ZOLOFT: Bizzare Suicide: New York

First two paragraphs read: “Toxicology results on Chris Corna released this week do not change the Westchester medical examiner’s conclusion that the popular Colorado restaurateur’s death was a suicide, but police are not closing their investigation.”

“The car Chris Corna of Steamboat Springs was driving very early May 18 crashed into a bridge abutment after he slit his throat, the medical examiner said. A bloodied kitchen knife was found in the car. Either trauma was enough to kill him, Medical Examiner Millard Hyland said at that time.”

Paragraph four reads: “Hyland said today that toxicology tests found appropriate amounts of a medicine, a tranquilizer used to treat anxiety, were in Corna’s system. The tranquilizer, sertraline, he said, is used in Zoloft.”

http://lohud.com/article/20090807/NEWS02/908070399/-1/SPORTS

Suicide ruling remains in Colo. restaurateur’s Port Chester death after toxicology results

By Leslie Korngold • lkorngol@lohud.com • August 7, 2009

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PORT CHESTER – Toxicology results on Chris Corna released this week do not change the Westchester medical examiner’s conclusion that the popular Colorado restaurateur’s death was a suicide, but police are not closing their investigation.

The car Chris Corna of Steamboat Springs was driving very early May 18 crashed into a bridge abutment after he slit his throat, the medical examiner said. A bloodied kitchen knife was found in the car. Either trauma was enough to kill him, Medical Examiner Millard Hyland said at that time.

The initial finding of suicide elicited numerous e-mails and calls to The Journal News and Port Chester police from family and friends of the Steamboat Springs businessman saying it was not possible. He was on the East Coast having just proposed to a Greenwich woman and was doing well financially.

Hyland said today that toxicology tests found appropriate amounts of a medicine, a tranquilizer used to treat anxiety, were in Corna’s system. The tranquilizer, sertraline, he said, is used in Zoloft.

The “quantities are not over the top for someone taking it regularly,” the medical examiner said.

Hyland did not know if Corna was on the medication regularly. But even if it had been administered just this one time, it was still not enough to kill Corna and “it would be very difficult to attribute suicidal tendencies to the drug,” Hyland said.

There was no alcohol in Corna’s system, and the only other chemical present was a byproduct of the breakdown of sertraline, Hyland explained.

Port Chester police have been investigating the curious accident and wanted to see the toxicology report. Today, police said they were continuing their investigation into the circumstances of the death but would not elaborate

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CELEXA & EFFEXOR: Suicide: 40 Year Old Woman: New York

Paragraphs three and four read:  “The results of an autopsy and toxicological examination have determined the cause of death to be from respiratory suppression with pulmonary edema, secondary to a drug overdose, a release from the state police says.”

“The drugs present that caused the overdose were determined to be Celexa and Effexor, medications prescribed for depression and anxiety, the release adds. Alcohol was also present.”

http://www.stargazette.com/article/20090826/NEWS01/908260338/Hatch+death+ruled+a+suicide

Hatch death ruled a suicide

August 26, 2009

After a 10-month investigation, the death of Kimberly R. Hatch has been ruled to be a suicide.Advertisement

The 40-year-old woman was found dead in her house at 704 Shady Drive, Endwell on Oct. 11 of last year after troopers responded to a 911 call.

The results of an autopsy and toxicological examination have determined the cause of death to be from respiratory suppression with pulmonary edema, secondary to a drug overdose, a release from the state police says.

The drugs present that caused the overdose were determined to be Celexa and Effexor, medications prescribed for depression and anxiety, the release adds. Alcohol was also present.

Dr. James Hayes, the coroner in the case, has ruled the death to be a suicide, said Cpt. James E. Barnes, of the state police.

Hayes said the investigation took 10 months because police had to consider all aspects in the case, consult with the district attorney and coroner’s offices and brief the family on the developments.

The case is now closed, the release says

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ANTIDEPRESSANT: Suicide: England

Second paragraph reads:  “Steven Rodgers was found dead in his bed after overdosing on prescription drugs for a heart condition and depression.”

http://www.sunderlandecho.com/news/Lovesplit-torment-ended-in-tragedy.5524741.jp

Love-split torment ended in tragedy

Published Date:
05 August 2009
By Lisa Nightingale

A father killed himself after falling into depression contributed to by years of problems with his estranged wife, an inquest heard.

Steven Rodgers was found dead in his bed after overdosing on prescription drugs for a heart condition and depression.

He was discovered on February 3 by new partner Susan Redmayne who had let herself in to his flat in Front Street in East Boldon.

She had become concerned for his safety after he failed to turn up to his job as assistant manager at Morrisons in Seaburn and she was unable to contact him.

Miss Redmayne, said: “I went in and saw the dog and two letters. I looked on the table and his car keys were still there.

“I began searching for him and the last place I went into was the bedroom and that’s where I found him.

“I went up to him and touched him, he was stone cold.”

Yesterday, an inquest into his death heard results from a toxicology report showed Mr Rodgers had levels of propanol, a betablocker, and mirtazapine, an anti-depressant, at levels where either one was “sufficient enough to cause sudden death”.

Coroner Terence Carney was told by Mr Rodgers’ sister, Kathleen, how after the 44-year-old, originally from Sunderland, was diagnosed with angina he had felt more tired but had carried on working.

He was also going through the process of a divorce after 10 years of marriage. The separation had been acrimonious and for the past two years he had endured late-night visits and phonecalls from his estranged wife.

He was also worried about his finances after falling behind with debt payments.

Miss Rodgers, said: “He would stay in a lot as he was frightened Pauline would cause trouble. She had been down to his works recently.

He used to laugh it off as he didn’t want us to worry.

“He wouldn’t go into details but he always said she was hanging around and knocking on his door, sometimes at 4am.”

Miss Redmayne told Mr Carney how the police and bomb squad were called out on two occasions after he found mobile phones taped underneath his vehicle.

A police officer attending the inquest said she had no knowledge of these calls.

Miss Redmayne added: “I just felt he couldn’t take anymore. He had just hit rock bottom.”

Mr Carney, said: “There is no doubt in my mind this was a man who for some considerable time and more recently has been suffering from acute depression.

“It appears that his domestic situation was the factor of much of that depression and I agree with the evidence I have heard from family for some considerable time he was suffering ongoing anxiety and pressure of an unresolved domestic situation.

“Clearly the effects in my view of that ongoing stress have impacted greatly on this man’s decision to ultimately kill himself.”

Speaking after the inquest, Mr Rodgers’ estranged wife, Pauline, of Herrington, said she was too distraught to attend yesterday’s inquest and didn’t want to upset the rest of Steven’s family.

She added: “I was upset when I found out he had a heart attack. I was past myself.

“To find out he had really acute heart problems was upsetting. You can’t be with someone all those years and not feel anything, and I do.”
Mr Carney gave a narrative verdict and recorded his death was as a result of taking propanol and mirtazapine.

He also recorded that he self-administered these drugs, consequently killing himself, and that at the time he was suffering from acute depression.

Speaking after the inquest his family said Steven was “one in a million”.

