DEPRESSION MED: 15 Year Old Hangs Himself: Illinois

FDA ‘black-box’ warning – In 2003, the U.S. Food and Drug Administration began warning of an increased risk of suicidal thoughts among youths taking anti-depressants. In 2004, the agency required a new, more stringent label when antidepressants were prescribed to those under 18.

Between 2003-04 the youth suicide rate jumped 14 percent
– the steepest increase ever seen – while the number of antidepressant prescriptions for youths dramatically dropped during the same period: 20 percent for children 10 and under, 12 percent for 11-to-14-year-olds and 10 percent for 15-to-19-year-olds.

Paragraphs 29 & 30 read: “He stopped going to school and began attending an outpatient program, seeing a therapist and a psychiatrist and taking medication for depression and anxiety. He tried returning to school on a half-day basis, but soon became overwhelmed with makeup work and inquiries from classmates who heard rumors he had tried to kill himself. After a few days in school, Iain asked to be readmitted to the hospital, where he stayed for a week, his parents said.”

“But as summer approached, he began showing signs of improvement. He was easier to communicate with, did his chores when asked and his doctors believed they had found the right balance in his medication, his father said.”

Paragraph 32 reads: “Lain’s parents and friends say they do not know of any incidents that might have triggered what happened June 3, when his father found him in the basement. His death was ruled a suicide by hanging, according to the Cook County Medical Examiner’s Office. He did not leave a note.”

Bullied boy’s short life ends in suicide
Jul. 5, 2009 08:20 AM
Associated Press

CHICAGO – The bullying seemed inescapable.

His family and friends say it followed Iain Steele from junior high to high school
– from hallways, where one tormentor shoved him into lockers, to cyberspace, where another posted a video on Facebook making fun of his taste for heavy metal music.

“At one point, (a bully) had told (Iain) he wished he would kill himself,” said Matt Sikora, Iain’s close friend.

Iain’s parents know their son had other problems, but they believe the harassment contributed to a deepening depression that hospitalized the 15-year-old twice this year. On June 3, while his classmates were taking final exams, he went to the basement of his home and hanged himself with a belt.

His death stunned his quiet suburb west of Chicago and unleashed an outpouring of support for his parents, William and Liz, who say greater attention should be paid to bullying and its connection to mental health.

“No kid should be afraid for himself to go to school,” his father said. “It should be a safe environment where they can intellectually thrive. And he was, literally, just frightened to go to school, fearing what he would have to deal with on that day. And it was day after day.”

A school spokeswoman said she did not believe Iain was bullied. Police are investigating the allegations.

Nearly 30 percent of American children are bullied or are bullies themselves, according to the National Youth Violence Prevention Resource Center. Bullying can be physical, verbal or psychological and is repetitive, intentional and creates a perceived imbalance of power, said Dr. Joseph Wright, senior vice president at Children’s National Medical Center in Washington.

Soon, the American Academy of Pediatrics will for the first time include a section on bullying in its official policy statement on the pediatrician’s role in preventing youth violence.

Wright, a lead author of the statement, said the decision to address the issue was due to a growing body of research over the last decade linking bullying to youth violence, depression and suicidal thoughts.

Last year, the Yale School of Medicine conducted analysis of the link between childhood bullying and suicide in 37 studies from 13 countries, finding both bullies and their victims were at high risk of contemplating suicide.

In March, the parents of a 17-year-old Ohio boy who committed suicide filed a lawsuit against his school alleging their son was bullied. Instead of seeking compensation, they are asking the school to put in place an anti-bullying program and to recognize their son’s death as a “bullicide.”

Iain Steele enjoyed riding his skateboard, his father said, but after hip surgery in 8th grade limited his mobility, he picked up the guitar and impressed an instructor with his musical talent.

He was revered by younger kids in the neighborhood, often fixing their skateboards, settling their disputes and including them in games. “He was a very gentle, kind kid, compassionate to a fault,” his father said. But Iain’s embrace of heavy metal set him apart from classmates. He let his hair grow to shoulder-length and wore mostly black clothing, including jeans with chains and T-shirts of heavy metal bands with dark, sometimes morbid lyrics.

For this, his classmates at McClure Junior High School often called him “emo” – a slang term for angst-ridden followers of a style of punk music, said Sikora, 15.

The bullying could also be physical, Iain’s friends and parents said. In 8th grade at McClure, one bully pushed Iain into a locker while he was on crutches and accused him of faking an injury to get out of gym class. Iain rarely shied away from his tormentors, however, and in this case, he punched the bully in the jaw, his father said.

“He was mainly bullied only because he was different, or hurt, or stupid things like that,” said Sikora. “He never bothered anybody. … It was all just because he was different and an easy target.”

William Steele said his son had trouble ignoring the bullying because it “was just sort of relentless.” It got to the point where the father sat down with the principal at McClure and with a bully’s mother. But the harassment did not subside.

Steele said, “(Iain) had a real trust issue because he felt like, particularly at McClure, the system let him down, that it didn’t deliver on its promise to protect him from bullying.”

McClure Principal Dan Chick said in an e-mail “the District 101 community is deeply saddened by this recent tragedy of losing one of our children.” Chick said he takes bullying very seriously but declined to discuss details of Iain’s case because of privacy issues.

“As with all situations, I investigated this specific matter and took appropriate actions within the limits of my authority,” Chick said.

After graduating from McClure in 2008, Iain began attending the south campus for freshmen and sophomores at Lyons Township High School, where he found new friends – and new tormentors. A new bully emerged who at first acted friendly but then posted a homemade video on Facebook pretending to be Iain playing heavy metal on guitar.

“It was like a public humiliation to (Iain),” Sikora said.

The family of the student did not respond to requests for comment.

Jennifer Bialobok, a spokeswoman for Lyons Township High School, said “bullying is obviously not tolerated at LT,” but added, “I don’t think we’re naive enough to think that bullying behavior doesn’t exist.”

Two years ago, Lyons Township created a “speak up line” in which students can anonymously report “inappropriate or unsafe behavior,” and the school hangs posters defining bullying and explaining how to report it, Bialobok said. If any student reported being bullied, a thorough investigation would take place, with consequences ranging from parental notification to out-of-school suspension, she said.

Bialobok said she could not discuss Iain’s case because of student privacy laws, but, “we don’t believe that bullying was an issue while Iain was attending LT. Counselors and a host of other support personnel worked routinely to make his experience at LT a positive one.”

Local police have not documented incidents of bullying involving Iain but are still conducting interviews, Deputy Chief Brian Budds said.

By this winter, Iain’s mental health had begun a downward spiral, his parents said. In February, he told them he was having suicidal thoughts and asked to be admitted to the hospital.

