerged that were so intense that the only thing that kept me alive is that I was sobbing too hard to do anything. I had suicide thoughts before but it was more of a passive feeling, like “I hate life and want to die, but if it doesn’t happen now oh well.” The suicide feelings brought on my Prozac were so intense that I felt I needed to do it NOW; I couldn’t put off killing myself.

I remember being so scared of these feelings that one night while I cried my eyes out I walked to my mom’s room and woke her up, told her all the feelings. She told me to quit taking them and called my doc first thing in the morning. I waited to say something because 1) I thought Prozac just took a little while longer to take effect or that I didn’t wait long enough from the kind of A.D. I tried before and 2) I thought no one would believe me because it makes no sense for a medication that’s supposed to treat suicidal tendencies to be causing them, especially not a medication that has been around for so many years!

I like to add that I found Buspar to be effective in easing my depression but after I took it for a while I began to get extremely mean. Finally I found Effexor XR to be the best for me. I never had problems with it and I have been off for almost 2 years and am still fine.

Hayley Adams

500 total views, no views today

Prozac and Alcohol

“I have experienced blackouts when drinking alcohol and engaging in embarrassing and even dangerous behaviors during the blackouts.”

I want to share my recent experience with Prozac. My e-mail address may be posted, but not my name.

I have taken Prozac for close to 15 years, and I would have to say it has provided relief from my depression. Several months ago, I was going through an ugly marital separation and other problems and felt very depressed again. My doctor doubled my Prozac dosage from 20 mg. to 40 mg.

I have always been a social/moderate drinker, consuming 1-2 glasses of wine with dinner most evenings. It never presented a problem on the 20 mg. of Prozac. However, since increasing my dosage, I have experienced blackouts when drinking alcohol and engaging in embarrassing and even dangerous behaviors during the blackouts. I am also craving alcohol in a way I never have before. I also feel that my short-term memory has been negatively impacted.

It has taken me several months to make the connection between my recent behavior and the altered Prozac dosage, but I am absolutely convinced the first is a result of the second.


480 total views, no views today

Student's Life Destroyed on Prozac

“(After begging my doctor to put me on Prozac,) I just felt insane. I felt like screaming, tearing my clothes off and running around like a madman.”

I wrote to this site several weeks ago about sending in my story. As I wrote it that night, the anger, fear and trauma built so badly that I ended up ranting and rambling. I needed some time away to think and to collect my thoughts about this nightmare so that I could do it justice on paper. I will try to make it as brief as I can:

In 1991, my parents separated. I was 18 at the time. My mom had been seeing a psychiatrist and was taking Prozac. She turned into a completely different person. She was vengeful, angry and borderline psychotic. My mom told me that my dad was an alcoholic (I since have learned she is as well) and that we have depression in our family. She recommended that I see a psychiatrist as well. I blew her off and went to college the next year. I starting drinking once a week (parties) in college and started becoming depressed. It was harder to get up in the mornings now and I remembered what mom had told me.

I panicked and went to the doctor. Mom went with me to the doctor (right before she left home) and I practically begged him to put me on Prozac if that was “what I needed.” He assured me that the side effects were dry mouth, possible weight gain, nausea, etc. I took the stuff and almost immediately started feeling badly (the doctors told me that that was impossible as it would take two weeks to get into my system.

They have since concluded that some patients are effected in a few days. I just felt insane. I felt like screaming, tearing my clothes off and running around like a madman. I told my doctor that the stuff was making me crazy but he told me that it was me and not the pills (For the record, he was an MD who could prescribe meds. I was referred to him by a psychologist.) So we upped the dose. I had also been taking a benzodiazepine (Klonopin) because I was having trouble sleeping and I immediately became addicted. The doctor never told me that these pills were addictive. I stayed on Klonopin for three years and mixed and matched medications constantly as my condition worsened. I tried to save a drug problem with more drugs and I spiraled completely out of control as I was caught in that vicious cycle we all have heard about.

I tried countless anti-depressants. I was later diagnosed with manic-depression and schizophrenia. The possibility exists that the Prozac helped my depression and left my manic phase alone (or aggravated it.) Medications are constantly evolving and the doctors don’t even know sometimes so I have no real answers. I took Paxil for a day and puked my guts out. I took Luvox and all I thought about was killing people. I took muscle relaxers and other pills while my addiction went unnoticed by doctors in two states. I switched to Atavin in 1995 and drugged myself completely to death for two years. I was taking the near maximum dose. I was later told by other doctors that I should never have been on benzodiazepines for that long. I told one doctor that I needed to quit taking the benzos as they were killing me. He apparently misunderstood me and told me that I would be on them for the rest of my life. I’m assuming he meant the other medications I was taking. I had to go to another doctor to phase down off of the benzos. I had a grand mal seizure by coming off them two days early (I had been phasing down for months.) This was at the Kentucky State Fair in front of my mother and sister and I almost died.

