SSRIs: Sharp Drop in Brain Activity + Worsening Depression & Suicidality

NOTE BY Ann Blake-Tracy (www.drugawareness.org):

Hopefully if you have followed my work or read my book, “Prozac: Panacea or Pandora? – Our Serotonin Nightmare,” you know that I have made the argument for a decade and a half that antidepressants are the most similar drugs we have ever seen to dissociative anesthetics like PCP or Ketamine. They just work in a little slower motion is all. This research would confirm that by showing adrop in brain activity within ONLY 48 hours of use! All one needs to do is go to the one color page inmy book with brain wave patterns of a 31 year old male on Prozac for six months. The brain waves show that the patient is in a total anesthetic sleep state and dreaming while talking with those doing the test on him!
_______________________________________
Paragraph five reads:  “Prior research, Hunter said, has shown that between 8 and 14 percent of depressed patients develop thoughts of suicide while taking the most common forms ofdepression drugs, known as selective serotonin reuptake inhibitors (SSRI). Although reports have suggested that SSRIs are to blame, no firm link between these drugs and thoughts of suicide has been established.”

Paragraphs seven and eight read:  “The researchers treated 72 people suffering from majordepressive disorder (MDD) with one of two SSRIs, fluoxetine or venlafaxine, or with a placebo. All were evaluated by a clinician using the Hamilton Depression Rating Scale, a standard instrument that assesses the severity of a wide range of depression symptoms. Of the 37 participants on medication,five (13.5 percent) had worsening thoughts of suicide.”

“All of the participants were also examined using QEEG, which evaluates brain function based on thebrain‘s electrical activity. Among the 13.5 percent of participants who got worse, the researchersfound a sharp drop in brain activity within 48 hours of the start of medication. The dropoccurred in the midline and right-frontal sections of the brain, areas known to control emotions.”

SSRI Stories note:  In regard to placebo & suicidality, it should be remembered that the majority of placebo patients are ‘wash-out’ patients from other antidepressants and thus are actually inantidepressant withdrawal which can be extremely dangerous.

http://www.physorg.com/news189972383.html

Simple test can detect signs of suicidal thoughts in people taking antidepressants

April 8, 2010 By Mark Wheeler

(PhysOrg.com) — UCLA researchers have developed a non-invasive biomarker that may serve as a type of early warning system for doctors and patients.

While antidepressant medications have proven to be beneficial in helping people overcome majordepression, it has long been known that a small subset of individuals taking these drugs can actually experience a worsening of mood, and even thoughts of suicide. No clinical test currently exists to make this determination, and only time  usually weeks  can tell before a psychiatrist knows whether a patient is getting better or worse.

Now, UCLA researchers have developed a non-invasive biomarker, or indicator, that may serve as a type of early warning system.

Reporting in the April edition of the peer-reviewed journal Acta Psychiatrica Scandinavica, Aimee Hunter, an assistant research psychologist in the UCLA Department of Psychiatry, and colleagues report that by using quantitative electroencephalographic (QEEG), a non-invasive measurement of electrical activity in the brain, they were able to observe a sharp reduction of activity in a specific brainregion in individuals who proved susceptible to thoughts of suicide  within 48 hours of the start of treatment.

Prior research, Hunter said, has shown that between 8 and 14 percent of depressed patients develop thoughts of suicide while taking the most common forms of depression drugs, known as selective serotonin reuptake inhibitors (SSRI). Although reports have suggested that SSRIs are to blame, no firm link between these drugs and thoughts of suicide has been established.

This study suggests, for the first time, a link between worsening suicidality and specific changes inbrain function while on these medications.

The researchers treated 72 people suffering from major depressive disorder (MDD) with one of twoSSRIs, fluoxetine or venlafaxine, or with a placebo. All were evaluated by a clinician using the Hamilton Depression Rating Scale, a standard instrument that assesses the severity of a wide range of depression symptoms. Of the 37 participants on medication, five (13.5 percent) had worseningthoughts of suicide.

All of the participants were also examined using QEEG, which evaluates brain function based on thebrain‘s electrical activity. Among the 13.5 percent of participants who got worse, the researchers found a sharp drop in brain activity within 48 hours of the start of medication. The drop occurred in the midline and right-frontal sections of the brain, areas known to control emotions.

Of note, eight of the 35 participants taking a placebo (22.9 percent) also had increased thoughts of suicide. However, the placebo participants did not show the precipitous drop in brain activity within the first 48 hours.

“This is the first study to show a change in brain function after the start of medication that appears to be linked to the subsequent development of worsening thoughts of suicide during antidepressant treatment,” Hunter said. “Importantly, changes in this biomarker did not predict worsening suicidal thoughts in the placebo-treated subjects, so the results suggest that the biomarker specifically detected medication-related worsening only.”

QEEG is a relatively inexpensive instrument that is non-invasive; measurements are obtained by placing electrodes on the scalp. As a result, Hunter said, further development of this biomarker could potentially lead to a tool that could be used by clinicians to predict, in the early stages of treatment, whether an individual suffering from depression will develop thoughts of suicide.

Provided by University of California Los Angeles

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Understanding Paxil Birth Defects

Ann Blake-Tracy says:

Your comment is awaiting moderation.

After two decades of tracking mothers and babies exposed to SSRI
antidepressants during pregnancy I shutter to ever see a mother take one of
these drugs. If those adverse effects listed in this article are not bad enough
to consider exposing a baby to, we have yet to witness the full effects of these
drugs upon offspring. These babies brains will not be fully developed until they
are in their 20’s. The full negative effects upon that developing brain will not
be known until then. Knowing what I know after 20 years of researching these
drugs and tracking patients who have taken them, I DO NOT WANT TO SEE WHAT IS
COMING!!

Ann Blake-Tracy, Executive Director,
International Coalition for Drug
Awareness
http://www.drugawareness.org & http://www.ssristories.drugawareness.org

Understanding Paxil Birth Defects

In December 2005, GlaxoSmithKline (GSK) posted its Paxil findings on its
website regarding pregnant women taking antidepressants. In this announcement,
GSK noted that it was revising its pregnancy precaution category from C to D.
This revision was based on recent studies that indicated positive evidence of
human fetal risk. In addition, GSK was placing this information in the WARNINGS
section of the Paxil label.
The FDA then advised pregnant women to switch from Paxil to another SSRI
drug, such as Prozac or Zoloft. This warning was based on the results of an
analysis of Sweden’s birth registry that showed women who took Paxil were 1.5 to
2 times more likely to give birth to a baby with heart defects than women who
took other selective serotonin reuptake inhibitors (SSRIs) or no antidepressant
at all.
Studies also showed that complications were reported for babies born to
mothers who had taken antidepressants such as Paxil in the third month of
pregnancy. Such complications included breathing difficulties, turning blue,
seizures, changing body temperature, feeding problems, vomiting, low blood
sugar, stiffness, tremor, irritability or constant crying. In other words, just
like adults, newborn babies of mothers who have taken Paxil while pregnant,
experience similar withdrawal symptoms. Because of this, tube feeding, help with
breathing and longer hospitalization may be needed. Premature births in pregnant
women exposed to SSRIs such as Paxil have also been reported.
Based on such reports obstetricians went so far as to recommend that
women avoid Paxil and reconsider using any SSRI antidepressant during pregnancy.
Still, other physicians maintain that the benefits of mothers getting treatment
for their depression outweigh the risks to the fetus.
The most common birth defects caused by antidepressants have been found
to be holes or other malformations in the chambers of the heart. Often the

defects heal on their own, but more severe cases need surgical procedures. GSK
is investigating how Paxil could be causing such defects.
In addition, antidepressant drugs are known to imbalance blood sugar
metabolism thereby worsening gestational diabetes. However, it is doubtful that
this is explained to expectant mothers who are given such drugs.
Medical professionals in women’s mental health point out that it is
important to aptly gauge the timing of medications prescribed for women who are
pregnant. Paxil is currently one of the most popular antidepressants in the
world, and roughly 25 percent of its users are women of childbearing age —
between 18 and 45.