He stopped going to school and began attending an outpatient program, seeing a therapist and a psychiatrist and taking medication for depression and anxiety. He tried returning to school on a half-day basis, but soon became overwhelmed with makeup work and inquiries from classmates who heard rumors he had tried to kill himself. After a few days in school, Iain asked to be readmitted to the hospital, where he stayed for a week, his parents said.

But as summer approached, he began showing signs of improvement. He was easier to communicate with, did his chores when asked and his doctors believed they had found the right balance in his medication, his father said.

“He seemed to be in a calm, happy place,” he said.

Iain’s parents and friends say they do not know of any incidents that might have triggered what happened June 3, when his father found him in the basement. His death was ruled a suicide by hanging, according to the Cook County Medical Examiner’s Office. He did not leave a note.

Looking back, Iain’s parents wonder what factors besides bullying may have contributed to their son’s depression.

Iain’s favorite heavy metal bands, such as Lamb of God and Children of Bodem and Bullet for My Valentine, often have lyrics with dark messages. One Bullet for My Valentine song is about being bullied, and another song contains the refrain: “The only way out is to die.”

Also, Iain was deeply hurt this spring after a brief relationship with a girl he met in his outpatient program. The two exchanged text messages, but her parents and therapists advised against them dating and about two months ago barred her from having communication with him.

Still, Iain’s parents remain convinced bullying played a significant role in their son’s depression. As Iain’s story spread through the community, many people approached Liz Steele to describe their own experiences with bullying, depression or suicide, she said.

“A lot of people don’t want to talk about mental health or bullying because it’s a difficult thing to talk about, but we need to talk about it,” she said. “It shouldn’t be a stigma.”

Meanwhile, the community has rallied behind the Steeles. In Iain’s memory, his classmates tied white ribbons around hundreds of trees in the neighborhood. On June 10, about 500 people attended a memorial service at First Congregational Church of Western Springs.

Rich Kirchherr, senior minister at the church, said the community has felt a “deep and abiding sadness” since Iain’s death. Kirchherr said few people seemed aware that Iain was bullied.

“There is an acknowledgment now, as people have discovered that Iain might not always have been treated with the respect that every person deserves,” Kirchherr said. “Many people were surprised to hear that.”

Friends have established several Facebook groups in his memory, including the “Iain Steele Remembrance Group,” which has more than 700 members. The commentary on the group’s wall was summed up by a Lyons Township High School student who said she did not know Iain but had learned an important lesson from his death.

“I’m learning to treat everyone with respect, even people who I don’t know well or people who I might not get along with,” she wrote. “If there is anything good that can come out of this tragedy, the responsibility lies with us to live with kindness and be aware that life is fragile.”

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DEPRESSION MED: Talk Radio Show Host Fired for “Wacky” Personality Change…

Paragraph two reads: “The Hammer, sacked by ESPN Radio in May partly because of a couple of wacky nights he blamed on a change in depression medication, will sit in with Big Dick the next couple of afternoons 4-6 p.m. – today, Friday, Monday and Tuesday, to be exact – on Rational Radio KMNY 1360 AM’s and see where this thing goes.”

BREAKING NEWS: Greg Williams, Take III
By Richie Whitt in Radio, TV and that Damned Media
Thursday, Jul. 2 2009 @ 7:00AM

Welcome back.

If you were surprised by Greg Williams’ cameo on with Richard Hunter yesterday afternoon, you haven’t been paying attention.

The Hammer, sacked by ESPN Radio in May partly because of a couple of wacky nights he blamed on a change in depression medication, will sit in with Big Dick the next couple of afternoons 4-6 p.m. – today, Friday, Monday and Tuesday, to be exact – on Rational Radio KMNY 1360 AM’s and see where this thing goes.

No defined role, and the gig is somewhere comfortably between a tryout and full-time. It’s the Wild Ass Circus, so who knows?

“It’s the talk radio equivalent of a jam session,” Hunter told me last night. “We wanted to do it before he went to ESPN, but he had a contractual conflict.”

I know this: Williams should be – and is – thankful to have a friend like Richard Hunter.

First, BDH invited him to be a groomsman in his wedding at this jumpin’ joint in Las Vegas. And now – you listening, Ticket boys? – when Williams needs a friend in the business Hunter is doing the opposite of turning his back on an old buddy.

I know, what a concept.

“There are two guys that I owe for my break in radio, and I will always have a place for either one of them to join me on air,” says Hunter. “Hammer’s one of them, and the other one is his former partner. I owe both those guys big time.”

No, I don’t think he’s referring to RJ Choppy.
Tags: Big Dick Hunter, Greg Williams, radio

 1,306 total views

PROZAC: Man Kills Girlfriend: Stabs her Over 200 Times: New Zealand

Second paragraph from the end reads: “She knew he could be mean and nasty when he was under stress and that he had been seeing a psychotherapist for years. She also knew he was on the antidepressant drug known as prozac.”

SRI Stories note: A second article follows and states that the girl was stabbed over 200 times.

Tutor had ‘nasty, mean side’ ex-girlfriend tells court
11:31AM Thursday Jul 02, 2009

Sophie Elliott was stabbed to death. Photo / Supplied
Living with Clayton Weatherston could be “a bit like walking on eggshells”, a former girlfriend of the 33-year-old former University economics tutor told the Christchurch High Court this morning.

The trial was later adjourned until tomorrow after a juror collapsed.It will reconvene at 10am tomorrow.

The young woman whose identity is suppressed was in a relationship with Weatherston for two to three years until 2007 when he became involved with Sophie Elliott, a 22-year-old Honours student.

Weatherston stabbed Miss Elliott to death at her Ravensbourne home on January 9 last year and is on trial for murder.

He has admitted manslaughter but denies the killing was murder. The defense says he was provoked by the pain of the tumultuous relationship with Miss Elliott and because she attacked him with a pair of scissors.

The young woman was giving evidence on the seventh day of Weatherston’s trial.

To defense counsel Judith Ablett-Kerr QC, she said she learned she had to be “quite careful” with Weatherston. If she said something that set him off he would “really go off”.

But she agreed their relationship was generally loving and kind although she found it really stressful when he came under stress “He had two sides, a loving and generous side and a nasty, mean side which he seldom showed in public,” the woman said.

During their time together, she had never challenged Weatherston nor questioned his sexual performance. And she would not have compared his sexual organs to anyone else’s although she did once “reluctantly” when he asked her directly.

She never implied he was “a retard” but Weatherston told her Sophie Elliott had called him that.

” I thought she was probably saying it in jest and I suggested that to him. I said I didn’t think it was directed to his intelligence or meant that way.

“But he took it differently, and referred to it several times,” the young woman said.

She knew he could be mean and nasty when he was under stress and that he had been seeing a psychotherapist for years. She also knew he was on the antidepressant drug known as prozac.

“You knew he was psychologically fragile?” Mrs Ablett-Kerr asked, and the witness agreed there was “an element of fragility” to his personality.

Second paragraph reads: “The university tutor is accused of killing Sophie Elliott by stabbing her more than 200 times.”