I was a solid B student with an IQ near the upper two percent in HS and I was also a successful athlete. There had been no major disciplinary problems in my schooling life up until I started taking medications. I never partied in HS and probably had only a few drinks of wine in my life before I was 18. Before the medication, I averaged a 3.0 my freshman year in college with the intent to do better. The pills sent my life into a tailspin. I dropped out of college several times after seeing my GPA dip to a 1.0. I bounced from drunk parent to drunk parent and doctor to doctor. I had been on pills until recently, even though I had kicked the Atavin for good seven years ago. I was unable to work during this time as I was addicted.

They tell us that the pills are non-addicting but they don’t understand people with addiction issues. I get addicted to anything. ANY powerful drug will addict me and the anti-depressants and mood stabilizers were no different. After fighting for my right to get clean and free of drugs and doctors (with both parents and doctors), I have made it to some sanity. I ballooned up to 242 pounds on the pills (one social worker asked me once if I would rather be fat or mentally ill.) I have since gotten down to a very healthy and athletic 185 and I feel great. I have also invested in proper nutritional supplementation. Natural supplements, especially fish oils, work and I regret not trying them earlier. In 1998, I had a domestic dispute with my dad and I was arrested and committed. I was abused, bullied and intimidated at the “mental health clinic” where I was committed, where I was put on more pills (after being coerced into signing my rights away.) Most of the rest of the “treatment” was having social workers tell me how to grocery shop (!) and play Scattergories with me and other patients (no joke.) I was also insulted in the clinic and overheard lines like “people think we’re Nazis and criminals.”

One social worker even told me, “There is no such thing as justice.” I may be misquoting exactly how she said it but the message was that justice was a fallacy in the real world. So I knew that I had no rights in this place. They charged me $500 a day (I couldn’t say no as I was a prisoner) and told me about disability and it’s insurance the day that I was to be released five months later. In the meantime, I had been put in a group home, where a miscommunication between the case worker there and the mental health clinic led to me being arrested and put back into the clinic. I was told by the clinic that I could stay as long as it took me to find a job, although the normal period was two weeks. After two weeks I didn’t have a job, so they kicked me out. Terrified, I left and went back to the clinic to talk about what had happened. The police were waiting for me and arrested me as I had “broken the rules of the group home by leaving.” I swear this is the God honest truth.

I now owe these snakes $54,000 for pills that got me addicted and for playing Scattegories while I was a prisoner. I have taken their pills, gotten addicted and have been unable to work. They continued to experiment, make more money and blamed a lot of the problems on me. I called up my original MD in 2001 and confronted him about the issue of medications actually causing the symptoms they are supposed to be treating (since proven my doctors.) I asked him if he knew about these potential problems when he prescribed the first round of meds and didn’t tell me. He said that he did after I continued to press him. I called him a bastard and he hung up (I will also note that he didn’t return any of my calls to talk to him and I had to get him at home.) I tried to report him (symbolically and as a public service) very recently. The woman I was trying to talk to answered me very rudely and in a belittling fashion that I couldn’t report something that long ago. I have since read a lot on this issue and feel that I am just another victim of corporate psychiatry (look it up online.) I am hurt, angry and betrayed by people who took an oath to help me. Some doctors were stooges while others knew the risks and didn’t tell me. These issues put my life at risk and have led to poverty and financial ruin for me.

I have talked to lawyers and they told me that they don’t even touch addiction cases of psyche meds, even if the doctors err. Apparently, these people have dictatorial power to experiment on citizens like me who suffered enough emotional abuse from drunken parents and cruel school children. I also have tried to contact newspapers online with the story but they have not written back to me. I have run from this issue as I feel I have no hope for retribution, satisfaction or justice (they also told me in the clinic that paybacks are bad. Gee I wonder why.) If anyone wants to contact me on this subject, I will be more then happy to talk. I will also be more then happy to fight as I still owe these so-called people $54,000. I don’t even have the money to declare bankruptcy right now. The payments are supposedly ability to pay but I get notices in the mail every month from the clinic.