Nick Johnson serves as lead counsel with Johnson Law Group, with principal
offices located in Houston, Texas. Johnson represents plaintiffs with injury
cases involving Defective Drugs. Contact Nick Johnson at 1-888-311-5522 or visit
http://www.johnsonlawgroup.com

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DEPT. of DEFENSE: Link Between Vet Suicides & Medications

Paragraph six of main article reads:  “Quality data
collection and analysis are critical components behind effective prevention
efforts. The Department made great strides over the last 12 months on gathering
critical information to understand the complexity of factors leading to suicide
and ways to prevent such tragedies from occurring within our communities. Data
collected by the DoD Suicide Event Report (DoDSER) tell us that we must continue
to educate our population and build programs, as there continue to be multiple
opportunities to intervene. For example, we are learning that 30% of individuals
who died by suicide communicated their potential self harm; 49% had been
seen in a medical/support clinic/program within 30 days of suicide;
and
26% sought broadly defined mental health resources.”

Paragraph 34 of main
article reads:  “In recent years, antidepressant medications,
particularly the use of Selective Serotonin Reuptake Inhibitors (SSRIs) have
been closely evaluated for the increased risk of suicide-related behaviors in
adolescents and young adults associated with their use
. In recognition

of this risk, the FDA’s requires a “black box” warning in the product labeling
of all antidepressant medications that advises clinicians to closely monitor any
worsening in depression, emergence of suicidal thinking or behavior, or unusual
changes in behavior, such as sleeplessness, agitation, or withdrawal from social
situations. Close monitoring is especially important during the first four weeks
of treatment. The FDA also recognizes that depression and other psychiatric
disorders are themselves associated with increased risks for
suicide.”

http://www.pennlive.com/newsflash/index.ssf?/base/national-15/12670299869190.xml&storylist=health

Link Between Medication And Veteran Suicide

2/24/2010, 10:27 a.m. EST
The Associated Press

(AP) ­ xfdte MEDICATION-AND-SUICIDE sked

TESTIMONY February
24, 2010 LOREE K. SUTTON, M.D. DIRECTOR U.S. DEPARTMENT OF DEFENSE HOUSE
VETERANS AFFAIRS LINK BETWEEN MEDICATION AND VETERAN SUICIDE Roll Call, Inc.
1255 22nd Street N.W. Washington, D.C. 20037 Transcript/Programming: Tel.
301-731-1728 Sales: Tel. 202-419-8500 ext 599 sales@cqrollcall.com www.cqrollcall.com Roll Call, Inc. is a private firm not
affiliated with the U.S. Government. Copyright 2010 by Roll Call, Inc.
Washington, D.C. U.S.A. All materials herein are protected by United States
copyright law and may not be reproduced, distributed, transmitted, displayed,
published or broadcast without the prior written permission of Roll Call, Inc.
You may not alter or remove any trademark, copyright or other notice from copies

of the content.Statement of Loree K. Sutton, M.D. Director, Defense Centers of
Excellence for Psychological Health and Traumatic Brain Injury Special Assistant
to the Assistant Secretary of Defense for Health Affairs U.S. Department of

Defense

February 24, 2010

Introduction

Chairman Filner, Mr.
Buyer, distinguished Members of the Committee; thank you for the opportunity to
appear here today to talk to you about the Department of Defense‘s (DoD) efforts
to reduce the number of suicides across our force.

On behalf of DoD, I
want to take this opportunity to thank you for your continued, strong support
and demonstrated commitment to our service members, veterans, and their
families.

Over the last nine years, a new era of combat emerged, where
counterinsurgency and asymmetric warfare are the norm. This shift continues to
place a great amount of strain on our most important resource, our service
members. Despite the operational challenges facing them and their families, they
remain incredibly resilient, motivated, and well-trained. The Department
recognizes the need to provide the resources and programs necessary to maintain
their resilience and motivation. Our core messages tell our service members and
their families that they are not alone; treatment works; the earlier the
intervention the better; and reaching out is an act of courage and
strength.

The Department also recognizes that the total number and rate

of suicides continue to rise and this is of deep concern at all leadership
levels. Today, I will share with the Committee our current efforts to reduce the
number of suicides across the Force, and the role of medication and
suicides.

Suicide has a multitude of causes, and no simple solution.
There are many potential areas for intervention, and it is difficult to pinpoint
the best approach because each suicide is unique. Recognizing this, DoD is
tackling the challenge using a multi- pronged strategy involving comprehensive
prevention education, research, and outreach. We believe in fostering a holistic
approach to treatment, leveraging primary care for early recognition and
intervention, and when needed, providing innovative specialty care. The areas of

focus to reduce risk include: (1) conducting data collection and analysis to
detect contributing risk factors; (2) facilitating partnerships across DoD,
federal agencies, and civilian organizations to increase collaboration and
communication; (3) reducing stigma and increasing access to resources to provide
needed care; and (4) using research to close gaps and identify best practices.
Data Surveillance

Quality data collection and analysis are critical
components behind effective prevention efforts. The Department made great
strides over the last 12 months on gathering critical information to understand
the complexity of factors leading to suicide and ways to prevent such tragedies
from occurring within our communities. Data collected by the DoD Suicide Event
Report (DoDSER) tell us that we must continue to educate our population and
build programs, as there continue to be multiple opportunities to intervene. For
example, we are learning that 30% of individuals who died by suicide
communicated their potential self harm; 49% had been seen in a medical/support
clinic/program within 30 days of suicide; and 26% sought broadly defined mental
health resources.

Historically, the Services used unique suicide
surveillance systems. In January 2008, the National Center for Telehealth and
Technology (T2), a Defense Centers of Excellence (DCoE) component center,
launched the DoDSER Annual Report. The DoDSER Annual Report was developed to
standardize data collection and reporting. Pulling data from all branches of the
military, it captures over 250 data-points per suicide with details, summaries,
and analyses of a wide range of potential contributing factors. DoDSER Annual
Report data include specific demographics, suicide event details, treatment, and
military history, among others. The variables are designed to map directly to
the Centers for Disease Control and Prevention’s National Violent Death
Reporting System to support direct comparisons between military and civilian
populations.

By standardizing data and reporting,
DoD tracks and analyzes suicide data and contributing risk factors proactively
to inform and improve future prevention, intervention, and treatment services.
The DoDSER Annual Report is revised annually based on input from the Services.
The data facilitate the review and evaluation of the effectiveness of suicide
prevention initiatives and their execution over time. DoDSER represents the
strides DoD has taken to better understand what some of the
underlying factors are for suicide. The Department uses this tool to inform
current efforts and initiatives. []

According to the Armed Forces
Medical Examiner System (AFMES), in January 2010 there were 24 confirmed

suicides, all in Regular Components within the DoD. In calendar year 2009, AFMES
reported that there were 312 confirmed suicides, with 286 confirmed in Regular
Components and 26 confirmed in the Reserve Components. Demographic risk factors
include: male, Caucasian, E-1 to E-4, younger than 25 years old, GED or less
than high school education, divorced, and in the Active Duty Component. Other
factors associated with suicide, which are consistent with data from civilian
populations, are: substance abuse, relationship issues, and legal,
administrative (Article 15), and financial problems. Although the impact of
deployment is still under investigation, a majority of suicides do not occur in
the theaters of operation. 16% of suicides occurred in Iraq or Afghanistan.
Despite the knowledge gained and data collected, it is important to resist
oversimplifying or generalizing statistics. Each suicide is as different as a
person is unique.