Tears flow at Weatherston trial
Published: 12:29PM Thursday July 02, 2009

Source: NZPA/ONE News

Emotions spilled over in the murder trial of Clayton Weatherston in Christchurch on Thursday as letters he wrote after his arrest were read to the court.

The university tutor is accused of killing Sophie Elliott by stabbing her more than 200 times.

A former girlfriend of the accused, who has name suppression, read a letter she sent him while he was in jail.

“This will be a rough ride, you’ll be ok,” she read.

As Weatherston’s ex-girlfriend began to cry, there were tears from Clayton Weatherston too. His lawyer had to take over reading a letter he had written back.

“I’m nervous about court on Thursday and I’m annoyed my side will not be made public,” the letter, from just days after he stabbed Elliott to death, read.

The woman, who had been Weatherston’s girlfriend for three years, said she had written to him before she knew the extent of Elliott’s injuries.

“When I found out what had gone on…I couldn’t believe it and I wouldn’t have written a letter,” she said.

She also told the defense about the night Weatherston attacked her and kicked her across a room.

“Just before he kicked me he said ‘you ungrateful bitch’.” t

She agreed he was stressed and on anti-depressants at the time.

Just after the court adjourned, one of the jurors collapsed in the jury room.

A doctor in the court’s public gallery gave the juror medical assistance before he was taken away by an ambulance.

“We will get a report from the hospital after they have been able to assess his condition,” Justice Potter said.

If he is too unwell to continue, the court will reconvene at 10am on Friday with a jury of just 11.

Here is the complete list of adverse reactions attributable to SSRI medications:

1. Insomnia

2. Vivid and violent dreams

3. Inability to detect dreams from reality (The world takes on an other-worldly aspect)

4. No emotions

5. Inability to feel guilt or cry

6. Nausea

7. Loss of appetite

8. Rash; Breathing or lung problems

9. Heart fluttering

10. Shaking – jitteriness

11. Unusual energy surges at times producing super human strength (adrenalin rushes)

12. Memory impairment

13. Hair loss

14. Blurred vision or pressure behind the eyes

15. Inability to discontinue use of drug and increasing own dose

16. Cravings for alcohol, sweets, and other substances or drinking large sums of alcohol, coffee or other caffeinated drinks, diet pop with NutraSweet, etc.

17. Headaches

18. Swelling and/or pain in joints

19. Burning or tingling in extremities

20. Muscle twitching or contractions

21. Tongue numbness and slurred speech

22. Sweating

23. Dizziness

24. Confusion

25. Chills or cold sweats

26. Muscle weakness

27. Extreme fatigue

28. Diabetes or hypoglycemia

29. Lowered immune system

30. Seizures or convulsions

31. Weight gain or weight loss

32. Mood swings

33. Altered personality

34. Symptoms of mania, ie., inability to sit still or restlessness, racing thoughts, acting silly or giddy (like a teenager again)

35. Sexual promiscuity leading to unwanted pregnancy or divorce

36. Irresponsibility, wild spending sprees, gambling, criminal behavior, shoplifting, embezzling, stealing, hostility, etc.

37. Deceitfulness

38. Blank staring

39. Inability to see any alternatives in situations

40. Hyperactivity

41. Aggressive or violent behavior

42. Wanting to ram other cars or driving irrationally

43. Impulsive behavior with no concern about consequences

44. Numbness in various body parts – legs go numb and right out from under patient

45. Sexual organs go numb making orgasm impossible

46. Pulling away from loved ones and others (isolating oneself)

47. Divorce

48. No desire to be touched

49. Paranoia

50. Falsely accusing others of abuse – family members or acquaintances

51. Loss of spirituality

52. Feeling “possessed” or that something evil is inside

53. Self destructive behavior and suicidal ideation

54. Suicide attempts

55. Muscle tremors

56. Loss of co-ordination

57. Mania

58. Psychosis


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ANTIDEPRESSANTS: Soldier’s Condition Worsens: U.S.A.

Cravings for both alcohol and cigarettes in those who never used them before are reported regularly by those taking antidepressants.

Paragraphs 14 through 18 read: “Marcus, whose name has been changed for fear of reprisal from his former military leaders, sat in a worn easy chair in his Salem studio apartment sucking on his third Marlboro in less than 20 minutes and nervously twirling an ink pen from Salem Hospital. A tall bottle of a generic prescription antidepressant sat on the end table he crafted out of leftover two-by-fours from a fencing project he worked last year. The shades were pulled and the glimmer from his lamp highlighted beads of perspiration on his forehead in the warm room.”

“’Before I left, I never smoked, not once,’ he said, as he took another long drag, letting the smoke linger in his mouth before letting it loose with a slow exhale. ‘There were a lot of things I didn’t do, ‘ he said. ‘That tour f***ed me up. When I got back, they expected me to return to life like it was before. No s***, like nothing had ever changed’.”

“Things had changed for Marcus, who said he couldn’t manage to keep his job as a welder because he would get sudden flashbacks to that one day in the Afghan village.”

“Change had also occurred for his 26-year-old wife, whom he said left him shortly after he returned, adding additional stress for the veteran to overcome.”

“’I’m the one who drove her away,’ Marcus admitted, wiping away several tears. ‘I would yell at her constantly. I hit her. I was never, never like this before I went to Afghanistan, never’.”

Soldiers return from the frontlines to face war with VA
By Sheldon Traver
from WillametteLive, Section News

Posted on Tue Jun 30, 2009 at 08:45:07 PM PDT

This year marks a milestone for the Oregon Army National Guard.

More than 3,000 soldiers have already left or are preparing for deployment to Iraq in 2009. It will be the largest deployment for the Oregon Army National Guard since World War II.

However, questions have recently been raised about the care veterans receive upon their return from war. Some Oregon weekend warriors are finding a Department of Veterans Affairs that is unwilling or unable to care for the long-term physical and mental disabilities they are now facing.

With little outside help, some have given up the fight and others continue to struggle for the benefits they say they deserve.

The Veterans Affairs office in Portland disputes these claims, saying it is doing more for veterans now than any time in the past, and points to increased services and a new processing facility in Hillsboro that has prepared the federal agency to aid all returning veterans.

Todd Marcus

In November 2006, then-23-year-old Army specialist Todd Marcus was on patrol in a small Afghan village outside of Kabul.

He carried his M-16 barrel down with his finger just inside the trigger housing. He sweltered under more than 50 pounds of combat gear, including body armor and a Kevlar helmet. Beads of perspiration trickled down to the palms of his gloved hands. Even with the fingertips cut off, the salty runoff made the cuts in his hands sting and itch.

Approximately 100 meters to his left, Marcus saw an Afghan police officer walking a few meters behind another police officer in patrol formation. The officer looked nervous as he scanned the rooftops, looking for those who might intend to kill him. Each little boy, each expectant mother could have been a suicide bomber, paid or extorted by insurgents to end their lives in a desperate bid to feed their families.