Again, I swear that this is all the God honest truth. I wouldn’t have believed it myself if it hadn’t happened to me. I am a college graduate with a degree in history and a minor in political science and I am not stupid (I’m studying for the Mensa test now.) I knew what was happening to me the whole way but was too sick to fight it. If anyone has any information on organizations that fight these kinds of things, please let me know as I have tried many things. And, for God’s sake, don’t go to these people if you can help it. Watch your health, take the proper supplements and take care of yourselves. In my experience, if you go to these people and take their pills, you just put a gun in your mouth and pulled the trigger. I also have to live with the pain and shame of this stuff forever.

PS- Sorry it took so long but it’s a long story. I would like my name and E-mail printed as I would like to be a leader in the confrontation of these issues. If you have any questions, please E-mail me.

Jeff Riley
(Please excuse the E-mail ID. I get angry about past stuff sometimes.)

687 total views, 6 views today

10/31/2002 • Ethyl-Eicosapentaenoate Could Be Effective In Persistent Depression

10/31/2002 • Ethyl-Eicosapentaenoate Could Be Effective In Persistent Depression

By Elda Hauschildt

Archives of General Psychiatry, 2002; 59: 913-919

Ethyl-eicosapentaenoate at a dose of 1 gram per day could be effective in treating depression in patients with persistent illness after standard antidepressant therapy.
Ethyl-Eicosapentaenoate Could Be Effective In Persistent Depression

By Elda Hauschildt

Archives of General Psychiatry, 2002; 59: 913-919

Ethyl-eicosapentaenoate at a dose of 1 gram per day could be effective in treating depression in patients with persistent illness after standard antidepressant therapy.

“Ethyl-eicosapentaenoate offers an approach to depression that is radically different from that of existing drugs,” say British researchers who conducted a double-blind trial of the drug. They suggest the drug’s position in the treatment spectrum needs to be established by further trials.

The investigators, from Swallownest Court Hospital in Sheffield, England and Laxdale Research in Stirling, Scotland, randomised 70 patients with persistent depression despite ongoing therapy with an adequate dose of standard antidepressant.

Patients received either placebo or ethyl-eicosapentaenoate at one of three dosages: 1 g/d, 2 g/d or 4 g/d. Therapy lasted 12 weeks and was in addition to background medication, which remained unchanged.

Of 52 patients in ethyl-eicosapentaenoate group, 46 (88 percent) completed therapy, as did 14 of 18 patients (78 percent) receiving placebo. No adverse events were observed.

Participants in the 1-g/d ethyl-eicosapentaenoate group showed significantly better outcomes than placebo participants on three assessment scales: the 17-item Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory.

In the intention-to-treat group, nine of 17 patients (53 percent) in the 1-g/d ethyl-eicosapentaenoate group achieved a 50 percent reduction in the Hamilton Depression Rating Scale score. This compared with five of 17 patients (29 percent) in the placebo group.

The researchers observed improvements on all individual items in the three assessment scales with the 1-g/d ethyl-eicosapentaenoate dosage compared with placebo. They say there were beneficial effects on items rating depression, anxiety, sleep, lassitude, libido and suicidality.

There was little evidence of efficacy in 2-g/d ethyl-eicosapentaenoate participants, and 4-g/d ethyl-eicosapentaenoate participants displayed non-significant trends toward improvement.

1,176 total views, no views today

Married to Zoloft and I Want a Divorce

“I quit cold turkey. Big mistake! Five days later I ended up in the hospital emergency.

I knew something was really wrong.”


On September 1997, I went to see my doctor to complain, for the fifth time, (I had seen my doctor five times that month) of nausea and that I had very little energy. She got upset with me and told me that I was in denial, and that my problem was really depression. She prescribed me Zoloft.

At that time, I had just began my first semester in university. My illness did not go away. I felt sick and run down. Six weeks went by, and one day I got violently sick and ended up in the hospital. As it turns out, the reason I had been ill was not because of a depression I knew I had, but because I had a viral infection that had gone untreated for months.

After I was treated for this infection, I continued taking Zoloft, as I thought it my help me cope with my final exams. I continued taking Zoloft or a few months and finally decided to come off the drug. I quit cold turkey. Big mistake! Five days later I ended up in the hospital emergency.
I knew something was really wrong. The psychiatrist re-ordered Zoloft, and the withdrawal effects quickly disappeared.

After that experience, I knew that I could not quit this drug abruptly, so, a year later, I tried the tapering off method. I went from 150 mg to 50 mg in a matter of four months. The withdrawals became progressively worst, to the point that I could no longer function normally. I had difficulty putting words together; my short term memory was greatly disturbed and I felt like I as losing all mental capacity. I could not read anymore; a pass time I really enjoyed. I could no longer write; and writing was one of my favorite hobbies. To make a long story short, I had to start taking Zoloft again at a dose of 100 ml, just to be able to function.