The full article contains 615 words and appears in Sunderland Echo newspaper.
Page 1 of 1

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CELEXA: Death: Probably a Suicide: Day After Leaving Hospital: England

Paragraph nine reads:  “Consultant pathologist Dr Dariusz Golka said the cause of death was overdose of the anti-depressant citalopram  [Celexa].”

http://www.blackpoolgazette.co.uk/blackpoolnews/Man-took-overdose-a-day.5545843.jp

Man took overdose a day after hospital

Published Date: 12 August 2009

A MAN died from a fatal overdose less than 24 hours after being released from hospital, an inquest heard.

Philip John Bromley, of Handsworth Road in North Shore, was found on his kitchen floor by his daughter on the morning of July 29, 2007.

An ambulance was called, but paramedics could not save the 40-year-old former civil servant.

Blackpool Coroner’s Court was told the previous day he had taken anoverdose of blue tablets – later revealed to be benzodiazepines he had bought on the street – crushed up into a drink.

His daughter had called an ambulance after finding him seeming like he was drunk, “slurring” and with blue staining on his lips.

He was discharged from hospital later that night.

The locum doctor who treated him had told the inquest Mr Bromley, who suffered mental health problems and was under the crisis team from Lancashire Care Trust, said his observations, clinical condition and blood samples were normal.

Mr Bromley was seen by the mental health night practitioner at the hospital, who stated in a report about the incident he had assessed Mr Bromley and although he indicated he had on-going difficulties, he denied any suicidal intent.

Consultant pathologist Dr Dariusz Golka said the cause of death was overdose of the anti-depressant citalopram.

Coroner Anne Hind said she could only record the verdict Mr Bromley took his own life. She said: “It is very concerning how easily available such drugs are.”

The full article contains 251 words and appears in n/a newspaper.
Page 1 of 1

  • Last Updated: 12 August 2009 9:47 AM
  • Source: n/a
  • Location: Blackpool

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Experts: Women are drinking more, DUIs are up 28.8% from 1998-2007

Note from Ann Blake-Tracy: After researching and warning for two decades that this crisis with alcohol consumption would come, I can tell you the reason so many women are now drinking is because they are the main ones taking antidepressants which in turn cause overwhelming cravings for alcohol. And it has long been known that women suffer more adverse reactions to antidepressants than men do.

But why cravings for alcohol? These drugs drop the blood sugar causing cravings for sugar and/or alcohol and NutraSweet. Sugar and alcohol initially bring the blood sugar up quickly causing one to instinctively reach for them in a “self medicating” way because they quickly address the low blood sugar level. The problem with doing this is that both substances then drop the sugar levels even lower than before thus producing a vicious cycle of craving more and more sugar and/or alcohol. (To read the science behind this go to www.drugawareness.org)
Another aspect to this increased use in alcohol being tied to antidepressant use is the fact that antidepressants produce mania or Bipolar Disorder so frequently. (See the research article we posted earlier this week showing that 81% of those diagnosed with Bipolar Disorder have been found to have previously taken antidepressants or Ritalin.)
Initially doctors refused to prescribe the first SSRI, Prozac, because of its strong potential to chemically induce mania. There are several types of mania that are recognized. Many have never even heard of these types of mania. And most do not think of these various types of mania when they hear the term Bipolar. Let’s list just a few to shed some additional light on this drinking problem women, who have always taken more antidepressants than men, have developed since these drugs have become so widespread in use.

Pyromania: A compulsion to start fires
Kleptomania: A compulsion to embezzle, shoplift, commit robberies
Dipsomania: An uncontrollable urge to drink alcohol
Nymphomania and erotomania: Sexual compulsions – a pathologic preoccupation with sexual fantasies or activities

So there it is in black and white plain as day – one of the forms of mania, dipsomania, is described as an “uncontrollable urge to drink alcohol.” Could it be any clearer?

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And look at one of the comments from the article below:
“Younger women feel more empowered, more equal to men, and have been beginning to exhibit the same uninhibited behaviors as men,” said Chris Cochran of the California Office of Traffic Safety.
Does that not describe manic behavior – “empowered” or all powerful with grandiose thoughts of one’s self and “uninhibited”? Those have always been earmarks warning of mania.
Hopefully this news about women and drinking will FINALLY wake America up to what first caught my attention with the use of antidepressants – the OVERWHELMING out-of-character cravings for alcohol that is produced by these drugs. (Find much more additional information on this subject at www.drugawareness.org)
Ann Blake Tracy, Ph.D., Executive Director,
International Coalition For Drug Awareness
Website:
www.drugawareness.org & www.ssristories.drugawareness.org
Author: Prozac: Panacea or Pandora? – Our Serotonin Nightmare
& CD or audio tape on safe withdrawal: “Help! I Can’t Get
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Experts: Women are drinking more, DUIs are up

http://us.rd.yahoo.com/dailynews/ap/brand/SIG=br2v03/*http://www.ap.org

AP – Graphic shows driving under the influence arrests for men and women for 1998 and 2007; includes alcohol-impaired …
By LISA A. FLAM, Associated Press Writer Lisa A. Flam, Associated Press Writer 10 mins ago

NEW YORK – It seemed too horrendous even to imagine. But the case of the mother who caused a deadly wrong-way crash while drunk and stoned is part of a disturbing trend: Women in the U.S. are drinking more, and drunken-driving arrests among women are rising rapidly while falling among men.

And some of those women, as in the New York case, are getting behind the wheel with kids in the back.

Men still drink more than women and are responsible for more drunken-driving cases. But the gap is narrowing, and among the reasons cited are that women are feeling greater pressures at work and home, they are driving more, and they are behaving more recklessly.

“Younger women feel more empowered, more equal to men, and have been beginning to exhibit the same uninhibited behaviors as men,” said Chris Cochran of the California Office of Traffic Safety.

Another possible reason cited for the rising arrests: Police are less likely to let women off the hook these days.

Nationwide, the number of women arrested for driving under the influence of alcohol or drugs was 28.8 percent higher in 2007 than it was in 1998, while the number of men arrested was 7.5 percent lower, according to FBI figures that cover about 56 percent of the country. (Despite the incomplete sample, Alfred Blumstein, a Carnegie Mellon University criminologist, said the trend probably holds true for the country as a whole.)

“Women are picking up some of the dangerously bad habits of men,” said Chuck Hurley, CEO of Mothers Against Drunk Driving.

In New York’s Westchester County, where Diane Schuler’s crash killed her and seven other people last month, the number of women arrested for drunken driving is up 2 percent this year, and officers said they are noticing more women with children in the back seat.

“We realized for the last two to three years, the pattern of more female drivers, particularly mothers with kids in their cars, getting arrested for drunk driving,” said Tom Meier, director of Drug Prevention and Stop DWI for the county.

In one case there, a woman out clubbing with her teenage daughter was sent to prison for causing a wrong-way crash that killed her daughter’s friend.

Another woman was charged with driving drunk after witnesses said she had been drinking all day before going to pick up her children at school. Authorities said the children were scared during the ride, and once they got home, they jumped out of the car, ran to a neighbor’s house and told an adult, who called police. The mother lay passed out in the car, and police said her blood alcohol level was 0.27 percent — more than three times the legal limit.

In California, based on the same FBI figures, women accounted for 18.8 percent of all DUI arrests in 2007, up from 13.5 percent in 1998, according to the California Office of Traffic Safety.

Nearly 250 youngsters were killed in alcohol-related crashes in the U.S. in 2007, and most of them were passengers in the car with the impaired driver, according to the National Highway Safety Administration.

“Drunk drivers often carry their kids with them,” said MADD’s Hurley. “It’s the ultimate form of child abuse.”