Suddenly, a bright flash of light filled Marcus’ peripheral vision, followed by a percussion of hot wind that knocked him aside. His sunglasses flew off and the smell of cordite wafted through the air with a cloud of concrete and dust. He looked toward the ground where the blast originated. The Afghan police officer that was walking just yards from him lay in a pool of blood along with two other officers. An improvised explosive device planted inside the corner of a bullet-riddled concrete home had taken their lives.

Once the carnage and chaos was over, all Marcus could do was cry.

Although it was the only combat action he saw, Marcus said he was severely wounded, not medically, but mentally. However, the same government that agreed to send hundreds of thousands to war is failing to provide veterans like Marcus with proper care upon their return.

Lack of funding, personnel, and an overtaxed veterans administrative system has left many without the care they were promised, according to a 2006 report by the General Accounting Office.

“(The) VA does not know the number of veterans it now treats for PTSD,” and more significantly, the “VA will be unable to estimate its capacity for treating additional veterans… and therefore, unable to plan for an increase in demand for these services,” it said in the report. Additionally, outdated procedures and processes have slowed ability to process veterans’ benefits significantly, said Troy Spurlock, a veteran who has dealt with the Veterans Benefits Administration for himself and others.

Marcus, whose name has been changed for fear of reprisal from his former military leaders, sat in a worn easy chair in his Salem studio apartment sucking on his third Marlboro in less than 20 minutes and nervously twirling an ink pen from Salem Hospital. A tall bottle of a generic prescription antidepressant sat on the end table he crafted out of leftover two-by-fours from a fencing project he worked last year. The shades were pulled and the glimmer from his lamp highlighted beads of perspiration on his forehead in the warm room.

“Before I left, I never smoked, not once,” he said, as he took another long drag, letting the smoke linger in his mouth before letting it loose with a slow exhale. “There were a lot of things I didn’t do,” he said. “That tour f***ed me up. When I got back, they expected me to return to life like it was before. No s***, like nothing had ever changed.”

Things had changed for Marcus, who said he couldn’t manage to keep his job as a welder because he would get sudden flashbacks to that one day in the Afghan village.

Change had also occurred for his 26-year-old wife, whom he said left him shortly after he returned, adding additional stress for the veteran to overcome.

“I’m the one who drove her away,” Marcus admitted, wiping away several tears. “I would yell at her constantly. I hit her. I was never, never like this before I went to Afghanistan, never.”

In 2008, Marcus called and made his first appointment with a Veterans Affairs specialist. It took months to get the initial appointment with the compensation and pension specialists and months more for the VBA to make a decision on his claim. His claim for benefits and treatment for post-traumatic stress disorder was denied.

“They said I was faking it,” he said. “Wel,l f*** them. If they can’t look me in the eye and see that I’m f***ed up, I don’t know what to do.”

Troy Spurlock

Spurlock, a Newberg resident and employee with the Yamhill County Sheriff’s Office knows the struggles veterans face as they attempt to get the care to which they believe they are entitled. As a military police officer and a private during the first Gulf War, he was exposed to unidentified chemicals that caused fibromyalgia.

He also has a host of other ailments, injuries and post-traumatic stress requiring ongoing care. Additionally, he was systematically harassed and threatened by soldiers in his own unit.

However, unlike Marcus, he fought the system and has seen some, though not total, success serving as his own advocate.

“As soon as I got out I started the process,” Spurlock said. “I immediately realized that it’s a typical government bureaucratic process that acts much like an insurance company does. When you do finally get to see someone, you get a quick five-minute ‘Hi, how are you, what’s your claim and thank you I’ll read your file.’ You really have to jump through hoops to substantiate your claim.

“It’s not an adequate medical exam and doesn’t even touch the complexities of issues soldiers go through,” he added.

Veterans Affairs

The Department of Veterans Affairs is divided into three unique parts: the National Cemetery Division, the Veterans Hospital Administration (VHA) and the Veterans Benefits Administration (VBA).

Portland VHA spokesman Mike McAleer works with Oregon’s returning soldiers who return from deployments overseas. He said more is being done now to help soldiers reintegrate and get the benefits they need than any time in the past.

“We send folks to where the soldiers are,” McAleer said. “We provide them with information for enrollment and try to get them into the medical system. We also try to get them information about the services we provide. We want them to be successful when they enter the civilian-warrior portion of their lives.”

There are currently more than 330,000 vets eligible for medical benefits in Oregon, although McAleer said only one-third are taking advantage of them. Oregon Guard men and women returning from active duty are entitled to full medical coverage for five years, including mental health services.

Returning veterans need to sign up, even if they aren’t ready to file a claim,” McAleer said. “They can even do it online. It will streamline the process when they are ready to file a claim.”

To file a claim, there are many hands in the process. Veterans can file medical disability claims themselves or with the help of a specialist. The claim is filed through the VBA. If accepted, a new compensation and pension processing center in Hillsboro conducts medical and psychiatric exams. More than 1,000 requests for examination from the VBA are processed at the Hillsboro facility.

“This is where we compile information and send it to the VBA for processing,” McAleer said. “I think we’re doing a good job of reaching out to veterans and want to do more to help them.”

Once exams are complete, the files return to the Veterans Benefits Administration for further processing.

“Our organization has established a strategic goal of completing a claim in 125 days,” said Lisa Pozzebon, Assistant Director of the VA Regional Office in Portland. “Currently we have an average of 146 days.”

Claims that require a highly specialized exam or ones in the appeals process take longer, she said.

Tim Wehr

Spurlock spends part of his off time trying to reach veterans and help them navigate the stormy VA paperwork waters. His MySpace web site,, has links to nonprofits working to help vets. Additionally, he has made it his mission to help his colleague, Tim Wehr of Sheridan, receive benefits he initially applied for in 1970 after returning from Vietnam with a purple heart, bronze star and many other decorations and awards.

Wehr currently receives a small amount of money as disability payments for an injury to his ear and PTSD. The Yamhill County Sheriff’s deputy said he still has flashbacks, especially when he hears a helicopter. He said he used to compulsively drop and roll any time he heard a helicopter, but recently was able to overcome this behavior.

Most of his military and medical records were lost in a 1972 fire that destroyed a federal records building and left many vets unable to prove their service and disabilities. He reapplied for benefits in the early 1980s, this time for skin conditions, which later included skin cancer related to exposure to Agent Orange, an herbicide used extensively during the Vietnam War. While his claim for PTSD and hearing problems was accepted, it was denied for his chloracne (Agent Orange-related skin condition) and a knee injury. He gave up trying – until he met Spurlock through a mutual friend.