According to AFMES, there were 26 confirmed suicides in
calendar year 2009 among the Reserve Components, which include all Active Guard
and Reserves. Due to the unique nature of their service, there are challenges
associated with capturing all suicide completions, preparatory behavior and self
harm without intent to die among National Guard and Reserve populations when
they are not on active or activated status. To address this issue, DoD is
examining ways to utilize information gathered from existing tracking and
reporting systems including, but not limited to, insurance and benefit data. The
DoD continues to support National Guard and Reserve populations through numerous
initiatives to increase outreach, care, and resources on all fronts.

The
numbers also tell us that prevention is not enough, as 36% of military suicides

had a history of a mental disorder. The integrated efforts of prevention,
intervention, and treatment are essential to DoD’s approach to tackle the
challenge of suicide.

Facilitating Partnerships

Continued
collaboration with the Department of Veterans Affairs (VA) and other federal,
private, and academic organizations is a key part of DoD’s overall
strategy.

Conferences serve as dissemination and outreach platforms by
providing local and regional coordinators with innovative ideas to implement
within their communities and providing DoD and VA with the opportunity to gather
feedback on communities’ needs. The annual DoD/VA Suicide Prevention Conference
provides such a forum. With over 900 attendees, the 2010 conference shared
practical applications, results from research and pilot studies, guidance from
senior DoD and VA leaders on the way forward, and testimonies emphasizing the
importance of seeking help.

We work closely with our partners at the VA
to ensure that the transition out of service and into VA care is seamless and
that service members, veterans, and families receive the care they deserve. The
DCoE coordinates information and resources with VA’s National Suicide Prevention
Lifeline (1-800-273-TALK), and National Resource Directory. As part of this
partnership, DCoE worked with VA and the Substance Abuse and Mental Health
Services Administration (SAMHSA) in December of 2009 to modify the introductory
message on the Lifeline, so that callers are instructed to press “1” if they
are a United States military veteran or Active Duty Service Member (ADSM) or are
calling about one. This expansion increases the scope of services that are
available to ADSMs who may be in crisis.

Collaborative care is an example

of an immediate solution that DoD is aggressively implementing. According to
DoDSER data, 36 percent of completed suicides had a history of a mental health
condition. Providing mental health services in conjunction with primary care is
an important part of our prevention strategy because early detection and
intervention is a key to preventing suicide behaviors. Each Service is
developing collaborative care models based on recommendations from a National
Institute of Mental Health (NIMH) study. The DCoE collaborates with the Services
to integrate the best practices from these models to develop consistent
standards across DoD. DCoE is currently implementing a controlled trial study at
six sites and 18 clinics of collaborative primary care to inform future
efforts.

In August 2009, the DoD Suicide Prevention Task Force was
established under the purview of the Defense Health Board. The goal of the task
force is to provide recommendations to legislative and administrative bodies on
suicide prevention within the military.

The Department recognizes the
importance of eliminating the toxic threat of stigma by transforming its culture
from reactionary to a more proactive environment by engaging leadership to
encourage transparency, accountability, candor, and respect. The DoD is
promoting awareness among leaders and urging them to lead by example in matters
related to health and well-being. In addition, changes in policies and messages
to all levels help create a safe culture to seek help. One significant change
was the revision of question 21 on the questionnaire for security clearances on
whether a service member has sought mental or behavioral help in the past year.
DoD believes that service members should not have to deny themselves the care
they need and deserve out of fear of repercussions. Our efforts to combat stigma
will continue alongside our efforts to provide the best prevention, intervention
and treatment options.

Additionally, DoD is undergoing a cultural
transformation to push care closer to the service members and their families. An
emphasis on early intervention for antecedent issues such as post- traumatic
stress, depression, and substance abuse can help address needs before they
develop into bigger issues that could contribute to suicides. This population
based approach enables DoD to engage multiple audiences including peers,
families, units, and communities to support suicide prevention, risk reduction,
and overall health promotion. The Services also have programs to address needs
before they develop into issues that must be addressed in a specialty care
setting.

DCoE helps combat stigma through the Real Warriors Campaign, a
public education initiative that reinforces the notion that reaching out is a
sign of strength. Under the theme of “Real Warriors, Real Battles, Real
Strengths,” this effort provides concrete examples of service members who sought
care for psychological health issues and are maintaining a successful military
career. While primarily focused on stigma, the Real Warriors Campaign is
actively engaged in the fight against military suicide in a number of

ways:

The website prominently displays the National Suicide Prevention
Lifeline on every page;-Two video profiles of service members involved in the
campaign openly discuss their struggles with suicidal ideation from a position
of strength and optimism having reached out for care that is working; and-The
site allows service members, veterans, families and health professionals to
confidentially reach out to health consultants around the clock through the Real
Warriors Live Chat feature or by calling the DCoE Outreach Center.

The
Campaign’s message boards include numerous posts from service members who share
their coping strategies for dealing with suicidal ideation. The site includes
content that focuses on suicide prevention and substance abuse. Short,
documentary-style videos illustrate the resilience exhibited by service members,
their families, and caregivers.

Since the Real Warriors Campaign launched
in May 2009, the website, www.realwarriors.net,
saw more than 45,500 unique visitors from 127 countries, with more than 69,128
visits and 450,000 page views. The DoD believes that stigma can be defeated by
encouraging and supporting service members to reach out when help is
needed.

critical component of DoD’s strategy is advancing research. As
part of DoD’s research portfolio, the RAND Center for Military Health Policy
Research is reviewing and cataloguing suicide prevention programs across the
Services with recommendations for enhancements of current programs. The results
will be released March 2010 and disseminated to inform future program
development.

A pilot study that showed promise in the civilian sector is
the Caring Letters Program. In a randomized clinical trial, sending brief
letters of concern and reminders of treatment to patients admitted for suicide
attempt, ideation, or for a psychiatric condition was shown to dramatically
reduce the risk of death by suicide. In an effort to determine the applicability
to military populations, the National Center for TeleHealth and Technology (T2)
is piloting a program at Ft Lewis, Washington. The goals of the Caring Letters
Pilot are to (1) test the feasibility of expanding the program to other military
treatment facilities, (2) collect preliminary outcome data, and (3) evaluate the
method of letter transmittal (email vs. postal mail). Since its inception in
July 2009, 81 letters have been sent. Efforts are currently underway to plan a
multi-site randomized control trial.

Many programs are currently in place
to raise awareness among service members, train civilian providers supporting
our service members and communities, and increase leadership involvement in
behavioral health efforts. The programs are on all levels, from the national
level down into local communities. These initiatives, including programs that
provide face-to-face support or online support, demonstrate DoD’s multi-pronged
approach and commitment to ensuring service members and families have access to
the best resources. Some examples of these efforts are detailed
below:

Each Service has its own suicide prevention initiatives tailored
to its culture. In November 2007, DoD established the DCoE to offer a central
coordinating point for activities related to psychological health concerns and
traumatic brain injuries. DCoE focuses on the full continuum of care and
prevention to enhance coordination among the Services, federal agencies, and
civilian organizations. DCoE works to identify best practices and disseminate
practical resources to affected communities. In this effort, emphasis is placed
on building resilience, supporting recovery, and promoting reintegration to
ensure a comprehensive, multi-faceted, and proactive approach in promoting
health and wellbeing.