I have been on Zoloft since 1997.Zoloft ruined my life. Sure, I was depressed before 1997, but at least, then, I was in control of my life. I had some good days. Now the good days are few and far between.(I can’t remember when I felt joy.)I went from being a functional woman with drive and hope for the future; to a scared nervous wreck. I don’t even look or feel the same anymore. It’s like being someone else. Before Zoloft, I always kept my house clean and tidy; I weighed 120 pounds and looked great; I had hobbies which kept me sane; I had a support system and my family admired and praised me. Now, I weigh 208 pounds; I little confidence and drive; I used to be good with money but now I have maxed out my credit; I have become an angry and bitter person; I have thoughts of suicide every day; I have no friends left; In sum, I am not me anymore.

Three days ago, I decided to quit cold turkey again. I am writing this now, because I know that in a few days, I won’t be able to put one word in front of the other. I already feel the withdrawals. Every time I move, my eyes lose focus and my head feels funny. It feels like it skips a beat. It’s very difficult to describe and to tell the truth, I don’t want to see my doctor because he won’t take me seriously. Since I’ve been on Zoloft, I have attempted suicide 11 times. I want myself back. I want that drug out of my system and only hope that it hasn’t caused permanent physical damage.

Zoloft ruined my life.



This is Survivor Story number 8.
Total number of stories in current database is 48

652 total views, 1 views today

Celexa / Citalopram Hell

realized now that the hell I was going through was a direct result of taking Celexa.”


Hopefully my story will be an eye-opener to those who are offered this drug (as SSRIs are so commonly offered to those unknowingly suffering from BZD-induced depression and/or withdrawal).

About 2.5 years ago, I was prescribed Citalopram (Celexa, Cipramil) for depression. I had no other symptoms of “anxiety disorders”, etc, I was just “down”. I was assured that it was a wonderful, revolutionary new drug—-safe, non-addictive. A veritable happy-pill; nothing short of a wonder-drug.

Little did I know that this drug was anything but safe, harmless, or non-addictive; little did I know how this drug was going to ruin my life.

Initially, Celexa didn’t appear to be very effective, and so my dose was increased (from 20mg/day to 40mg/day, then to 60mg/day, if I remember correctly). “Nothing to worry about”, or so I was told.

I experienced two major side-effects whilst on Celexa (the real problems began later). I lost all short and medium-term memory. To this day, I can remember very little of those six months of my life. Furthermore, my mood drastically altered. Far from alleviating my depression, I became angry, withdrawn, and more depressed than ever before.

After six months of being on Celexa, I was brought rapidly (far too rapidly) off it over the period of a few weeks, and eventually came fully off them.

Two weeks later, all hell broke loose.

At first, I thought it was a very bad case of flu—-all my joints and muscles ached to the point of burning, my sinuses became painful, all the lymph nodes in my body swelled up. My head seemed as though it was on fire; unlike any migraine I had ever experienced before. I rapidly lost weight until I was well under 7.5 stone (about 105lbs or 45kg, and I’m about 5’10” in height). Everything I ate, I vomited straight back up, I couldn’t keep food down at all (and at one point, I couldn’t keep water down either). My memory was the same as when I was on the drugs (i.e. very little).

I felt like I was dying—-and if I’d lost much more weight, I probably would have.

I went back to our doctor’s surgery. He diagnosed that I was suffering from “some severe condition like glandular fever”, and had me rushed up into inpatient admissions at our local hospital.

I’ll spare you the details of the incredibly poor hospital treatment I received; I was bombarded with all kinds of obtuse theories about my suffering, which were eventually winkled down to “unidentified viral infection” and “possibly CFS/ME”.

A few months later, I was still suffering—-I’d made a slight improvement, and then the illness seemed to reverse course, and I got rapidly worse again. Once again I saw the same doctor; once again he seemed genuinely concerned; once again I was admitted to hospital. This time they added a little twist to their already absurd theories; I apparently had “both CFS/ME and severe sinusitis”. To combat this supposed sinusitis, I was put on a regimen of both intravenous and oral antibiotics.

Bear in mind that, at this point, I had no reason to suspect that Celexa, or, rather, my withdrawal from it, was causing these symptoms.

I was on these antibiotics for what seemed like an eternity; in total, I’d guess I was given the equivalent of around 50 courses of antibiotics. Needless to say, my body became much weaker as a result.

It was now about a year since I had come off Celexa. My condition seemed to be gradually improving, but I was still incapacitated by the symptoms. Due to circumstances that I don’t plan on making public, I became aware of the side effects of another class of psychotropic drugs, benzodiazepines.