In 2007, Spurlock was given the power of attorney for Wehr’s VA claims. Spurlock has managed to pull together many of Wehr’s old records to justify claims; however, both men feel the VBA is impeding their efforts. Several of the letters to and from the VBA regarding Wehr’s claims are available at

Veterans Service Center manager Kevin Kalama said claims for conditions related to Agent Orange exposure don’t require the same level of documentation as other service-related disabilities.

“We will presume he was exposed to Agent Orange because of where he was in Vietnam during that time,” he said. “If we can find a record that he stepped foot in Vietnam during that time period, it is presumed he had exposure.” Wehr said this has not been true with his case.

The most recent denial came when the VA claimed that Spurlock’s power of attorney privileges had ended, despite no paperwork showing a POA is appointed for a limited time.

“The VA is continuing to stonewall my claims any and every chance it gets without clear and legal justification,” Wehr said in a letter to the Veterans Affairs office in Portland dated June 15, 2009. “Meanwhile, I will be preparing to submit my entire file to Senator Wyden’s office and request a congressional investigation into this utter lack of professionalism and lack of attention to detail in this matter.”

Protecting Yourself

With the current deployments, Spurlock said troops need to take steps while in Iraq to reduce problems later.

“Keep a copy of all of your medical records,” he advised. “Any time you see a doctor for anything, you need to keep that. Don’t wait too long… and don’t be dismayed by any instant denial. That is just routine.”

Veterans should also research their own medical conditions and have the information on hand when talking to the VA.

“The biggest thing is not to give up,” Spurlock emphasized. “They will try to wear you down, but don’t let them.”

Making sure all medical records are available is crucial to avoid delays, McAleer acknowledged. Currently the VA is working with the Department of Defense for access to medical and personnel records. He said this will help veterans and the VBA to process claims more efficiently.

Although he couldn’t speak about any individual cases, he said Marcus must make every effort to go to a clinic and get screened for PTSD and any other ailments.

“We have a clinic in Salem,” he said. “We are trying to make it as easy as possible for our veterans to get the help and services they need.”

One of the biggest pieces of advice that was offered by McAleer is to file all the known claims at one time.

“The process can be really frustrating if you are doing it in bits and pieces,” he said.

He added that veterans should keep a call list of people they served with to verify claims if needed.

Despite efforts to treat returning troops, one thing is certain: many of these complexities are leading to tragic endings.

In 2008, the Army reported nearly 150 suicides within its ranks. Every military branch except the Coast Guard has seen an increase in suicide rates. However, steps are being taken to curb the rise.

Both the Joshua Omvig Suicide Prevention Act, increasing mental-health assessments, and the Wounded Warriors Act, designed to help soldiers transitioning from active-duty to veteran status, are intended to aid active duty and returning soldiers. Studies are under way at the Madigan Army Medical Center near Fort Lewis, Wash., to assist in this effort.

This is little consolation for veterans who don’t have a desire to kill themselves, but simply want care for physical and mental injuries and benefits they were promised upon enlistment.

Marcus said his experience with the VA has left him soured and he doesn’t have any immediate plans to return. He admits he occasionally daydreams about refilling his antidepressants and taking them in a one-night alcohol-induced party for one.

He said he won’t do it, because “God doesn’t accept cowards who take the easy way out.”

In the back of his mind, he believes he’ll get help one day, or simply be cured by a miracle.

“I don’t know what may change, tomorrow or next year,” he said. “F*** the VA. I don’t need ’em. One of these days I’ll get my head straight and have a family. It’ll all be good.”

 1,159 total views

Strattera Deaths (German TV Request) False Reports from Eli Lilly

Wed Nov 12, 2008

We have received a request from a German TV crew who is doing a special on Lilly’s newer ADHD medication, Stratera. These investigative reporters from Germany are doing a 45 minute piece and looking for experiences of tragedy /suicide or severe adverse reactions in children treated for ADHD with this drug. I know we have had reports, but I do not keep close track anymore of which drug is involved after so many cases because all these drugs work basically the same way. An antidepressant is an antidepressant no matter what you callmit or what you prescribe it for or how you explain its supposed uniqueness. So if you or someone you know has been through a Strattera-induced nightmareand would be willing to help get some exposure of this in the press, please get in touch with me so that I can put you in touch the reporters.

O nce you read the following article on Strattera deaths you will see how very important it is to get information about this drug out to the public –

especially throughout the UK and Europe. What is going on here IS CRIMINAL!!
And here is just one example out of the article below that is full of data on how
the government agency in the UK who oversees these drugs is ignoring
critical information – even fatalities, and doing NOTHING but making excuses
for their own behavior:

MHRA has for almost three years been in possession of data showing that
Strattera in many cases actually can cause or worsen the œcondition it is
claimed to alleviate. More than 700 reports were submitted to the manufacturer,
Eli Lilly, about Strattera inducing “œpsychomotor hyperactivity. Lilly called
this an exacerbation of the “œunderlying ADHD”. If we would apply this to
the area of real medicine and to diabetes we could say that the patient got a
diabetes medication with resulting heavy increase in blood sugar level. Such a
medication would probably be withdrawn very fast from the market. But the
MHRA has not yet, after three years, succeeded to get even a bad quality review
of these cases done not even from the manufacturer.

Do read the rest of the information because it is clearly eye opening!! This
newer ADHD drug, Strattera, which is really an SSRI antidepressant, is
getting away with murder right under everyone’s noses. So definitely if you
know someone who is willing to talk to this news crew about their experience with
this drug, please do let me know ASAP.

Thank you,

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

_atracyphd1@…_ (mailto:atracyphd1@…)


October 20, 2008
_Print this article_

Strattera adverse effects: UK Medicines Agency refuses to act
By Sepp Hasslberger

_Pharma_ (

Janne Larsson, an investigator and reporter in Sweden, has obtained
information about adverse event reports on Eli Lilly’s ADHD drug Strattera,
using the Swedish freedom of information laws. The data, coming from both the FDA’s
adverse reaction database and from reports to the UK’s Medicines agency, shows
numerous adverse effects and scores of deaths by suicide.

Yet the agency, even after repeated prodding by Larsson to initiate action,
has refused to budge or even acknowledge that there is a problem. MHRA
apparently accepts the drug’s producer Eli Lilly’s data rather than its own and
FDA’s adverse event reports.

Image credit: _Monheit Law_

Larsson says: An investigation of MHRA™s handling of the harmful effects of
the ADHD drug Strattera has proven the following:

MHRA has ignored data about instances of death among children in connection
with Strattera treatment. At least 41 children have died. The agency has not
investigated the reported cases and does not even have a compiled summary of
cases with fatal outcome. Further the agency has allowed the manufacturer Eli
Lilly to give false information about the number of fatal cases and has
taken no action against the company once the false information was revealed.