Arrests of drunken mothers with children in the car remain rare, but police officers can generally list a few.

In the Chicago suburb of Wheaton, Supreme Court Justice Antonin Scalia‘s daughter was stopped by police after she pulled away from a McDonald’s with three of her kids in the car. She pleaded guilty to drunken driving and was sentenced to 18 months of court supervision.

Sgt. Glen Williams of the Creve Coeur, Mo., police department recalls stopping a suspected drunken driver on her way to pick up two preschoolers.

Sometime later, “she told me it actually changed her life, getting arrested,” he said. “She was forced to get help and realized she’d had a problem.”

The increase in arrests comes as women are drinking excessively more than in the past.

One federal study found that the number of women who reported abusing alcohol (having at least four drinks in a day) rose from 1.5 percent to 2.6 percent over the 10-year period that ended in 2002. For women ages 30 to 44, Schuler’s age group, the number more than doubled, from 1.5 percent to 3.3 percent.

The problem has caught the attention of the federal government. The Transportation Department’s annual crackdown on drunken driving, which begins later this month, will focus on women.

“There’s the impression out there that drunk driving is strictly a male issue, and it is certainly not the case,” said Rae Tyson, spokesman for the National Highway Traffic Safety Administration. “There are a number of parts of the country where, in fact, the majority of impaired drivers involved in fatal crashes are female.”

Schuler’s relatives have denied she was an alcoholic and said they were shocked to learn of her drug and alcohol use before the July 26 crash. The wreck, about 35 miles north of New York City, killed Schuler, her 2-year-old daughter, her three nieces and three men in an oncoming SUV she hit with her minivan. Schuler’s 5-year-old son survived his injuries.

Schuler, a cable company executive, could have had a drinking problem that her family didn’t know about, said Elaine Ducharme, a psychologist in Connecticut who has seen more excessive drinking, overeating, smoking and drug abuse during the recession.

Unlike men, women tend to drink at home and alone, which allows them to conceal a problem more easily.

Because of this, they seek treatment less often than men, and when they do, it is at a later stage, often when something catastrophic has already happened, said Dr. Petros Levounis, director of the Addiction Institute of New York at St. Luke’s-Roosevelt Hospital Center.

“Our society has taught us that women have an extra burden to be the perfect mothers and perfect wives and perfect daughters and perfect everything,” Levounis said. “They tend to go to great lengths to keep everything intact from an external viewpoint while internally, they are in ruins.”

In the current recession, women’s incomes have become more important because so many men have lost their jobs, experts say. Men are helping out more at home, but working mothers still have the bulk of the child rearing responsibilities.

“Because of that, they have a bigger burden then most men do,” said clinical psychologist Carol Goldman. “We have to look at the pressures on women these days. They have to be the supermom.”

And just becoming a parent doesn’t mean people will stop using drugs or alcohol, Ducharme said: “If you have a real addictive personality, just having a child isn’t going to make the difference.”

___

Associated Press writers Solvej Schou in Los Angeles, Mark Tarm in Chicago and Betsy Taylor in St. Louis contributed to this report.


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Kauffman Study – (SSRI) Drugs: More Risks Than Benefits?

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009

SSRI Bombshell by Joel M. Kauffman, Ph.D. Tuesday, March 31st, 2009

Selective Serotonin Reuptake Inhibitor (SSRI) Drugs: More Risks Than Benefits?

Joel M. Kauffman, Ph.D.

ABSTRACT

Anecdotal reports have suggested that selective serotonin reuptake inhibitors (SSRIs) may cause suicidal or violent behavior in some patients. Because of the publicity surrounding certain events, and the numerous lawsuits that have been filed, a review of benefits and risks is needed.

At most 30% of patients receive a benefit from SSRIs beyond the large placebo effect in certain mental conditions, especially depression, according to a recent meta-analysis of published trials. An equally recent meta-analysis of all SSRI trials submitted to the FDA showed a small benefit for the severely depressed patients only. Many early unpublished trials did not show any benefit. Adverse effects are common, occurring in up to 75% of subjects.

Severe adverse effects may be underreported.

Meta- analyses of controlled trials did not include any actual suicides or murders, but only suicidality, some finding, in 1991 and 2007, no evidence even of suicidality.

Other meta-analyses using many of the same trials found that suicidality doubled to 1 in 500 on SSRIs compared with placebo or non-SSRI antidepressants, but did not include any actual suicides or murders. The trial designs were devised by SSRI makers to prevent reports of suicides, by eliminating subjects with the slightest trace of suicidal tendencies. Retrospective studies by others showed actual suicides on SSRIs with a relative risk (RR) of 2–3 compared with non-SSRI antidepressants, with an increased incidence of 123/100,000. Lower doses than the smallest available ones were found to maintain benefits in a majority of patients while reducing risks.

table_03_zoloftbusted1

[PLEASE NOTE THAT THE SSRISTORIES DATABASE REFERRED TO BY DR. KAUFFMAN IN THIS STUDY IS NO LONGER POSTED AT THE URL LISTED ABOVE BUT HAS BEEN MOVED TO THE URL www.ssristories.NET ]

No causal connection between SSRIs and suicide and/or violence has been proved; neither has it been ruled out. Physicians need to be vigilant, and aware of legal precedents that may subject them to enhanced liability when prescribing these drugs. The Genesis of SSRIs Fluoxetine (Prozac in the U.S., see Table 1), introduced in 1988 to combat depression, was the fourth selective serotonin reuptake inhibitor (SSRI) on the U.S. market, after being seriously considered by Eli Lilly as an antihypertensive drug. Unlike the earlier “tricyclics” (amitripyline, clomipramine, dothiepin, imipramine, etc.) and other drug classes, SSRIs acted on the brain to raise levels of the neurotransmitter serotonin without raising the levels of norepinephrine. This was thought to be a benefit in treatment of depression, and later anxiety, panic, social phobia, obsessive- compulsive disorder (OCD) , and many other conditions. The SSRIs listed in Table 1 are among the most frequently prescribed in the U.S., and compete with the five non- SSRIs shown, and others.

ssri-drug-table1

Benefits of SSRIs

A prominent recent meta-analysis of Bridge et al. included 27 trials of SSRIs for three defined mental conditions: major depressive disorder (MDD), OCD, and non-OCD anxiety disorders. Benefits, compared with placebo, were found to be highly statistically significant. For MDD, data from 13 trials showed benefit in 61% vs. 50% on placebo, a gain of 11% absolute (NNT=10), <0.001 for all ages of participants. For OCD, data from six trials showed benefit in 52% vs. 32% on placebo, a gain of 20% absolute (NNT=5), <0.001 for all ages. For non-OCD anxiety, data from 6 trials showed benefit in 69% vs. 39% on placebo, a gain of 30% absolute (NNT=3), <0.001 for all ages. These results represent the maximum expectation of benefit from SSRIs since 22 of the 27 trials were financially supported by SSRI makers, and thus subject to the routinely positive bias of industry-sponsored clinical trials. Jay S. Cohen, M.D., author of the 2001 book , wrote that half his patients did well on fluoxetine, but he noted a high incidence (50%) with side-effects. Cohen also cited a pre-approval study showing that the standard 20 mg per day starting dose helped 65% of patients, while 5 mg helped 54%, so Cohen became one of the pioneers in using lower doses before Lilly made them available. The 1996 entry for paroxetine, at least, confirmed that the 17 most common side-effects were dose-dependent.