The Suicide Prevention and Risk Reduction Committee
(SPARRC), chaired by DCoE, provides a forum for inter-Service and VA partnership
and coordination. Members include Suicide Prevention Program Managers from the
Services and representatives from the National Guard Bureau, Reserve Affairs,
VA, Office of Armed Forces Medical Examiner, T2, Substance Abuse and Mental
Health Services Administration, and others. This committee is the main venue for
ensuring collaboration and consistency in system-wide communication related to
suicide, risk reduction policy initiatives, and suicide surveillance metrics
across the military. A SPARRC website is currently in development to serve as a
“clearinghouse” for suicide prevention information, contacts, innovative
approaches, and tools.

Additionally, the DCoE Outreach Center coordinates
with Military OneSource, accessible by phone at 1-800-342-9647. Licensed mental
health consultants are available to listen, answer questions, and refer callers
to a wide range of services 24 hours a day, seven days a week, 365 days a year.
Military OneSource provides services on a range of other topics including
education, relocation, and parenting.

Another DoD program that encourages
seeking care is inTransition, which provides a bridge of support for service
members while they are transitioning between health care systems or providers.
The program assigns credentialed “Supercoaches” on a one-on-one basis to service
members in transition. These “Supercoaches” provide support, encouragement, and
promote continued use of behavioral health services.

In an effort to
increase access to resources and align with modern communication platforms, DoD
is harnessing technology and social media tools. Afterdeployment.org, an
interactive website developed by T2, provides service members and families
behavioral health information using an anonymous platform. This mental wellness
resource is designed to help service members and families manage the challenges
faced after a deployment. In addition, Afterdeployment.org launched a series of

free podcasts, available on iTunes, discussing a variety of mental health issues
affecting service members and families. Since the rollout in August 2008,
Afterdeployment.org has seen 86,083 visits to its website. Afterdeployment.org
is currently developing both a mobile version of the site and a mobile
application. The portability will allow access to resources regardless of
location.

Telebehavioral health refers to use of telecommunications and
information technology for clinical and non-clinical behavioral health care
services. Telebehavioral health may include the use of videoconferencing,
web-based cameras, email and telephone. T2 is exploring ways to supply timely
telebehavioral health services to service members in theater and during health
screenings immediately upon return to the continental United States. The use of

technology provides service members and their families access to psychological
health care even in the most extreme and/or remote circumstances. Medication and
Suicide Risk

The Department supports the use of psychopharmacological
treatments as a key component of mental health care. Scientific evidence over
the past several decades points to the role of medications in limiting the
severity and duration of illness as well as for preventing relapses and
recurrences. These findings have been translated into recommendations for
clinicians in the VA-DoD Clinical Practice Guidelines for Major Depressive
Disorder, Post-Traumatic Stress Disorder, Psychoses and Substance Use Disorder.
These guidelines are updated periodically as required to reflect the most
current knowledge concerning each of these conditions. Recognizing that all

medications carry potential risks as well as benefits, clinicians must exercise
their judgment in applying these guidelines and determining the most effective
use of medications, other therapies which include Cognitive Behavioral Therapy,
Cognitive Processing Therapy and/or Prolonged Exposure treatment, or a
combination of medication and therapy. Therapy must be monitored, with careful
attention to diagnosis, dosing, clinical response and potential adverse
events.

In recent years, antidepressant medications, particularly the use
of Selective Serotonin Reuptake Inhibitors (SSRIs) have been closely evaluated
for the increased risk of suicide-related behaviors in adolescents and young
adults associated with their use. In recognition of this risk, the FDA’s
requires a “black box” warning in the product labeling of all antidepressant

medications that advises clinicians to closely monitor any worsening in
depression, emergence of suicidal thinking or behavior, or unusual changes in
behavior, such as sleeplessness, agitation, or withdrawal from social
situations. Close monitoring is especially important during the first four weeks
of treatment. The FDA also recognizes that depression and other psychiatric
disorders are themselves associated with increased risks for
suicide.

Accordingly, the Department uses multiple tools to address the
identified risk for antidepressant as well as other medications, as scientific
evidence reaches the threshold for action. These methods include dissemination
of safety alerts to clinicians, patient information sheets, pharmacy monitoring
for harmful combinations of prescribed medications, adherence to The Joint
Commission standards governing medication reconciliation, compliance with the
reporting of adverse events, increasingly sophisticated use pharmacotherapeutic
analysis as well as training and education programs in evidence-based modalities
reflecting the most current clinical practice guidelines.

The DoDSER data
base, while still maturing, provides an unprecedented repository of Service
suicide surveillance data that will continue to inform our efforts. Further, we
look forward to the payoff from continued research investments.

Way
Forward

Suicide is a problem that needs solutions now. DoD is focused on
rapidly translating best practices into applicable tools for service members and
families. At the same time, DoD continues to improve on collaborative
relationships across the Services and with national experts, collecting data,
and in research efforts that will accelerate improvements in current services
and programs as well as spur new innovations. In addition, DoD will also
continue to evolve and leverage our population-based system to push innovations
in prevention and care toward the service member and family.

DoD’s
current initiatives to address the challenges placed on service members and
their families are progressing, but we recognize that there is still much to be
done. In order to build on our current efforts and successfully shift to a model

of population-based care, we identified the following areas of additional
focus.

An issue of increasing concern is suicides of military family
members and how to support surviving families. At this point in time, DoD does
not track suicides of military family members. However, DoD recognizes the
importance of engaging and supporting this population, as their sacrifices
deserve our recognition. The DoD Suicide Prevention Task Force met this year
with surviving families at the Tragedy Assistance Program for Survivors (TAPS)
Seminar. The DoD Task Force will provide recommendations to the Secretary of

Defense and Congress. Efforts will be focused on increasing outreach to
families; providing families with more education and training to recognize the
signs of suicidal behavior and where to seek help; and supporting families after
a suicide event. In addition, for calendar year 2010, SPARRC partnered with TAPS
to form a sub-committee to identify additional needs of families and to
recommend concrete solutions.

Postvention, which refers to all activities
and response after a suicide event, is another area of growing attention. The
goals of postvention include: (1) promote healing, (2) reduce risk of contagion,
and (3) identify those at risk and connect them to help. Postvention is also
viewed as a form of prevention for survivors. This year, DoD will work with the
Services to promote consistent postvention protocols across
programs.

Connect/Frameworks Suicide Postvention Program is a civilian
program that utilizes evidenced supported protocols to promote an integrated
community based response to suicides. Postvention protocols and guidelines
include topics such as discussing cause and method of death; how to address
needs of families; memorial service activities; and media coverage and
messaging.

In addition to prevention, intervention, and treatment, DoD is
shifting attention to increasing resilience. DoD promotes a holistic approach
that optimizes the physical, psychological, and spiritual components of the
human condition. The DoD is also piloting resilience programs in military
settings to determine applicability and effectiveness within military
populations. While the impact of deployment on suicide is still under
investigation, it cannot be denied that an era of high operational tempo and
persistent conflict increases pressure on our warriors. A comprehensive approach
to enhancing resilience actively confronts the increasing stressors service
members face in this environment.

2010 will also provide DoD further
opportunities to demonstrate a public health model of prevention, by supporting
peer-to-peer programs in the Services and continuing to increase the number of

mental health providers in communities. DoD is actively engaged in hiring more
mental health providers and providing them with quality and continued training.
Conclusion

Through our united and concerted efforts, we can continue
making a change for the better. DoD recognizes the need to provide the resources
and programs necessary to maintain the resilience and motivation of our service
members and families. We will continue to emphasize education as we deliver our
core messages. “You are not alone; treatment works; the earlier the intervention
the better; and reaching out is an act of courage and strength.”