MHRA has for almost three years been in possession of data proving that
Strattera can cause agitation, mania and psychotic reactions with hallucinations
among children. Yet no warning has been issued to doctors and parents. The
agency has withheld these disastrous consequences despite clear evidence. Due
to bureaucratic procedures no warnings have been issued even if Eli Lilly reluc
tanly conceded to include these harmful reactions in its information to the
public almost a year ago.

MHRA has for almost three years been in possession of data showing that
Strattera in many cases actually can cause or worsen the œcondition it is
claimed to alleviate. More than 700 reports were submitted to the manufacturer,
Eli Lilly, about Strattera inducing œpsychomotor hyperactivity. Lilly called
this an exacerbation of the œunderlying ADHD. If we would apply this to
the area of real medicine and to diabetes we could say that the patient got a
diabetes medication with resulting heavy increase in blood sugar level. Such a
medication would probably be withdrawn very fast from the market. But the
MHRA has not yet, after three years, succeeded to get even a bad quality review
of these cases done“ not even from the manufacturer.
The background data for these conclusions can be found in the following text
and in the linked documents. When reading the data below please remember the
promise from the MHRA: we take any necessary action to protect the public
promptly if there is a problem._MHRA, About us_
( [1]

Note that the linked documents (within letters described below) in most
cases could not be obtained in UK where the issuance of them would be deemed as
prejudicing œthe ability of the Assessory body to offer impartial advice and
where the MHRA wants to allow marketing authorisation holders the chance to
respond to regulatory action and make commercial decisions before data are
in the public domain. (MHRA, e-mail about FOIA-request, 29th September,
2006). However the documents could be obtained in Sweden, even if the MHRA has
tried to stop the issuance of them by implying that publication could threaten
the relations between Sweden and UK.
Deaths among children in connection with Strattera treatment

In May I submitted detailed data about cases of Strattera death to the MHRA.
1st October I finally got an answer from the Scientific Assessor of the
Vigilance and Risk Management of Medicines (VRMM). 7th October I got an answer
from Professor Kent Woods, CEO of the MHRA, referring to the letter sent by the
Scientific Assessor.

My data about Strattera deaths can be found _in the letter_
( Strattera: Eli Lilly gave false
information about
deaths from Strattera treatment “ a request for full investigation from 15th
May. [2]
The answer from the Scientific Assessor shows that MHRA is continuing to
ignore data about instances of death among children and adults in connection
with Strattera treatment. Despite limited resources and having to rely on data
released by reluctant medical agencies I had been able to produce a summary of
reported cases of Strattera death. Thats much more than the MHRA, with its
immense resources, had been able to do.

The agency was provided with specific data about instances of death forming
an excellent starting point for a full investigation. But instead of using
the data the MHRA used its energy to explain why it is impossible to
investigate these cases further, and in doing so presents some remarkable

The Scientific Assessor states _in the letter 1st October_
( [3]:

in order to calculate the total number of reports with a fatal outcome
it is not simply a case of adding up reports with a fatal outcome mentioned
in our assessment reports of the PSURs [Periodic Safety Update Reports] and
those available on the FDA website as these different sources may contain
duplicate information. [Emphasis added.]

I fully agree and it takes only a casual reading of my letter from 15th May
to find out that much care has been taken to exclude possible duplicates. It
is quite easy to see that the data presented about fatal cases in my letter
is NOT simply a case of adding up reports with a fatal outcome. The only
way to come to another conclusion would be not to look in the first place and
it is a condemnation of the effectiveness of the agency to state the following
in the letter:

We have looked at the data you have sent us to see if they can add insight
to the statutory sources of data we have received and do not think that they
are of benefit as we cannot verify their source or accuracy. (p. 3)
[Emphasis added.]

I must add to all the data provided in my letter 15th May that the our

of the information about fatal cases is FDA™s Medwatch system and the PSURs
(submitted directly to the MHRA). I must make it clear that is very easy for
a lay person to find out that almost all reports about fatal outcome from
Strattera treatment submitted to the FDA came from Eli Lilly!

Thus the our of the information about fatal cases was in most of the
cases the manufacturer itself“ Eli Lilly. And yet the MHRA has not been able
to verify the source or accuracy of the information. The MHRA Scientific
Assessor states in the letter:The sources of data that regulators use such
as company data, spontaneous adverse reaction reports and literature are set
out in European and national law.
My FOIA request earlier this year to get a compilation of fatal cases in
connection with Strattera treatment was answered 12th August:

Thats very good and now we know that the data I submitted to the MHRA about
all fatal cases from Strattera treatment “ in the absolute majority of cases
were known by and reported via the manufacturer Eli Lilly.
The MHRA holds no data other than that previously released to you [the
misleading data from Eli Lilly in November 2007, see my letter from 15th May
more data] which was the data provided by the company. If you have any
questions about FDA data or the data provided by the company, you should
contact those organisations.

In other words the MHRA didn’t have a compiled summary of cases with fatal
outcome in August and the agency has not to this point been able to compile
such a summary.

As the agency has not been capable of getting the data or not even been
capable of using the specific data submitted for its use in a full
investigation NO action is taken despite the many verified deaths among
children in connection with Strattera treatment. This disregard for the safety of children is a scandal which should lead to a full formal investigation by the
Department of Health.

Drug induced agitation, mania and psychosis with hallucinations

Ive been contacted by parents asking if Strattera can induce mania and
psychosis with hallucinations. Their children have had such symptoms. The
parents have not found any warnings about it and their childrens doctors don’t
think that the symptoms are caused by the drug. The parents were desperate.

However the MHRA has known for almost three years that Strattera can cause
agitation, mania and psychotic reactions with hallucinations among children,
but has refused to issue warnings about it.

The Scientific Assessor from the MHRA _in the letter of 1st October_
( [3] now confirms my
earlier arguments that the agency had knowledge about these effects a long time ago:

following an initial request in the assessment report for the Periodic
Safety Update for the period (dates 27-05-2005 to 26-11-2005) we asked Eli
Lilly for more information to enable us to review this issue in more detail. (p. 2)

This means that in the period ending 26th November, 2005 at the time when
Strattera was approved only in UK and four other European countries, but not
in the 22 additional European countries where it is now approved Eli Lilly
and the MHRA had knowledge about these disastrous effects in children taking
Strattera. But neither the MHRA nor Eli Lilly told anything about it and
Strattera was approved in 20 additional European countries in April 2006.
Image credit: _Wikimedia Commons_

Professor Kent Woods, CEO of the MHRA seems to be very misinformed by his
staff when answering about Strattera in a recent _letter of 7th October, 2008_
( . In the letter Professor Woods
states [4]:

The MHRA is committed to ensuring that all safety concerns are subject to
robust scientific assessment and the best possible regulatory action is taken
in a timely manner. We strive to maintain the highest standards of work and
review our practices to ensure these standards are maintained or improved
upon where necessary. (p. 1)

In their 3rd March, 2006 report Psychiatric Adverse Events Associated with
Drug Treatment of ADHD: Review of Postmarketing Safety Data [5], the FDA
stated that there was compelling evidence for a likely causal association
between [Strattera/amphetamine drugs] and treatment emergent onset of signs and/or
symptoms of psychosis or mania, notably hallucinations, in some patients.