In four observational cohort studies of four common SSRIs reported by physicians as part of the prescription-event monitoring program in the UK, with more than 10,000 patients in each drug group, only 36% of the physicians reported fluvoxamine as effective, compared with 60% for fluoxetine, sertraline, and paroxetine. These possible benefit rates, which include the placebo effect, parallel the percentage of patients remaining on the drug for 2 months.

See: Over Dose: the Case Against the Drug Companies

An old trial of placebo for anxious and depressed subjects reduced distress in 43%. Three meta-analyses of the antidepressant literature that appeared in the 1990s independently concluded that two-thirds of the effectiveness attributed to SSRIs is actually placebo effect. In a series of nine controlled studies on hospitalized patients with depression, 57% of those given placebo showed improvement in 2–6 weeks. A 1998 meta-analysis of 47 trials on antidepressant medication including SSRIs indicated that 75% of the response to them was duplicated by placebo. This meta-analysis was criticized on several grounds. Therefore, Irving Kirsch, Ph.D., of the University of Connecticut, with other authors, obtained data submitted to the FDA on every placebo-controlled clinical trial on the six most widely used SSRIs, and published a meta-analysis on 47 trials, finding a small, clinically insignificant effect.

This work was updated in 2008:

Analyses of datasets including unpublished as well as published clinical trials reveal smaller effects that fall well below recommended criteria for clinical effectiveness. Specifically, a meta-analysis of clinical trial data submitted to the U.S. Food and Drug Administration (FDA) revealed a mean drug–placebo difference in improvement scores of 1.80 points on the Hamilton Rating Scale of Depression (HRSD), whereas the National Institute for Clinical Excellence (NICE) used a drug–placebo difference of three points as a criterion for clinical significance when establishing guidelines for the treatment of depression in the United Kingdom. Kirsch et al. concluded that the updated findings from 35 carefully vetted trials suggest that, compared with placebo, the four new- generation antidepressants ( fluoxetine, venlfaxine, nefazodone, and paroxetine) do not produce clinically significant improvements in depression in patients who initially have moderate or even severe depression.

They show statistically significant but clinically minor effects only in the most severely depressed patients. Moreover, the significance of the effect probably is based on a decreased responsiveness to placebo, rather than increased responsiveness to medication. Given these results, the researchers conclude that there is little reason to prescribe new- generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective. In addition, they write that the decreased placebo response in extremely depressed patients, combined with a response to antidepressants comparable to that of less severely depressed patients, is a potentially important insight that should be investigated further.

Even these unimpressive findings exaggerated the benefits of antidepressants. In three fluoxetine trials and in the three sertraline trials for which data were reported, the protocol allowed replacement of patients who, in the investigators’ judgment, were not improving after 2 weeks. The trials also included a 1–2 week washout period, during which patients were given a placebo prior to randomization. Those whose scores improved 20% or more were excluded from the study. In 25 trials, the use of other psychoactive medication was reported. In most trials, a chloral hydrate sedative was permitted in doses ranging from 500 mg to 2,000 mg per day. Other psychoactive medication was usually prohibited but still reported as having been taken in several trials.

Perhaps such considerations led David Healy, M.D., an SSRI expert, to his conclusion that “…these drugs do not convincingly work….” His evidence came from early unpublished clinical trials whose results were revealed to him at FDA hearings. For fluoxetine, Healy noted four trials with a positive result and four without. For sertraline, only one of five early studies showed benefit. Because of the huge placebo effect, 32–75%, most physicians unfamiliar with the studies revealing this effect are likely, in my opinion, to say that one-third to two-thirds of their patients are improved on SSRIs. This would also explain Dr. Jay S. Cohen’s findings on lower doses of fluoxetine.

SSRIs reportedly interact with 40 other drugs to cause “serotonin syndrome.”

This presents as twitching, tremors, rigidity, fever, confusion, or agitation. Serotonin/norepinephrine reuptake inhibitors (SNRIs) also may cause serotonin syndrome by interactions. Most tricyclic depressants do not have these interactions, with the exception of amitriptyline.

In a controlled trial of paroxetine vs. clomipramine sponsored by GlaxoSmithKline, 75% of the subjects had an adverse effect on paroxetine, 21% had a severe adverse effect, and 13% committed a suicidal act (1 in 8). The 1996 entry for paroxetine lists 17 side-effects with an incidence of ≥ 5% for approved doses.

They are: asthenia, sweating, constipation, decreased appetite, diarrhea (up to 15%), dry mouth (up to 21%), nausea (up to 36%), anxiety, dizziness, nervousness, paresthesia, somnolence (up to 22%), tremor (up to 15%), blurred vision, abnormal ejaculation, impotence, and other male genital disorders. Fully 31 additional side effects with an incidence at least 1% greater than placebo were listed, including uncontrollable yawning.

Murder, suicide, and suicidality were NOT [emphasis added] included.

Nor were they on comparable lists for fluvoxamine, or sertraline. For fluvoxamine, suicide were separately listed as “infrequent.”

For fluoxetine, suicidal ideation was listed as a voluntary report not proved to be drug related. For sertraline, suicidal ideation and attempt were listed separately as “infrequent.”

The entry for venlafaxine was: “…the possibility of a suicide attempt is inherent in depression.” Not found in the was weight gain, which Cohen lists as a serious side effect.

Typical dropout rates in recent trials are claimed to be 5% (see below), but these must be short trials, or trials with a run-in period. In a meta-analysis of 62 earlier trials with a total of 6,000 subjects, the mean total dropout rate and the proportion of dropouts due to side effects appear comparable to results in general practice: total dropout rates of between 30% and 70% have been reported by 6 weeks, of which some 30%–40% are attributed to side effects and the rest to failure of treatment. Early findings of severe adverse effects by SSRI makers came to light only after the class was established. Of 53 healthy volunteer studies on fluoxetine, the results of only 12 were openly reported.

From 35 healthy volunteer studies on paroxetine, pre-launch, the results of only 14 appeared. From 35 pre-launch healthy volunteer studies on sertraline, only seven appeared. Among the unpublished trials, there was one in which all volunteers dropped out because of agitation (akathisia). In published work on sertraline, data excluded material on behavioral toxicity, including at least one suicide of a Adverse Effects of healthy volunteer, and in a different trial, 2 of 20 volunteers became intensely suicidal. This last is consistent with the dropout rate of 5% for agitation alone in actual trials. It is also consistent with Lilly’s animal studies, in which previously friendly cats treated with fluoxetine started growling and hissing—an unheeded warning.

Just a year after fluoxetine was introduced, Bill Forsyth of Maui, Hawaii, had taken it for only 12 days when he committed one of the first murder/suicides attributed to any SSRI.

In the same year Joseph Wesbecker killed eight others and himself in a Louisville, Ky., printing plant where he worked, after 4 weeks on fluoxetine. Yet as early as 1986, clinical trials showed a rate of 12.5 suicides per 1,000 subjects on fluoxetine vs. 3.8 on older non-SSRIs vs. 2.5 on placebo! An internal 1985 Lilly document found even worse results and said that benefits were less than risks. Such documents were released into the public domain by Lilly as part of the settlement in the Wesbecker case. Fifteen more “anecdotes” of murder/suicide, three with sertraline, were listed by DeGrandpre.