We are
devoted to this effort and will continue to work aggressively to prevent the
unnecessary loss of life.

With the Committee’s continued assistance and
support, we will ensure our brave men and women in uniform and their families
have access to the resources they require.

On behalf of the DoD, thank
you for the opportunity to highlight these vital issues. I look forward to your
questions.

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SSRIs: Emotional Detachment: Personality Changes & Reduction in Positive…

Paragraph two reads:  “A recent study published in the
British Journal of Psychiatry found that the majority of
patients taking SSRIs experienced emotional detachment, feelings of
indifference, personality changes,
and a reduction in

positive and negative emotions.[1]”

http://www.medscape.com/viewarticle/716929

Physicians Are Talking About: Selective Serotonin Reuptake Inhibitors and
the Choice to Numb Out

Nancy R. Terry

Authors and
Disclosures

Posted: 02/18/2010

Selective serotonin reuptake
inhibitors (SSRIs), mainstays of psychopharmacology, effectively eliminate
suicidal ideation — not to mention feelings of exhilaration, caring, and
desire.

A recent study published in the British Journal of
Psychiatry
found that the majority of patients taking SSRIs experienced

emotional detachment, feelings of indifference, personality changes, and a
reduction in positive and negative emotions.[1]

Currently,
tens of millions of patients in the United States take SSRIs daily. However,
evidence pertaining to the long-term effects of these drugs is scant. “In a few
decades, as many as 15% of the world’s population might be on SSRIs,” comments a
psychiatrist. “Although the suicide rate might decrease, I wonder what the
long-term effect will be.”

The conjecture posited on Medscape’s Physician
Connect (MPC), an all-physician discussion board, launches a discussion about
the apparent choice in SSRI use — to be crippled by depression or functional
and emotionally numb.

MPC contributors commented that their anecdotal
experience aligns with that of the British study.

In several patients on
long-term SSRIs, I have noticed some subtle personality changes,” says a
psychiatrist. “Of course, there’s no way of ascertaining cause and effect
without a good, long-term study, but this is what I’ve observed: (1) SSRIs

decrease pain (irritability, depression) but also seem to increase the threshold
for what constitutes an exciting event (a person needs more novelty than
previously for the same effect); and (2) SSRIs increase apathy and have the
potential to decrease empathy.”

“It would be unrealistic,” adds another
psychiatrist, “to think that taking a medication which significantly impacts a
major neurotransmitter would not have, in some cases if not many, a significant
effect on a person’s personality, either short- or long-term.” The psychiatrist
comments that case studies documented in Peter Kramer’s book Listening to
Prozac
indicate that SSRIs strongly impact a patient’s feeling of “caring,”
which can affect the patient’s relationships with friends and family.

An
endocrinologist suggests that his colleagues view the film Numb, which
documents filmmaker Phil Lawrence’s struggle to stop taking the popular SSRI
Paxil. In the trailer for the film, Lawrence says, “I’m flatlined. This isn’t
me. This is me on Paxil®.”[2]

“These are the
wonder drugs of psychiatry,” argues a psychiatrist. “They continue to benefit
people over the long term, even at low doses. They help with anxiety, much more
robustly than with depression, but they help in depression too. If I had my way
Prozac®, Zoloft®, and Celexa® would be sold
over the counter.” The psychiatrist comments that the life-time prevalence of
depression is between 15% and 30%,[3] and most people remain
untreated for fear of persecution and judgment formation about their need to
take antidepressant drugs. Over-the-counter distribution, he reasons, would make

SSRIs more readily available to people who need them.

“I disagree about
the OTC [over-the-counter] issue,” replies Stephen Grcevich, MD, a child and
adolescent psychiatrist. “I think there are untoward effects of SSRIs that are
still poorly understood, such as the very small but statistically significant
risk of suicidal behavior in persons aged 25 and under. We also saw a subgroup
of kids who displayed significant disinhibition and indifference to academics in
a large, open-label, federally funded study looking at SSRI safety.” He comments
that he hopes to present the study data at the 2010 annual meeting of the
American Academy of Child and Adolescent Psychiatry (AACAP).

An internist
who frequently prescribes SSRIs, reports that she repeatedly experienced
suicidal thoughts while taking an SSRI for depression. “I have been placed by my
physician on Lexapro® 3 times. In each instance, my mood lifted and
crying decreased. I could sleep. In 3 days’ time, I started having thoughts that
came out of the blue, such as ‘I want to drive off this bridge.’ Stopping the
medication stopped the thoughts.” She says that she tells her patients about
this potential side effect, but no patient has related having a similar
response.

SSRIs and then SNRIs [serotonin noradrenaline reuptake
inhibitors] nearly killed me,” says an obstetrician/gynecologist. “They caused
narcolepsy, and I fell asleep and drove off the road.” He comments that his
level of apathy while taking the drugs was so extreme as to appear parkinsonian.
In my opinion as a patient, mild to moderate depression should be treated by
cognitive behavioral therapy, not meds.”

A surgeon comments that, in many
cases, SSRIs are given to patients who are only mildly depressed. “The drugs are
given as mood elevators,” he says. “We essentially are giving out the drug for
the same reason people self-medicate or abuse alcohol.”

“I do agree we
are pushed to start meds too early on mild cases sometimes,” says a family
medicine physician. “We must ask the tough questions of patients about suicidal
thoughts to determine the severity of their illness. Then start a multipronged
approach to treatment and not just write a script and send them out the
door.”

A neurosurgeon comments that clearly there are a number of
questions about SSRIs that need to be addressed:

  • Should we treat mild depression knowing the risks?
  • Are we educating patients about the possibility that they will experience
    apathy?
  • Are we increasing the risk for substance abuse in patients who attempt to
    counterbalance induced conditions of apathy and boredom?
  • Are the artificially high levels of serotonin caused by the use of SSRIs
    chronically changing the brain and making it impossible to withdraw from these
    drugs?


“I agree that higher doses and long-term use does blunt
emotions,” says a pediatrician. “I used Effexor® for about 7 years
and tried to wean off during that time, but at very low doses would redevelop
extreme sadness that resolved when I upped the dose.” He says that working with
his psychiatrist, he switched to Wellbutrin® and now experiences a
wider range of appropriate emotions. “However, if I did not have another option,
I would prefer Effexor® side effects over the chronic anxiety and
sadness I experienced for much of my life without it.”

The authors of the
British study reported a similar finding. Many participants in the study
considered whether they should stop taking their medication, but viewed the side
effects as preferable to the illness for which they were being
treated.

“And that is the problem, isn’t it?” comments an MPC
contributor. “We just don’t have meds that treat without some side
effects.”

The full discussion can be accessed at http://boards.medscape.com/forums/.29f65335

References

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ANTIDEPRESSANTS: Tell All Book: “Side Effects: Death”: by Former Lilly Exec

Paragraphs two & three read:  “Many of the
horrific school, workplace and mass shootings that have plagued parts of the
world over the years
may not have occurred if the pharmaceutical
industry had been completely honest about the side effects of psychotropic
medication, according to the new book Side Effects: Death – Confessions of a
Pharma Insider
by former executive director of the Swedish Branch of Eli

Lilly & Company John Virapen.”