(p. 17) 360 reports about the drug inducing these effects had been received
up to June 2005.

From this FDA report the MHRA had knowledge about the œcompelling evidence for Strattera causing these effects on or about 3rd March, 2006 but did nothing.

In August the same year (2006) the MHRA requested the same data set from Eli
Lilly that was submitted to the FDA and which formed the basis of the FDA
report for Strattera. The data was sent to the MHRA some days later. But the
agency then decided not to do anything with the information. Instead it was
decided that Eli Lilly the manufacturer should do an analysis of the data
and submit its conclusions to the agency.

Professor Kent Woods says in his letter: An important aspect to this [ robust scientific assessment, highest standards] is ensuring that data from all available sources have been consider This may be true in some other area but it is definitely not true for the
safety work around Strattera. A very good example of this is the complete
rejection of the robust scientific assessment of Strattera in the FDA report.
Answering the question why the agency did not use the compelling evidence for harm in the FDA report _an official at the MHRA declared in a letter_
( [6]:

Changes to European product information are based on assessment by EU
regulators, agreement between member states and in line with legal requirements
about product information, not on conclusions of FDA assessors. (25th May,
2007) [Emphasis added.]

Responsible officials at the MHRA had instead decided to rely completely on
the analysis of the manufacturer of the drug Eli Lilly. (In an article in
the Daily Mail this summer, Andrew Herxheimer, editor of the Drug and
Therapeutics Bulletin, and emeritus fellow of the Cochrane Centre commented:
Asking a drug company to review its own product is crazy, but it goes on quite a lot.
) [7]

At the end of 2007/beginning 2008 Eli Lilly submitted its review of
Strattera induced agitation, mania and psychosis with hallucinations to the
MHRA. It was a complete whitewash.

In summary: FDA was very clear about the psychosis-inducing effects of
Strattera; the MHRA did not listen. Instead the MHRA turned to the
manufacturer. Eli Lilly tried to explain away all the bad results found in its review. For
the full history about MHRA’s failure in this area and for a comparison of
the FDA report with the Lilly report, please see the following letter: _The
ADHD drug Strattera“ actions needed now_
( [8] from January 2008, and
the letter _The ADHD drug Strattera“
an analysis of reports of drug induced mania, psychosis and hallucinations_
( [9] from March 2008.

In the letter from March [9] Eli Lilly’s whitewash report for the period up
to November 2007 is presented. At the end of that report Lilly says [10]:

Nevertheless, Lilly will consider adding language regarding psychotic symptoms
including hallucinations to its product information sheet. (p. 1279)

Larsson – _Suicides & Psychiatric Drugs_

And so we come to October 2008 and the letters from Professor Kent Woods and
from the Scientific Assessor for Strattera. We are reassured that the MHRA
is acting to ensure that Strattera is used as safely as possible that

all safety concerns are subject to robust scientific assessment and the best
possible regulatory action, that any new safety signals are evaluated in
an independent, scientifically robust manner (Woods); we are told that

discussions between European Member States and Eli Lilly are ongoing to agree
on the most appropriate information to be included in the product information
for patients and prescribers; we are told to be patient, to understand that
it takes time from the point where œupdates have been agreed for inclusion in
the product information to the point where these will appear in the packs
in the market place due to movement of stock in the supply chain, and that
the appearances are estimated to be within the next 6 months (Scientific

It is probably hard to find a more obvious violation of the promise¦ we
take any necessary action to protect the public promptly if there is a
problem than the case described above. The worried parents still have no answers if
Strattera can induce the symptoms they find in their children. And the MHRA
knew about it three years ago but withheld the data. This should be
included in the investigation of the agency by the Department of Health.

Strattera causing hyperactivity“ the condition it was supposed to alleviate In my earlier letter to the Department of Health (29th August) I took up the data about the 700 forgotten cases of hyperactivity. I referred to my _letter 2nd January to the MHRA_
( [8] and gave data about the
fact that Eli Lilly had withheld sensitive information and classified harmful effects as an exacerbation of the underlying ADHD.

The logical solution would have been for the MHRA to request all data about
this security risk, followed by an independent review of the data. But this
was not done and as expected nothing is still done. MHRA asked Lilly for an
explanation about this signal stemming from Periodic Safety Update Report
5 (dates 27-05-2005 to 26-11-2005) but got no answer. Three years later the
Scientific Assessor from the MHRA writes in the letter from 1st October:

The information submitted by the MAH [Market Authorization Holder] has been
evaluated and the MAH will be requested to provide further detailed
information within the next 2 months to ensure the issue has been investigated
in a thorough and scientific manner. (p. 2) [3]

The MHRA got this safety signal almost three years ago and is still in
the process of getting some sensible answers from Eli Lilly.


I again request the Department of Health to take action. This does not
concern only the children in UK; it concerns the children in the whole of
Europe, indeed it concerns all the children of the world.

The failure of the agency will also mean that psychiatrists within The
Guideline Development Group in NICE can push through more treatment with
Strattera and other ADHD drugs. The MHRA is withholding the clear evidence for
harmful effects and the psychiatrists with close relations to the manufacturers
of the drugs can unimpeded recommend these medicines to unsuspecting
doctors and parents.

The answers given by Professor Kent Woods and the Scientific Assessor did
not in any way handle my concerns. On the contrary, they finally proved that a
full formal investigation of the matters raised above is needed.

Yours sincerely,

Janne Larsson

Reporter – investigating psychiatry
_janne.olov.larsson@…_ (mailto:janne.olov.larsson@…)

[1] MHRA, About us, _ (
[2] Larsson, Strattera: Eli Lilly gave false information about deaths from
Strattera treatment“ a request for full investigation, May 15, 2008,
_ (
[3] MHRA, Re: letter of 9th September 2008 to “Assessor responsible for
Strattera, October 1, 2008,
[4] MHRA, Re: Open letter to Pr. Kent Woods (10th August 2008), October 7,
[5] FDA, Psychiatric Adverse Events Associated with Drug Treatment of ADHD:
Review of Postmarketing Safety Data, released March 3, 2006.
[6] MHRA, answer FOI request, May 25, 2007,
_ (
[7] Daily Mail, Heart attacks and suicides… yet the dangers were all kept
so quiet. So how CAN you trust your medicine? July 7, 2008,
[8] Larsson, The ADHD drug Strattera – actions needed now, January 2, 2008,
[9] Larsson, The ADHD drug Strattera – an analysis of reports of drug
induced mania, psychosis and hallucinations, March 9, 2008,
[10] Eli Lilly, Cumulative review of Spontaneous Case Reports of Mania,
Psychotic Disorders, Hallucinations, and Agitation, Appendix 16 to Periodic
Safety Report 9 for Strattera, 2008,

See also:

_Doctors told to curb use of Ritalin in hyperactive children_
_Children’s suicide attempts raise concerns about ADHD medication_

_The ADHD drug Strattera: Lilly to issue warnings about psychosis,
hallucinations, mania and agitation_ (
_Strattera side effects_ (

_Strattera – 10,988 adverse “psychiatric reactions” reported in less than
three years_ (
_Attention Deficit Hyperactivity Disorder? No, they’re just naughty, say

 1,712 total views

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

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

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

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

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

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

adverse event report1.pdf

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

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

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

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

_atracyphd1@…_ (mailto:atracyphd1@…)


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

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

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

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

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

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

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

( number,
NCT00052078 _[]_
) .)