Lilly’s denials of a link to murder/suicide on national television and elsewhere cited a sponsored meta-analysis in in 1991, which exonerated fluoxetine as a cause of suicidal acts or thoughts without even mentioning actual murder or suicide. This study included only 3,067 patients of the 26,000 in the clinical trials it utilized. None of the trials had a declared endpoint of suicidality.

Some of the trials had been rejected by the FDA. No mention was made that Lilly had had benzodiazepines co-prescribed to minimizethe agitation that had been recognized with fluoxetine alone. The 5% dropout rate for anxiety and agitation (akathisia) would have taken out the most likely candidates for suicide. Nevertheless, the 1991 study had its intended effect. For example, in 2006 a 900-page tome entitled , which was aimed at attorneys, cited this study, and failed lawsuits concerning SSRIs. The 2007 meta-analysis by Bridge et al. may be influenced by indirect conflicts of interest that are hard to prove based on the financial disclosures.

Their paper pooled excess risk above placebo for “suicidal ideation/suicide attempt” from 27 trials. The excess risk was said to be 0.7% and statistically significant across all indications, but significant within each indication. Of the 27 trials, only five were sponsored by the drug maker, and one of these, the 2004 Treatment for Adolescents with Depression (TADS) study of fluoxetine, had the highest rate of suicidality—7% above placebo. Most of the same trials were used in a meta-analysis by the FDA, which found a statistically significant excess risk of 2% (4% vs. 2% on placebo, 1 in 50 more). Bridge et al. used a random-effects calculation, while the FDA used a fixed-effects calculation.

In commenting on the negative findings, Bridge et al. write: “No study [in our meta-analysis] was designed to examine suicidal ideation/suicide attempt as a study outcome, and in fact most trials were conducted in patients who had been carefully screened to exclude youths at risk.” No actual murders or suicides associated with SSRI use were reported. Did the designs of the studies preclude detection or reporting?

The Bridge meta-analysis was not just a vindication of SSRIs, as communicated to the by Gilbert Ross, M.D., Medical Director of the American Council on Science & Health. Ross went further, commenting that the FDA “Black Box warning” (see below) was counterproductive because it was discouraging the use of antidepressants! Ross speculated that the lethal rampage of the Virginia Tech shooter might have resulted from premature cessation of medications.

SSRIs in general have long lifetimes in the body. Fluoxetine and its active metabolite in particular have a half-life of 16 days, according to the 1996 . In a reexamination of trials in which suicides or attempts during the inadequate washout period were not blamed on the drug, it was shown that the relative risk (RR) of suicidal acts ranged from 3 for sertraline to 10 for fluoxetine.

A concurrent meta-analysis of 24 trials by Kaizar et al. utilized Bayesian statistics, a valid choice, in my opinion, because data do not have to follow a Gaussian or normal curve to yield valid results, and this method can be used to revise probabilities to determine whether a specific effect was due to a specific cause. They found an association between SSRI use and suicidality with odds ratios of 2.3 (95% confidence interval [CI] 1.3-3.8), when the diagnosis was MDD, not OCD, anxiety, nor ADHD. Non-SSRI antidepressants were said to have no association with suicide. This supports the FDA’s findings and requirement, as of October, 2004, for a Black Box warning for all SSRIs, to monitor children and adolescents for suicidality. Kaizar et al. were concerned that there were no completed suicides among 4,487 subjects in the trials; that the trial times were too short at median length of 8 weeks; and that in 10 of the 12 MDD studies, Again, there was no citation of actual suicides associated with SSRIs and no citation of Healy’s work.

Healy reviewed epidemiologic studies that have been cited to exonerate SSRIs. One was analyzed by Healy to show a threefold increase in suicidality compared with other antidepressants.While “treatment-related activation” has been considered primarily with regard to suicidality, it can lead to harm to others as well as to self. Healy summarized data on “hostile episodes” provided by GlaxoSmithKline from placebo-controlled trials with paroxetine in subjects of all ages: 9,219 on paroxetine and 6,455 on placebo. The rubric of “hostility” was used in the trial to code for aggression and violence, including homicide, homicidal acts, and homicidal ideation, as well as aggressive events and “conduct disorders.” No homicides were reported from these trials.

Overall, during both therapy and withdrawal, the RR was 2.1 for hostile events. In children with OCD the RR was 17. Separately, in healthy volunteer studies, hostile events occurred in 3 of 271 subjects on paroxetine vs. none of 138 on placebo. In trials of sertraline on depressed children submitted by Pfizer, 8 of 189 subjects discontinued for aggression, agitation, or hyperkinesis (a coding term for akathisia), compared with 0 of 184 on placebo. In clinical practice, the term akathisia has been restricted to demonstrable motor restlessness, but if that is the only effect, it would have been called dyskinesia according to Healy, who cites four studies linking akathisia to both suicide and homicide.

Actual suicides were combined with suicide attempts in a 2005 meta-analysis of 702 trials of SSRIs vs. either placebo or an active non-SSRI control. Studies were rejected if the citation was a review, a result of duplicate publication, too short, crossover, or had no reporting of actual or attempted suicide. The studies meeting the criteria included 88,000 patients. For attempted suicide, the RR was 2.3 for SSRIs vs. placebo (95% CI, 1.14-4.55). The number needed to treat to harm (sometimes called the “reverse NNT”) was 1 in 684. There was no difference in actual suicide. Of the 702 trials, 104 failed to report adverse events below a certain pre-set limit of 3%, 5%, or 10% of patients. Only 493 trials reported dropout rates, with a mean of 29%, and the mean follow-up time was only 11 weeks. Thus, there was clearly gross underreporting of adverse effects. PDR children and adolescents with an elevated baseline risk of suicide were excluded.

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 9

More importantly, because actual suicides are involved, Healy cited a study by Donovan et al. that demonstrated a RR=3.4 ( <0.01) for SSRIs compared with all non-SSRI antidepressants involving 222 actual suicides, of which 41 were among patients who had an SSRI within a month of their suicide. Also the British Drug Safety Research Unit recorded more than 110 suicides in 50,000 patients taking an SSRI, an incidence of 219/100,000 compared with 96/100,000 for the non-SSRI mirtazepine (Remeron), an increase of 123/100,000, or 1 in 813 (Table 2). Thus the RR for actual suicide in patients taking SSRIs was 2.3 (or 2.8 for paroxetine). Even here, though, no murders were listed.

In another study cited by Healy, Jick et al. reported 143 actual suicides among 172,598 patients taking antidepressants. The relative risk of suicide in patients taking fluoxetine was 2.1, compared with those taking the tricyclic antidepressant dothiepin. The risk was not age-dependent. SSRI makers keep insisting that there will be more suicides if SSRIs are used as frequently as now. But the RR of 2–3 shown in studies is a number that the number of suicides that may have been prevented, so SSRI use is associated with more suicides, not fewer.

The International Coalition for Drug Awareness in cooperation with the Prozac Survivors Support Group has produced a website on which about 1,600 violent incidents associated with SSRI use are described ( www.ssristories.net ). The first column on the type of incident (murder, school shooting, etc.) is a hot link to a publicly available description of the incident, typically a local newspaper article. A selection of 10 entries (rows) is presented here as Table 3. About 360 suicides are tallied as well as about 400 murder incidents, many of which were multiple murders, each linked to 26 not net includesSSRIs Provide 1,600 Anecdotes of Violence SSRI use (Rosie Meysenburg, personal communication, 2008 .