“Virapen claims that
anti-depressants and selective serotonin reuptake inhibitors
(SSRIs
) were known to have suicidal and homicidal side effects, even during
clinical trials.
Thanks to spin marketing and paid, positive articles in
scientific journals, he points out, the adverse reactions were often ignored or
given little thought by prescribing physicians and patients.”

http://www.prlog.org/10514103-what-big-pharma-knows-sideeffectsdeath.html

What Big Pharma Knows – “Side Effects: Death

Former pharmaceutical executive director reveals industry
secrets

FOR IMMEDIATE RELEASE
PR Log (Press
Release)
Feb 01, 2010 – P.O. Box 9949, College Station, TX.
77842 • Phone/Fax: 877-376-4955
http://www.virtualbookworm.cominfo@virtualbookworm.com

FOR IMMEDIATE RELEASE
Contact: Virtualbookworm.com Publishing Inc.

877-376-4955
reviews@virtualbookworm.com

What Big Pharma
Knows – “Side Effects: Death

Many of the horrific school, workplace and
mass shootings that have plagued parts of the world over the years may not have
occurred if the pharmaceutical industry had been completely honest about the
side effects of psychotropic medication, according to the new book Side Effects:

Death – Confessions of a Pharma Insider by former executive director of the
Swedish Branch of Eli Lilly & Company John Virapen.

Virapen claims
that anti-depressants and selective serotonin reuptake inhibitors (SSRIs) were
known to have suicidal and homicidal side effects, even during clinical trials.
Thanks to spin marketing and paid, positive articles in scientific journals, he
points out, the adverse reactions were often ignored or given little thought by

prescribing physicians and patients.

Virapen also asserts the
pharmaceutical industry has engaged in bribery and other major forms of
corruption to gain approval for and in the marketing of many drugs used to treat
such conditions as Attention Deficit Hyperactivity Disorder (ADHD),
schizophrenia, arthritis, pain, diabetes and many others. The industry also
“makes up” illnesses to enhance sales and market shares, he says.

To
boost sales, Virapen writes, large pharmaceutical corporations spend about
$35,000–$40,000 per year and per practicing doctor to persuade them to prescribe
their products. In addition to covering or “massaging” the negative effects of
drugs, many of the companies engage in “off-label marketing,” which encourages
physicians to prescribe the medicines for conditions for which they haven’t been
approved, Virapen reveals.

Born in British Guyana, John Virapen went
from a door-to-door conman to a pop star, to a pharmaceutical representative to
executive director of one of the largest drug companies in the world. He admits
to participating in bribery, false information and deception to help launch and
market some of the most popularly prescribed (and most dangerous) drugs. In an
effort to exorcise his demons and expose the tactics and dangers of the
pharmaceutical industry, he wrote this expose.

The book has been
published in four languages around the world and is a best-seller in Europe.

Side Effects: Death – Confessions of a Pharma Insider is available in
softcover (ISBN 978-1-60264-516-5) and e-book (ISBN 978-1-60264-517-2) hardcover
from Virtualbookworm.com, Amazon.com, and Barnesandnoble.com. This book can also
be ordered from most bookstores around the United States and United Kingdom.
More information can be found at the book’s official website, www.sideeffectsdeath.com.



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5/01/2001 – World Health Organization – SSRI Addiction

“A league table of withdrawal and dependency side-effects, published by the
WHO, shows that drugs including Prozac and Seroxat [Paxil] have produced far
more complaints from patients than old-fashioned tranquillisers . . . SSRIs
(selective serotonin reuptake inhibitors), including Prozac, are more
addictive than tranquillisers such as Valium.”

Yesterday, in several major newspapers Lilly placed full page ads offering a
coupon for a month of free Prozac. Do you think they warned the consumer in
those ads that these free pills were addictive? Because so few doctors are
aware of this withdrawal and do not know how to withdraw patients from SSRIs,
after the month on the “free” pills the patient would have to continue to
purchase the drug until they could find my tape on how to get off Prozac
safely.

If you had told me ten years ago, shortly after I began researching the SSRIs
and dealing with patients going through horrific withdrawal from Prozac, that
it would take TEN years for the World Health Organization to finally see what
I was seeing, I would not have believed it. It was so obvious! But I have
waited and waited and waited as I have warned and warned and warned of this
addiction and withdrawal and finally today we see the WHO admit it.

At least the WHO have warned the public now, but where is the FDA? Will they
finally at least admit this much about SSRIs? All of these organizations that
society thinks are there to protect them – where were they as millions
suffered needlessly? How many times do we need to see this repeated with one
drug after another before we realize that there is no protection to the
consumer via these agencies? Obviously “buyer beware” most definitely applies
in this arena of prescription drug use. This is why I feel it is so important
to educate the public about these drugs.

You can mark my words when I say that this is only one of MANY more
admissions that will continue to come confirming all the warnings that I gave
in my book about the SSRI antidepressants, Prozac: Panacea or Pandora?

Ann Blake-Tracy, Executive Director,
International Coalition For Drug Awareness
www.drugawareness.org and author of
Prozac: Panacea or Pandora? ()

http://news.independent.co.uk/uk/health/story.jsp?story=69366

01 May 2001
Home > News > UK > Health

World health watchdog warns of addiction risk for Prozac users

By Robert Mendick

29 April 2001

Prozac, billed for years as a harmless wonder drug, often creates more
problems than the depression it is supposed to be treating, warns the head of
the World Health Organisation’s unit monitoring drug side-effects.

Professor Ralph Edwards says Prozac and drugs similar to it are
overprescribed. A league table of withdrawal and dependency side-effects,
published by the WHO, shows that drugs including Prozac and Seroxat [Paxil]
have produced far more complaints from patients than old-fashioned
tranquillisers prescribed by doctors in the 1970s. Campaigners say this
proves that the drugs called SSRIs (selective serotonin reuptake inhibitors),
including Prozac, are more addictive than tranquillisers such as Valium.

“SSRIs are probably over-used,” says Professor Edwards. “They are used for
relatively minor psychiatric problems, and the issue of dependence and
withdrawal has become much more serious. You risk creating a greater problem.
For serious psychiatric problems, it is worth the risk. But if you are just
tired or going through a bad patch, well, people get over that without
medication.”

A spokeswoman for Eli Lilly, makers of Prozac, accepted there are potential
side-effects including head-aches, dizziness, sleeplessness and nausea but
added: “The benefits of Prozac far outweigh the downsides. Extensive
scientific and medical experience has demonstrated that Prozac is a safe,
effective antidepressant that is well-tolerated by most patients.”

Prozac has been taken by an estimated 35 million people worldwide since its
launch a decade ago. But the reputation of SSRIs as wonder drugs is being
questioned. Research by Dr David Healy, at the University of Wales, appeared
to show that two people in a trial group of 20 became violent after taking an
SSRI.

Dr Healy’s research may be presented as evidence in a High Court case being
brought by the family of Reginald Payne, a retired teacher who was taking
Prozac when he killed his wife then jumped off a cliff. The family is suing
Eli Lilly, claiming negligence and saying the pharmaceutical firm failed to
warn Mr Payne of side-effects, which they say include suicidal and violent
behaviour.

The experiences of Ramo Kabbani on Prozac prompted her to set up the Prozac
Survivors Support Group. In two years, it has taken 2,000 calls. Ms Kabbani
claims SSRI withdrawal causes side-effects ranging from flu-like symptoms
such as dizziness and aching muscles to suicidal tendencies. She began taking
Prozac to combat depression after the death of her 27-year-old fiance from a
heart attack.

“The medication stopped me working through the feelings of grief which had
caused the depression.” she says. “When I came off Prozac I became
super-sensitive and very emotional. I found it worse going through withdrawal
than going through the depression.”

Council for Involuntary Tranquilliser Addiction 0151 949 0102; Prozac
Survivors Support Group 0161 682 3296.

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4/23/2001 – Matt Miller's Zoloft tragedy featured in UK article

When Depression Turns Deadly:
Can Antidepressants Transform Despair into Suicide?