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


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

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

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


Study Design and Implementation

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

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

Study Subjects

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On the basis of logistic-regression analyses, pairwise comparisons indicated that subjects in the cognitive-behavioral-therapy group were significantly less likely to withdraw from treatment than were those in the sertraline group (odds ratio, 0.33; 95% confidence interval [CI], 0.13 to 0.87; P=0.03) or the placebo
group (odds ratio, 0.24; 95% CI; 0.09 to 0.67; P=0.006). Of the 488 subjects who underwent randomization, 459 (94.1%) completed at least one postbaseline assessment, 396 (81.1%) completed all four assessments, and 440 (90.2%) completed the assessment at week 12. Subjects were recruited primarily through advertisements (52.2%) or clinical referrals (44.1%).
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Figure 1. Enrollment and Outcomes.

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

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

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

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

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

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Table 1. Baseline Characteristics of the Subjects and Recruitment According
to Study Center.

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Table 2. Key Outcomes at 12 Weeks.

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

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

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

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

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

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

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

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

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

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

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

available with the full text of this article at

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This article (10.1056/NEJMoa0804633) was published at on
October 30, 2008. It will appear in the December 25 issue of the Journal.
Address reprint requests to Dr. Walkup at the Division of Child and
Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.
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32. Kiesler DJ. Some myths of psychotherapy research and the search for
a paradigm. Psychol Bull 1966;65:110-136. _[CrossRef]_
) _[ISI]_
The following investigators participated in this study: Steering Committee:
J. Walkup (chair), A. Albano (cochair); Statistics–Experimental Design: S.
Compton, S. Iyengar, J. March; Cognitive Behavioral Therapy: P. Kendall, G.
Ginsburg; Pharmacotherapy: M. Rynn, J. McCracken; Assessment: J. Piacentini,
A. Albano; Study Coordinators: C. Keeton, H. Koo, S. Aschenbrand, L. Bardsley,
R. Beidas, J. Catena, K. Dever, K. Drake, R. Dublin, E. Fontaine, J. Furr, A.
Gonzalez, K. Hedtke, L. Hunt, M. Keller, J. Kingery, A. Krain, K. Miller, J.
Podell, P. Rentas, M. Rozenmann, C. Suveg, C. Weiner, M. Wilson, T. Zoulas;
Data Center: M. Fletcher, K. Sullivan; Cognitive Behavior Therapists: E.
Gosch, C. Alfano, A. Angelosante, S. Aschenbrand, A. Barmish, L. Bergman, S.
Best, J. Comer, S. Compton, W. Copeland, M. Cwik, M. Desari, K. Drake, E.
Fontaine, J. Furr, P. Gammon, C. Gaze, R. Grover, H. Harmon, A. Hughes, K.
Hutchinson, J. Jones, C. Keeton, H. Kepley, J. Kingery, A. Krain, A. Langley,
J. Lee, J. Levitt, J. Manetti-Cusa, E. Martin, C. Mauro, K. McKnight, T. Peris, K.
Poling, L. Preuss, A. Puliafico, J. Robin, T. Roblek, J. Samson, M.
Schlossberg, M. Sweeney, C. Suveg, O. Velting, T. Verduin; Pharmacotherapists:
M. Rynn, J. McCracken, A. Adegbola, P. Ambrosini, D. Axelson, S. Barnett, A. Baskina,
B. Birmaher, C. Cagande, A. Chrisman, B. Chung, H. Courvoisie, B. Dave, A.
Desai, K. Dever, M. Gazzola, E. Harris, G. Hirsh, V. Howells, L. Hsu, I.
Hypolite, F. Kampmeier, S. Khalid-Khan, B. Kim, D. Kondo, L. Kotler, M.
Krushelnycky, J. Larson, J. Lee, P. Lee, C. Lopez, L. Maayan, J. McCracken, R.
Means,L. Miller, A. Parr, C. Pataki, C. Peterson, P. Pilania, R. Pizarro, H. Ravi,
S. Reinblatt, M. Riddle, M. Rodowski, D. Sakolsky, A. Scharko, R. Suddath, C.
Suarez, J. Walkup, B. Waslick; Independent Evaluators: A. Albano, G.
Ginsburg, B. Asche, A. Barmish, M. Beaudry, S. Chang, M. Choudhury, B. Chu, S.
Crawley, J. Curry, G. Danner, N. Deily, R. Dingfelder, D. Fitzgerald, P.
Gammon, S. Hofflich, E. Kastelic, J. Keener, T. Lipani, K. Lukin, M. Masarik, T.
Peris, T. Piacentini, S. Pimentel, A. Puliafico, T. Roblek, M. Schlossberg, E.
Sood, S. Tiwari, J. Trachtenberg, P. van de Velde; Pharmacy: K. Truelove, H.
Kim; Research Assistants: S. Allard, S. Avny, D. Beckmann, C. Brice, B.
Buzzella, E. Capelli, A. Chiu, M. Coles, J. Freeman, M. Gringle, S. Hefton, D.
Hood, M. Jacoby, J. King, A. Kolos, B. Lourea-Wadell, L. Lu, J. Lusky, R. Maid, C.
Merolli, Y. Ojo, A. Pearlman, J. Regan, S. Rock, M. Rooney, N. Simone, S.
Tiwari, S. Yeager.

**************Plan your next getaway with AOL Travel. Check out Today’s Hot
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 1,670 total views

Adult on Autistic Specrum destroyed by psychiatric medications. Paxil

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Things got still much worse. This was Hell!

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

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

In October 1999 I flushed everything and started the recovery.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Legal opinions I have sought are dismal.

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

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

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

Peter Christensen

July 9, 2004

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dixarit 0.025 mg – Feb 2/99 No recall.

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

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

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

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

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

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

This marked my total refusal of psychiatric medications.

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

Peter Christensen

 1,532 total views

Prozac Made Me Want to Kill Myself

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

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

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

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

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

Hayley Adams

 1,410 total views

Prozac and Alcohol

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

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

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

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

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


 1,378 total views

Student's Life Destroyed on Prozac

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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