As the number of “anecdotes” exceeds 1,600—hardly a small number—the association of SSRIs with murder/suicide, often combined, must be taken seriously. The SSRI website was searched to find combined murder/suicide incidents attributed to a specific SSRI. There were three for fluvoxamine, four for citalopram, 10 each for paroxetine and sertraline, and 31 for fluoxetine. Where the studies above substantiated suicide from SSRI use, the total on the SSRI website of 48 simultaneous murder/suicide incidents associated with SSRI use ties together SSRIs and murder. Since there were about two murders per suicide, we may infer that the murder rate on SSRIs could be about 250/100,000. Since no clinical trial involving multiple homicides is ever likely to be run, no firmer evidence is likely to be found. Healy noted that much of the evidence for suicide and murder came from the efforts of journalists and lawyers.
Note that the website carries a prominent warning that “withdrawal can often be more dangerous than continuing on a medication.” Nine violent events cited elsewhere—seven court cases of homicide (one attempted) and two assaults—were associated with specific SSRIs: three with paroxetine, three with sertraline, two with fluoxetine, and one with venlafaxine. Skeptics have cast doubt on whether the prescribed SSRIs were actually taken, especially since many medical records of juveniles were sealed. In the Columbine, Colo., shootings the toxicology report showed “therapeutic” levels of fluvoxamine in one of the shooters. The Red Lake, Minn., shooter had fluoxetine found, according to news items referenced on the website.

A 2004 editorial in by Simon Wessely, M.D., a spokes- man for Eli Lilly, and Robert Kerwin, Ph.D, cited only a single paper by Healy as a source of claims of suicidality that have found a receptive media audience. Tellingly, the only study described at length is by Jick et al. on the correlation of SSRI use and “attempted suicide,” in which the rates on dothiepin, amitriptyline, fluoxetine and paroxetine were not statistically different. Actual suicides in this study (seven on SSRIs) were not mentioned by Wessely and Kerwin, nor were the 143 suicides in Jick’s earlier paper. Jick et al. have been supported partially by GlaxoSmithKline and Pfizer. No study that reported actual suicides on SSRIs was described in detail, let alone refuted. Wessely and Kerwin wrote: “The problem is that depression is unequivocally and substantially associated with suicide and self-harm.” True, but this not the truth.

Table 2. Suicides Related to SSRIs or Mirtazapine

table_02_zoloftbusted1

The legal defense by Lilly, repeated by the media and others, is that any suicides are caused by the condition, depression, not by their drug—whether the violence is associated with short-term drug use, long-term drug use, increased doses, withdrawal, or rechallenge. There is no website, as far as I know, for violent acts committed by persons who never received SSRIs, or for total violent acts; hence the denominator for violent acts is not known. Also unknown is the fraction of potentially violent persons who are treated with SSRIs, or of persons treated with SSRIs who are potentially violent. The published studies on actual suicide, however, compare patients on SSRIs with similar patients on non- SSRI antidepressants or placebo. Children diagnosed with OCD, not depression, also became suicidal on SSRIs, as did healthy volunteers.

Actual two- to threefold increases in suicide rates have been demonstrated as well as they could be. How else could such effects be demonstrated? Who would submit, and what institutional review board or human subjects committee would approve a study explicitly designed to show whether assaultive, homicidal, or other violent behavior increases in subjects prescribed the study drug?

Denial by SSRI makers of culpability for these risks continues to this day. Whether physicians’ acting on the Black Box warnings of 2004 and 2007 for all SSRIs will diminish the incidence of murders and suicides is not yet known. Following the introduction of fluoxetine in 1988, only a year passed before an early user committed multiple murders and suicide; many other examples followed. More than 200 lawsuits have been begun by users of SSRIs and victims’ families charging wrongful death or failure to warn; these have had mixed outcomes. There is now legal precedent for SSRIs as a cause of murder, and the maker of the SSRI is potentially liable for damages, according to David Healy.

Eli Lilly responded with total denial to the lawsuits claiming a link between fluoxetine and violence. Several claims were settled out of court with secret details and no admission of guilt. The Australian David Hawkins was freed from a murder charge by a finding of temporary insanity caused by using sertraline. Tim Tobin of Wyoming won $6.4 million from SmithKline Beecham when a jury found that a murder/suicide committed by Donald Schell was attributable to use of paroxetine. There are four other homicide cases in which the SSRI was deemed to have contributed, resulting in a suspended sentence in one case and an insanity verdict in another.

One case of homicide, with a guilty verdict and a life sentence, followed a judicial ruling that akathisia was associated with SSRI use, but that a causal relationship with homicide could not be argued; thus the link of an SSRI with homicide was disallowed. This was in direct conflict with the findings of the four trials cited above. The SSRI website was searched to find murders related to a specific SSRI whose perpetrators were acquitted based on temporary SSRI-induced insanity. There were two cases with sertraline, four cases with paroxetine, and four cases with fluoxetine. So a precedent has been established for legal recognition that an SSRI can be a cause for murder, and that the drug maker can be found liable for damages. The notices of suicidality for the SSRIs found in the PDR or package inserts before 2004 did not really warn of actual suicide or murder.

200 SSRI-related Lawsuits

The Black Box warning of 2004 about possible suicide in children under 18 years of age did not cover adults or murder at any age, so potential liability for the SSRI makers still exists. In 2007 the warning was extended to persons under age 25 years. David Healy was quoted as saying that the warning was overdue, and that the risk was not likely to disappear above age 25. This was shown by the trials from GlaxoSmithKline on paroxetine cited above.

Antidepressants are extraordinarily difficult to assess for risks or benefits in trials. At most, 11%–30% of patients with depression or related conditions who take SSRIs actually benefited beyond the placebo effect on normal doses. Of the perceived benefit, 32%–67% can be attributed to the placebo effect. Adverse effects, mostly dose-dependent, will appear in up to 75% of patients on normal doses. Of these, studies suggest that suicidality will be observed in an additional 2%–13% (1 in 50 to 1 in 9) of patients on normal doses, beyond what is seen on placebo or many non-SSRI antidepressant drugs. This is sufficiently frequent that a typical prescribing physician should observe examples in routine practice.

The actual suicide rate could be about 123/100,000 (1 in 813) higher in patients on SSRIs than in those on tricyclics or placebo. Studies show that many more suicides are on normal doses of SSRIs beyond what is seen on placebo or many non-SSRI antidepressant drugs. Available data suggest that actual murders may be committed at about the rate of 250/100,000 (1 in 400) SSRI-treated patients beyond what is seen on placebo or many non-SSRI antidepressantdrugs, and that many more murders will be attempted on normal doses as well. While correlation does not prove causation, and results of court trials are not medical science, the data for suicide are solid, and the association of murder with suicide is very suggestive. Now that there is a stronger Black Box warning, physicians who ignore it may be liable for damages; the warning primarily protects the manufacturers of SSRIs. There is obviously great peril in drawing conclusions about causat i on from press report s or court decisions.

While manufacturers have a vested interest in exonerating their drugs, plaintiffs have an interest in blaming it, and defendants in exonerating themselves. We need careful, independent analysis of existing study data. In addition to randomized controlled trials, evidence from basic science ( neuropharmacology) and challenge/dechallenge/rechallenge investigations needs to be sought. Both the public and individual patients are imperiled by an incorrect answer to the pressing questions about these widely prescribed drugs. Future studies may show lower levels of murder and suicide with close supervision, and with better matching of this drug type to patient type.