ANNE McILROY
THE GLOBE AND MAIL
Saturday, April 21, 2001

www.globeandmail.com

When Matt Miller’s family moved to a bigger house in a new neighbourhood in
Kansas City, Mo., the athletic 13-year-old with thick blond hair found that
he couldn’t penetrate the cliques at his new school. He was a nobody, an
outsider.

“He was angry at us, he was angry at the school, his grades suffered. He
wasn’t himself,” said his father, Mark Miller.

The boy’s teachers recommended that he see a psychiatrist, who prescribed
Zoloft, an antidepressant in the same chemical family as Prozac.
The doctor said it would help Matt’s mood, make him feel better about
himself. The boy started taking the pills and seemed to be in good spirits
for a few days.

But then he began showing signs of intense nervousness and agitation. He
couldn’t sit still, his father remembers. He kept kicking people under the
table. His eyes were sunken and he couldn’t sleep, yet he had a restless
energy.

After six days on the drug, on July 28, 1997, Matt hanged himself in his
bedroom closet.

“Suicide always takes you by surprise, but no one could have imagined that
Matt would have done that,” Miller said in an interview. “There was no
previous attempt, no serious threat of it, no note, no premeditation.
“It was a very impulsive act I am convinced was brought about by the
stimulant nature of the drug.”

Miller has launched a lawsuit against Pfizer Inc., which makes Zoloft. He is
one of about 200 people who have sued — so far unsuccessfully — the makers
of Prozac and similar products. The plaintiffs contend that the drugs, known
as selective serotonin reuptake inhibitors, caused their loved ones to kill
themselves and, in some cases, hurt or kill others as well.
One of the few cases to go to trial so far was that of William Forsyth, a
63-year-old wealthy Hawaii businessman who stabbed to death his wife of 37
years and then killed himself in 1993. At the time, he had been taking
Prozac for 11 days for panic attacks.

In 1999, a jury in the civil lawsuit cleared Prozac of liability in the
deaths. Forsyth’s adult children began another suit last year accusing Eli
Lilly and Co., the maker of the drug, of covering up damaging details about
the antidepressant.

Chief among the scientific experts who have given people, including Miller
and Forsyth’s children, reason to believe that a link may exist between
antidepressants and suicide is Dr. David Healy, whom Miller has engaged as
an expert witness in his suit.

Healy is a well-known British psychiatrist who argues that Prozac and
similar drugs may trigger suicide in some patients, and that there should be
warning labels on the products.

To Miller, Healy is a hero, a crusading scientist with the guts and
credibility to challenge the powerful, multinational drug companies in an
era in which many researchers and institutions depend on them for funding.
But discussing the down side of Prozac does not appear to have been a good
career move. Healy’s blunt expression of his views may have cost him a job
at the Centre for Addiction and Mental Health, a teaching hospital
associated with the University of Toronto. The centre had been recruiting
him for months, but last year rescinded his written job offer after he gave
a speech warning that Prozac may trigger suicide in some patients.

Eli Lilly Canada Inc. is a major corporate donor to the centre, but
university and hospital officials say their decision had nothing to do with
wanting to please the drug company or to avoid damaging future fundraising
efforts. They say their reasons are confidential.
Healy says the only explanation he was offered was that his lecture
“solidified” the view that he was not a good fit.

For Eli Lilly’s part, it points out that a U.S. Food and Drug Administration
panel of experts voted six to three against requiring Prozac to carry a
suicide-risk warning label. In September of 1991, the FDA concluded that
there was no credible evidence of a causal link between the use of
antidepressant drugs, including Prozac, and suicides or violent behaviour.
And a paper published in March of 1991 by Jerrold Rosenbaum of Massachusetts
General Hospital found that patients on Prozac were not prone to suicide any
more than patients on other medication.

Eli Lilly said, in a written response to questions from The Globe and Mail:
“There is, to the contrary, published scientific evidence showing that
Prozac and medicines like it actually protect against such behaviour —
reducing aggressive and suicidal thoughts and behaviour.”

When Prozac was introduced in the late 1980s, it was billed as a wonder drug
that could combat depression with far fewer risks than previous medications,
including the danger of an overdose or problems when mixed with alcohol.
Prozac and drugs like it — Zoloft, Paxil and Luvox — were said to help
with emotional limitations such as low self-esteem and fear of rejection.
Prozac was a commercial as well as a medical miracle, sold to an estimated
40 million people worldwide since it hit the market.

The drug boosts levels of the neurotransmitter serotonin, which seems to
improve the mood of patients. But within a few years of Prozac’s launch came
hints that it brought out a dark side in a small fraction of users.
Martin Teicher, a researcher at Harvard University, published an article in
the American Journal of Psychiatry in 1990 that discussed six cases in which
patients became intensely preoccupied with suicide after taking the drug.
Other scientists also found a potential link between Prozac and suicide.

Healy says in one of his published papers that Eli Lilly scientists
collaborated with the FDA on designing an experiment that would measure how
serious the problem was, but they then decided against conducting it.
Instead, in 1991, Eli Lilly published an analysis of data taken from
existing trials. Its conclusion? There was no increase of suicidal thoughts
or suicide among depressed patients taking Prozac.

But Healy says in the paper that data from only about one-eighth of the
patients in the clinical trials were included. No mention was made that some
had been prescribed a sedative that may have alleviated an intense nervous
state that can lead to suicide, which is called akathisia, he says.
The analysis also did not point out that 5 per cent of patients dropped out
of the studies because they were anxious and agitated and may have been
suffering from akathisia, Healy says.

Another document, dated Nov. 13, 1990, shows that company scientists were
pressured by executives to soften physicians’ reports of suicidal thoughts
or suicide attempts, according to Harvard psychiatrist Joseph Glenmullen,
who obtained the document and is author of the book Prozac Backlash.
Additional evidence about the potential risks can be found in the patent for
a second-generation Prozac pill, which Eli Lilly has licensed. The patent
says the new and improved Prozac would decrease side effects including:
“nervousness, anxiety, and insomnia,” as well as “inner restlessness
(akathisia), suicidal thoughts and self-mutilation.”

But at the same time, Eli Lilly says these symptoms are not associated in
any significant way with taking the current version of Prozac.
The new Prozac — which incidentally was co-developed by Teicher, one of the
drug’s early critics — isn’t yet on the market, Last year, Healy published a
study in the journal Primary Care Psychiatry that said two of 20 healthy
volunteers taking an antidepressant in the same family as Prozac reported
feeling suicidal.

But by his calculations, probably 40,000 people have committed suicide while
on Prozac since its launch, above and beyond the number who would have taken
their own lives if their condition had been left untreated.

The German government now requires warning labels, and Britain is
considering them. Canada and the United States do not.
Healy says he is not opposed to Prozac and thinks that it can do a lot of
good. But he says it is unethical and irresponsible not to warn doctors
about the potential dangers, and believes Eli Lilly chose not to do so to
maximize profits.

He says family doctors seem to be increasingly prescribing Prozac and other
antidepressants to children and now to women complaining of severe
premenstrual symptoms, yet patients in North America do not have to be told
about the potential risks.

Eli Lilly and the other drug companies argue that depression, not
antidepressants, are to blame for suicides. Pfizer is trying to have Healy
barred from testifying in the Miller case, questioning his credibility as an
expert witness.

So what are Canadian consumers to think? Jacques Bradwejn, chairman of the
psychiatry department at the University of Ottawa, says he has reviewed the
literature and agrees with the FDA and Eli Lilly that there is no evidence
that Prozac and similar drugs cause more suicides than would have occurred
if patients had not been treated.