A little research revealed that many, many others had experienced unnervingly similar symptoms and conditions after withdrawing from not only Celexa—-but other SSRIs, notably Paxil (Seroxat, paroxetine), as well.

I realized now that the hell I was going through was a direct result of taking Celexa.

“After about 2 to 2.5 years, you can start to see the light at the end of the tunnel” —-paraphrased words of a Paxil survivor.

It’s now about 2.5 years since I withdrew from Celexa. Over this time, I’ve been making—-and continue to make—-a very slow, gradual recovery. I have two or three residual symptoms, but they are very, very slowly diminishing in intensity. I have near-constant pain and inflammation in one side of my head; and my memory and concentration is still not 100% of what it was.

Chances are that what Ashton says is true; neurological repair after damage by psychotropic drugs does occur in time.

This kind of experience is not unique. Try reading through the antidepressant web (, (, Paxil survivors, etc, etc resources.

My experience has surely brought new meaning to the phrase “hell on earth”. Be warned; accept these drugs at your peril.

James Moore



This is Survivor Story number 23.
Total number of stories in current database is 48

779 total views, 1 views today

Teenager Didn’t Know What He Was Doing on Paxil

He ended his life because of this damn drug.”


On Nov.6, 2000, my world was turned upside down. Life as I knew it was changed forever on that day. My beautiful 19 yr old son was put on the drug Paxil for depression. He was never monitored and I was never told of the dangers associated with this mind-altering drug.

He was on this drug for about 3 weeks. Then on Nov. 6,2000, my son took a shotgun and put it in his mouth and pulled the trigger. He ended his life because of this damn drug.

How can they claim that it is safe when all I hear is how dangerous this drug is and that when you are on it, you have to be monitored very closely.

I was told by the doctor that “it wouldn’t hurt him.” Well when I asked my son one day if he was still taking it, and he said yes, but he didn’t like the way it made him feel, I asked him what he meant by that.

He said “like I don’t know who I am or what I am doing”.

Now he is silenced forever and I am living a life of never having to see my son grow into a wonderful person. He will never have a family of his own thanks to that “damn wonder drug” known as PAXIL.

I wish that they would pull that drug from the market so no other family will have to live this nightmare.

Sally Vanwinkle



This is Survivor Story number 25.
Total number of stories in current database is 48

517 total views, no views today

Thanks to Prozac, I’m Surrounded by Murderers, Rapists and Worse

“The doctor said Prozac would make me happy. I’m not happy.”




I am so sorry to hear your son’s story. I am sorry I cannot contribute to his memorial fund financially, but I send you my support and prayers. (See the ICFDA Survivor Story“He Never Said Goodbye.”)

I am sure you are wondering why me, a convicted murderer, is writing. Your son and I have something in common. I was placed on Prozac in 1996 for depression. I was 18 and naïve. About three weeks into “treatment,” I became irrational. Paranoid, and violent. This was very out-of-character for me. In a week’s time, I slapped my girlfriend, beat up a friend, and purposefully crashed my truck into a stone wall. Now most people would notice they were behaving abnormally, but on Prozac, you think that you are rational, even at irrational times.

That is the best way I can explain it. I finally went over the edge on April 25th, 1996. I walked 13 miles to my father’s home in a trance-like state. I was very calm, but it was as if I was watching myself from outside.

At my father’s home, I visited with my father for a while, and in the middle of the visit while he bent over to pick something up, I shot and killed him. There was no reason for harming him. I loved my father very much. To this day, I can’t say exactly what I was thinking at that moment.

After the shooting, I turned myself in to police where I calmly confessed to the shooting. I knew now that my behavior was out of control. I told the police that the meds I was on had been making me act weird, but they didn’t want to hear my “excuses.”

Even at court, my attorney said he could find no evidence to show Prozac caused violence. The makers of Prozac even offered to aid the prosecution’s case against me. Protecting their drug al all costs.

To avoid the death penalty, I pleaded guilty to Murder Three. I am serving 22 1/2 to 60 years in a maximum security prison. I am surrounded by murderers, rapists, and worse every day. All I wanted was help. The doctor said Prozac would make me happy. I’m not happy.

Cases like your son’s and mine are not as rare as people think. I pray someday, we will find the justice we deserve and the truth will be told. I will keep you and your family in my prayers.

God bless you.

Kurt Danysh
1111 Altamont Blvd.
Frackville, PA 17931



This is Survivor Story number 36.
Total number of stories in current database is 48

473 total views, no views today