Conclusionsattemptedsimultaneous
Joel M. Kauffman, Ph.D.

Acknowledgements:
Joel M. Kauffman, Ph.D., professor of chemistry emeritus at the
University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19104-4495,
Contact: kauffman@bee.net.

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Frances E. H. Pane edited the manuscript. David Moncrief piqued my interest by providing a review copy of by Richard DeGrandpre.
The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 11
Potential conflicts of interest: The author has neither a financial interest in any drug mentioned, nor in any alternate treatments for treating any mental illness.

REFERENCES
DeGrandpre R.,Durham, N.C.: Duke University Press; 2006.

The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture.
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Jørgensen AW, Hilden J, Gøtzsche PC. Cochrane reviews compared
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Cohen JS. New York, N.Y.: Tarcher/Putnam; 2001.

Mackay FJ, Dunn NR, Wilton LV, et al. A comparison of fluvoxamine, fluoxetine, sertraline and paroxetine examined by observational cohort studies. 1997;6:235-246.

Park L, Covi L. Nonblind placebo trial. 1965;336-345.

Cole JO. Therapeutic efficiency of antidepressant drugs: a review. 1964;190:124-131.

Kirsch I, Moore TJ, Scoboria A, et al. The emperor’s new drugs: an analysis of antidepressant medication data submitted to the U. S. Food and Drug Administration. 2002;5(1):23-33.

Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. 2008;5(2):e45. doi:10.1371/journal.pmed.0050045.

Healy D. One flew over the conflict of interest nest. 2007;6(1):26-27.

Healy D. New York, N.Y.: New York University Press; 2004.

Healy D. FDA Psychopharmacologic Drugs Advisory Committee hearings. Available at:: www.healyprozac.com/PDAC. Accessed May 13, 2007.

Wolfe SM, ed. SSRIs can have dangerous interactions with other drugs. 2008;14(1):2-5. www.citizen.org/hrg/. Accessed Feb 4, 2009.

JAMA BMJ, Over Dose: The Case Against the Drug Companies.
Pharmacoepidemiol Drug Safety Arch Gen Psychiatry

JAMA
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Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.
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Braconnier A, Le Coent R, Cohen D. Paroxetine versus clomipramine in adolescents with severe major depression: a double-blind, randomized, multicenter trial. 2003;42:22-29.

Anderson IM, Tomenson BM. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. 1995;310:1433-1438.

Healy D. Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. 2003:72:71-79.

Healy D, Herxheimer A, Menkes DB. Antidepressants and violence: problems at the interface of medicine and law.
2006;3(9):1478-1487.

Beasley CM, Dornseif BE, Bosomworth JC. Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. 1991;303:685-692.

Cohen H. Antidepressants: clinical use and litigation. In: 2nd ed. O’Donnell JT, ed. Tucson, Ariz.: Lawyers & Judges Publ.Co; 2006:379-390.

Ross G. Black Box backfire. Apr 21, 2007.

Donovan S, Clayton A, Beeharry M, et al. Deliberate self-harm and antidepressant drugs. 2000;177:551-556.

Kai zar EE, Gr eenhouse JB, Sel t man H, Kel l eher K . Do antidepressants cause suicidality in children? A Bayesian meta-analysis. 2006;3:73-98.

Berenson ML, Levine DM.. 7th ed. Upper Saddle River, N.J.: Prentilee-Hall; 1998:213-217.

Healy D, Whitaker C. Antidepressants and suicide: risk-benefit conundrums. 2003;28:331-337.

Fergusson D, Doucette S, Glass KC, et al. Association between suicide attempts and selective serotonin reuptake inhibitors.2005;330:396-402.

Donovan S, Kelleher MJ, Lambourn J, Foster T. The occurrence of suicide following the prescription of antidepressant drugs.1999;5:181-192.

Jick SS, Dean AD, Jick H. Antidepressants and suicide.1995;310:215-218.

Wessely S, Kerwin R. Suicide risk and SSRIs. 2004;292:379-381.

Jick H, Kaye JA, Jick SS. Antidepressants and the risk of suicidal behaviors. 2004;292:338-343.

Carey B. FDA expands suicide warning on drugs. ,May 3, 2007:A17.

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Drug Injury:Liability, Analysis and Prevention.

Wall Street Journal,Br J Psychiatry Clinical Trials

Basic Business Statistics: Concepts and Applications J Psychiatry Neuroscience

New York Times:Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009

USA Trade Name Generic Name:
SSRIs
Celexa
Luvox
Paxil
Prozac
Zoloft
non-SSRIs
Effexor
Remeron
Serzone
Wellbutrin
(UK)
citalopram
fluvoxamine
paroxetine
fluoxetine
sertraline
venlafaxine
mirtazapine
nefazodone
bupropion
dothiepin USA Trade Name Generic Name
SSRIs
Celexa
Luvox
Paxil
Prozac
Zoloft
non-SSRIs
Effexor
Remeron
Serzone
Wellbutrin
(UK)
citalopram
fluvoxamine
paroxetine
fluoxetine
sertraline
venlafaxine
mirtazapine
nefazodone
bupropion
dothiepin

Physicians Desk Reference (PDR)
Joel M. Kauffman, Ph.D.
Table 1. Commonly Prescribed SSRIs and Other Antidepressants Selective Serotonin Reuptake Inhibitor (SSRI) Drugs:
More Risks Than Benefits?

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 7 Physicians Desk Reference (PDR)
Joel M. Kauffman, Ph.D.
Table 1. Commonly Prescribed SSRIs and Other Antidepressants Selective Serotonin Reuptake Inhibitor (SSRI) Drugs:
More Risks Than Benefits?

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 7

JAMAwhole12,69210,98313,74112,73450,15013,554

10 dead, 7 wounded: dosage increased one week before rampage
15 year old shoots two teachers, killing one: then kills himself
Columbine High School: 15 dead, 24 wounded
Four dead, twenty injured after Prozac withdrawal
Teen shoots at two students: kills his father
Jury finds Paxil was cause of murder-suicide
Man cleared of charges due to Paxil withdrawal defense
Not guilty by reason of Prozac induced insanity: mother kills daughter
Nine dead, 12 wounded in workplace shooting
11 year old hangs himself: lawsuit

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009

3,175 total views, 6 views today

DEPRESSION MED: Woman Stabs To Death A Man On A Stairwell: Australia

Paragraph three reads:  “Defence solicitor Bernie Balmer said Epshtein was on medication for anxiety, bipolar, depression, pain and one to lower her heart rate.”

http://www.theage.com.au/national/woman-in-court-over-stabbing-murder-20090803-e6l0.html

Woman in court over stabbing murder

Steve Butcher

August 3, 2009 – 12:04PM

A 21-year-old woman charged with the stabbing murder last week of a man in a St Kilda stairwell has appeared in court.

A lawyer for Natasha Epshtein told Melbourne Magistrates Court today his client had been treated by two doctors for five separate health conditions.

Defence solicitor Bernie Balmer said Epshtein was on medication for anxiety, bipolar, depression, pain and one to lower her heart rate.