But a small number of patients — even as many as 1 per cent — may fall
into a nervous state that could trigger suicide, he said, adding that more
research is needed to better understand the problem.

While Prozac may be overprescribed for patients who are not truly ill,
Bradwejn worries that the message that the Prozac is dangerous will do more
harm than good for those who are moderately to severely depressed.
“If the message is too alarmist, it could have a very negative effect on
Canadians.”

DEPTHS OF DESPAIR

A study by Dr. David Healy found that two of 20 healthy volunteers taking a
selective serotonin reuptake inhibitor in the same family as Prozac reported
suicidal feelings. This is the story of one of those people, a 30-year-old
woman who didn’t know what drug she was taking, as recorded in the study.
“On the Friday she telephoned early in the morning, distressed and tearful
from the previous night. Her conversation was garbled. She described almost
going out and killing herself. . .

“The night previously she had felt complete blackness all around her. . . .
She felt hopeless and alone. It seemed that all she could do was to follow a
thought that had been planted in her brain by some alien force.
“She suddenly decided she should go and throw herself in front of a car,
that this was the only answer. It was as if there was nothing out there
apart from the car. . . . She didn’t think of her partner or child. She was
walking out the door when the phone went. This stopped the tunnel of
suicidal ideation.

“She later became distraught at what she had nearly done and guilty that she
had not thought of her family.”

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Suicide after One Month on Celexa and lorazipam

“I do wonder just how often suicide, attempted suicides and murders are committed by people who are taking SSRI drugs.”

 

My son, 31 years of age, was prescribed Celexa 20mg/day and lorazipam .5mg as needed, July 22, 1999, on first visit without any form of physical examination and with only a short interview by a case worker and psychiatrist. He was seen on August 4, at which time the doctor said he was better. On August 21, 1999, he committed suicide. I cannot scientifically prove Celexa was the cause. I only know what others and myself know about him and his behavior. We are convinced the medication definitely increased his symptoms of frequent mood swings, anxiety, fear, inability to sleep, panic, anger, inability to concentrate.

Because of my son’s death (suicide) while taking Celexa, I have become aware of the habit of doctors prescribing selective serotonin reuptake inhibitors TOO OFTEN, and in my opinion, WITHOUT SUFFICIENT REGARD TO THE DANGEROUS SIDE EFFECTS AND/OR OTHER HEALTH CONDITIONS WHICH COULD BE THE CAUSE OF THE DEPRESSION. I do wonder just how often suicide, attempted suicides and murders are committed by people who are taking SSRI drugs.

On 9-17-99, I phoned Adverse Drug Reactions Medical Inquiries and was transferred to New Jersey Drug Safety. I spoke with Christine Casilana (uncertain of correct spelling), of Forest Pharmaceuticals. She took all pertinent information and assured me the report would be sent to the FDA. I specifically asked about the statement in the package insert that reads, “frequent adverse events are those occurring on one or more occasions in at least 1/100 patients”. Under “Psychiatric Disorders” those listed as frequent among others noted are: “impaired concentration, depression, aggravated depression, suicide attempt”. Christine explained that frequent – the 1/100 figure – meant that AT LEAST ONE (but the actual number could be higher than just one) out of 100 made a suicide attempt on Celexa.

One is a large percent when indicating DEATH, especially if it is YOUR loved one. I don’t mean to sound angry, I just want someone to pay attention. It is hard to believe this drug is given out so readily. The selective serotonin reuptake inhibitors are prescribed far to freely and without sufficient supervision of the patient AND with some doctors, without adequate examination.

 

Years 2000 and Prior

This is Survivor Story number 43.
Total number of stories in current database is 96

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08/02/1999 – SSRI Prescribing in Primary Care Draws Fire

Note that 8% of all general hospital psychiatric admissions caused by
SSRI-induced psychoses!–Thanks to Ann Blake-Tracy for passing this along.
Mark
———–

FromClinical Psychiatry News

SSRI Prescribing in Primary Care Draws Fire

Todd Zwillich, Senior Writer

[Clinical Psychiatry News 27(6):34, 1999. © 1999 International Medical
News
Group.]

————————————————————————
More primary care physicians are prescribing antidepressants, but some
observers worry that patients aren’t being evaluated closely enough for
potential adverse reactions or monitored appropriately while taking the
drugs.

Research is beginning to show that “large numbers” of prescriptions for
selective serotonin reuptake inhibitors (SSRIs) aren’t accompanied by a
diagnosis of depression or any other mental condition, said Stephen
Crystal, Ph.D., a researcher who studies prescribing trends at Rutgers
University in New Brunswick, N.J.

“We have a massive uncontrolled experiment going on out there,” he
said.

The number of doctor office visits including an antidepressant
prescription more than doubled between 1985 and 1994 to more than 24
million, according to data from the National Ambulatory Medical Care
Survey (NAMCS). Researchers attribute the rise to the popularity of
SSRIs.

While an estimated 11 million psychiatrist appointments included an
antidepressant prescription in 1994, more than 10 million other
antidepressant prescriptions were written by primary care doctors.
Preliminary analysis of survey data extending through 1996 shows that
antidepressant prescriptions are now more common in primary care
offices than in psychiatrists’ practices, according to Dr. Crystal.

Managed care is at least partly responsible for the trend. Primary care
physicians acting as gatekeepers in HMOs have been encouraged to treat
potentially depressed patients rather than refer them to specialists.
At the same time, primary care doctors are becoming more comfortable
with the newer SSRIs because they are relatively easy to use.

Toxicity and overdoses are rare, and potential drug interactions are
far less common than with other drug classes. The drugs may also
provide a convenient way to treat somatizing patients who have a few
depressive symptoms without a full-blown depressive episode.

But relatively few data exist to support SSRIs’ efficacy in treating
the “subthreshold” patients often seen in primary care. Many of those
patients may get SSRIs without any official diagnosis, according to Dr.
Harold Pincus, who last year published a study on psychotropic
prescribing using NAMCS data.

Office-based psychiatry practices tend to aggregate around more
affluent and better-educated patients in medium and large cities. Most
observers agree that primary care’s new dominance in antidepressant
prescribing makes the drugs available to a wider range of patients.

“Those who are underserved by specialists are nonwhite and not wealthy.
They are the ones who benefit most from primary care physician
prescribing,” said Dr. Gregory Simon, a psychiatrist who studies
prescribing patterns at Group Health Cooperative of Puget Sound in
Seattle.

The American Psychiatric Association recommends in its depression
treatment guidelines that patients continue their SSRI prescription for
4-5 months after complete remission of their symptoms. But data from
Group Health Cooperative–an HMO that emphasizes primary care treatment
of mental conditions–show that only 34% of patients on SSRIs refill
their prescriptions often enough to suggest continuous use.

At the same time, new data from the Rutgers group show that Medicare
patients treated in primary care are more than twice as likely as
similar patients treated in psychiatric settings to fill their SSRI
prescriptions only once, Dr. Crystal commented.

Others worry that physicians are not paying enough attention to patient
factors that could make initiation of SSRIs dangerous. Dr. Malcolm B.
Bowers Jr., a psychiatrist at Yale University in New Haven, told
CLINICAL PSYCHIATRY NEWS that SSRI-induced psychosis has accounted for
8% of all general hospital psychiatric admissions over a recent
14-month period. [emphasis added]

The pattern suggests that while SSRIs are a help to the majority of
patients who take them, more needs to be done to make sure that doctors
prescribing the drugs evaluate patients for psychotic predispositions
vulnerable to SSRIs. Such patients may include those with a history of
psychotic illness or early signs of mania.

“What is surprising is that this particular group of side effects is
really
underplayed,” Dr. Bowers said.

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