Epshtein appeared before Deputy Chief Magistrate Dan Muling in a low-cut, black t-shirt with close-cropped hair and tattoos on her upper chest.

She is charged with murdering Peter James Len on July 30.

Mr Balmer said she would consent to a DNA sample being taken at a later date.

She was remanded to appear again on November 30.

525 total views, 2 views today

DEPRESSION MED: Woman Assaults a Deputy Sheriff: Colorado

Paragraqphs two and three read:  “Tanya Eliz Moschetti, 42, 1253 12 1/2 Road, was arrested on suspicion of second-degree assault on a peace officer, third-degree assault and criminal mischief after deputies received a report of a possible overdose at her house and were told she was running around the house naked and breaking things, according to an arrest affidavit.”

“When deputies arrived, they noted Moschetti, who was standing outside and cursing at a man inside, was slurring her speech and had a distant gaze in her eyes. She said she was taking medication for depression.”

http://www.gjsentinel.com/hp/content/news/police/stories/2009/08/02/080309_3a_Blotter.html

Police blotter: August 3, 2009

Sunday, August 02, 2009

Assault suspect arrested

A Loma woman was arrested Saturday after she allegedly assaulted a sheriff’s deputy who had responded to a domestic disturbance at her house, the Mesa County Sheriff’s Department said.

Tanya Eliz Moschetti, 42, 1253 12 1/2 Road, was arrested on suspicion of second-degree assault on a peace officer, third-degree assault and criminal mischief after deputies received a report of a possible overdose at her house and were told she was running around the house naked and breaking things, according to an arrest affidavit.

When deputies arrived, they noted Moschetti, who was standing outside and cursing at a man inside, was slurring her speech and had a distant gaze in her eyes. She said she was taking medication for depression.

At one point, Moschetti tried to re-enter the house and struck a deputy on the arm when he tried to stop her.

Deputies arrested Moschetti and booked her into Mesa County Jail.

523 total views, 2 views today

Matt Miller – Zoloft (1 week!) – induced suicide

http://www.antidepressantsfacts.com/Matt-Miller.htm

By Anne McIlroy
As written in The Globe and Mail (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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SSRI Medications

Below is a the drug manufactures BEST GUESS as to how SSRI antidepressants work in your brain. They fully admit that they really don’t know how they work. However, we maintain that the positive effects that patients report come from the stimulant, amphetamine-like, nature of these mind-altering drugs.

Learn the truth about these drugs in “Prozac: Panacea or Pandora?”

What you need to know about serotonin-enhancing medications

Selective Serotonin Reuptake Inhibitors do exactly that: Inhibit the reuptake of serotonin, thus leaving excess serotonin which allows this stimulation to continue. It has long been known that inhibiting the reuptake of serotonin will produce depression, suicide, violence, psychosis, mania, cravings for alcohol and other drugs, reckless driving, etc. [See full list of reactions below]

The most popular drugs that produce this reuptake of serotonin are:

SSRI Antidepressants: Prozac, Serafem, Zoloft, Paxil, Luvox, Celexa, Lexapro

SNRI Antidepressants: Effexor, Remeron, Serzone, Cymbalta

Atypical Antipsychotics: Zyprexa, Geodon, Abilify, Seroquel, Risperdal

Weight Loss Medications: Fen-Phen, Redux, Meridia

Pain Killers: (Any opium or heroin derivative) Morphine, OxyContin, Ultram, Tramadol, Percocet, Percodan, Lortab, Demerol, Darvon or Darvocet, Codeine, Buprenex, Dilaudid, Talwin, Stadol, Vicodin, Duragesic Patches, Fentanyl Transdermal, Methadone, Dextromethorphan (commonly used in cough syrups), etc.

WARNING: Anesthetics can also fall into this group as well as drugs used for other purposes. Always check to see what the mechanism of action is in a drug before combining it with another serotonergic agent or using it soon after the use of a serotonergic agent because the combination of two can cause the potentially fatal reaction known as Serotonin Syndrome. As the main function of serotonin is constriction of smooth muscle tissue, Serotonin Syndrome produces death via multiple organ failure.

“Psychedelic agents mimic the effects of serotonin.”

The brain chemical these drugs increase, serotonin, is the same brain chemical that LSD, PCP and other psychedelic drugs mimic in order to produce their hallucinogenic effects. And remember that psychedelic agents are “a class of compounds with no demonstrated therapeutic use, a history of extensive abuse, and the ability to provoke psychosis. Yet many brain researchers value the psychedelic agents above any of the other psychoactive drugs” because “the research into psychedelic drugs has already enriched our understanding of how the brain regulates behavior.” (Dr. Solomon Snyder, DRUGS AND THE BRAIN). Just how much will these brain researchers learn from our experience with these drugs designed to specifically increase serotonin, the same brain chemical the psychedelic agents mimic to produce their effects?

We know that these drugs interfere with serotonin metabolism (demonstrated by levels of the serotonin metabolite 5HIAA). It is not serotonin that is low in these disorders, it is this by-product 5HIAA, which indicates the level of serotonin metabolism, that is low in depression, suicide, etc. Yet as serotonin (5HT) goes up serotonin metabolism (5HIAA) generally comes down. We already have studies demonstrating at what percentage each of these drugs increase 5HT and decrease 5HIAA. Here are the results of elevated levels of serotonin (5HT) and decreased levels of serotonin metabolism (5HIAA):

Elevated 5HT (serotonin) levels:

  1. schizophrenia, psychosis, mania, etc.
  2. mood disorders (depression, anxiety, etc.)
  3. organic brain disease – especially mental retardation at a greater incident rate in children
  4. autism (a self-centered or self-focused mental state with no basis in reality)
  5. Alzheimer’s disease
  6. old age
  7. anorexia
  8. constriction of the blood vessels
  9. blood clotting
  10. constriction of bronchials and other physical effects

Lower 5HIAA (serotonin metabolism) levels:

  1. suicide (especially violent suicide)
  2. arson
  3. violent crime
  4. insomnia
  5. depression
  6. alcohol abuse
  7. impulsive acts with no concern for punishment
  8. reckless driving
  9. dependence upon various substances
  10. bulimia
  11. multiple suicide attempts
  12. hostility and more contact with police
  13. exhibitionism
  14. arguments with spouses, friends and relatives
  15. obsessive compulsive behavior
  16. impaired employment due to hostility, etc.

All are exactly what patients and their families have continued to report to be their experience on these drugs since Prozac was introduced! These individuals are frantically searching for answers while this research sits right under our noses. Although this is a totally different picture than pharmaceutical marketing departments would have us believe, marketing claims and reality rarely have much in common.

Researchers tell us that five, ten or twenty years later it is not uncommon to find we have another thalidomide on our hands. Raising 5HT (serotonin) and lowering 5HIAA (serotonin metabolism) in such a high number of people can produce very serious, extensive and long term problems for all of society. Even more frightening for the future of our society is the rapidly rising and widely accepted practice of prescribing these drugs to small children and adolescents. This crucial medical research must be addressed openly, without delay, rather than remain buried in seldom read medical research documents as has been the case in the past with other mind-altering medications, once thought to be safe, which were subsequently prohibited by law.

[SOURCE: PROZAC: PANACEA OR PANDORA?, BY ANN BLAKE TRACY]

  • Adverse SSRI Reactions
  • Prozac Package Insert
  • Hyperserotonemia
  • Serotonin Syndrome

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