Leonie's Blog

This week we heard of another citalopram inquest, that of 50-year-old Carol Andrews, a former RAF steward who had ‘it all to live for’. Carol died after consuming a lethal dose of citalopram (an SSRI antidepressant) and felodipin (used to treat high blood pressure).

At the inquest, Carol’s sister Sheila said her behaviour was noticeably different in the weeks before her death – which she attributed to her new doctor doubling her citalopram dosage. She said that ‘everything was going well for Carol after a long period of difficulty’ and that the increase in dosage was the only possible reason she could think of [for her death]. The coroner recorded Carol’s death as ‘misadventure’. While raising her concerns, Sheila said ‘I can only hope this can prevent the same mistake and hopefully no one else will have to suffer as my family have by losing Carol’.

So, will Sheila’s warning on the dangers of citalopram make a difference? Sadly, there were numerous others before her, including me and the assistant state pathologist. Indeed, Dr David Healy has spent many years warning consumers of the dangers of antidepressants, particularly SSRIs. For decades, SSRIs, including Citalopram (marketed as Cipramil and Celexa) have caused grave concern, not least as they have been shown to significantly increase the risk of suicide. While the black-box warning that accompany all SSRIs prescribed in the U.S. goes some way to warn American consumers, we in other countries are not similarly forewarned. The exception to this rule are often survivors (with the anger and/or energy to protest), such as Katinka Blackford Newman, Bobby Fiddaman and Truthman – and then there are the bereaved parents, albeit, too late for their own child. For example, following the SSRI-induced death of her 14-year-old son (Jake), Stephanie McGill Lynch has campaigned for a similar warning to be provided to Irish consumers, (as yet, to no avail). Similarly, AntiDepAware is a fine example of triumph over adversity, showing how a broken heart can result in amazing things – undoubtedly, saving others from a similar fate.

Thus, while Carol’s sister has been admirably vocal raising her concerns, sadly, she is just another in a long list of worried relatives trying to raise awareness with this particular drug. Indeed, in 2015, at the inquest of a 64-year-old prominent scientist Margaret Tisdale, Margaret’s sister Linda raised her concerns about the citalopram she had been prescribed. She said: “I felt that she wasn’t depressed, but was instead very anxious and stressed. I was concerned about the Citalopram she was prescribed, when I looked up the side effects. I don’t think she knew how serious the side effects could be.

Yet, in 2010 (a few years before Carol or Margaret’s deaths), a different coroner called for an urgent inquiry into citalopram following the death of Yvonne Woodley, aged 42. Surprisingly, at Yvonne’s inquest, Dr Christopher Muldoon, representing the drug company Lundbeck, said: ‘The drug is safely used by millions of people but it could cause someone to take their life who had not previously thought of doing so. Yvonne’s mother told the hearing she saw her daughter turn into a ‘zombie’ after taking the drug. She said: ‘The change in my daughter was remarkable. She was a stable, happy, calm person but in three weeks the decline was rapid to a woman who was trembling, had panic attacks and wouldn’t make eye contact. She was like a zombie. The eyes were blank and flat and there was no emotional response. Yvonne displayed every single side-effect of the drug.’

In 2008, Ian Fox, a postal-worker aged 65, died after throwing himself in front of a train. He had been prescribed citalopram the previous month and had expressed a wish to come off it, complaining of confusion and anxiety. Speaking at his inquest, Ian’s wife Maria blamed her husband’s death on the drug – the coroner subsequently ruled the adverse effects of Citalopram had played a part in his death.

Fifteen years before Carol’s death (2003), another inquest heard that Stephen Leggett, a 53-year-old teacher, set himself on fire just 5 days after being prescribed citalopram. Convinced the drug was to blame, Stephen’s wife said “People ask me why he did it and say, ‘well, you’ll never know’. I do know – I believe he was completely out of his mind because of this drug”.

So, will Carol’s death make a difference this time? We can certainly live in hope.

Ireland has seen far too many murder-suicides for such a small country – with much discussion and no easy answers.  The usual knee-jerk reaction of ‘evil bas**rd’ hasn’t helped to solve these cases or indeed, stop any future cases of familial annihilation. Psychiatry will often blame the ‘underlying mental illness’ of the perpetrator, whether or not there was any evidence pointing to historical psychiatric issues. Suggestions that a prescribed drug or drugs may have played a part are shut down with scorn, despite effects such as suicide, violence and emotional blunting listed in the PILs (Patient Information Leaflets). Indeed, ever since SSRI antidepressants (Selective Serotonin Re-Uptake Inhibitors) were introduced to the masses, murder-suicide cases thought to be drug-induced have consistently surfaced, leaving a global trail of ssri-induced destruction that has lingered for decades – see SSRI-Stories.

From the 1993 case of William Forsyth Sr., who killed his wife and himself 2 weeks after being prescribed fluoxetine (aka Prozac), to Donald Schell, a 60 year-old granddadd who took 2 paroxetine pills (aka Seroxat and Paxil) before fatally shooting his wife, daughter, 9-month-old granddaughter and himself (1998). In the Schell case, paroxetine was found to be 80% responsible and GlaxoSmithKline ordered to pay $6.4m to the family’s surviving relatives – yet still people find it hard to accept that a drug prescribed by a friendly GP could cause such harm.

Nevertheless, similarities include a recent antidepressant prescription (or dosage change), with ‘out of the blue’, ‘out of character’, ‘restlessness’ and ’emotional blunting’ among other common threads. Friends might express their shock and attest to a ‘down to earth’, ‘cheerful and chatty’, ‘all round good guy (or woman)’ or ‘respected member of the community’ whose actions ‘were completely out of character’.

Tragically, the latest case in Margaret River, Australia, seems to fit an SSRI-induced profile.  Yesterday, Perth’s version of the Sunday Times published an article titled Margaret River massacre: Depression drug clue to grandfather’s murder of family. Like Donald Schell, Peter Miles, a 61 year-old granddad, had recently started taking an antidepressant(s) – mere weeks before he fatally shot his wife, daughter and four grandchildren. According to the article, close friends of this highly regarded granddad now suspect that the drug he was prescribed may have triggered or worsened ‘homicidal and suicidal thoughts’. One friend said:

Cynda told us Peter had gone onto antidepressants in the last few weeks. I feel for the sake of society that these mind-altering drugs should be exposed as dangerous.

The article also pointed out that while friends of Mr Miles stressed they did not know which type of antidepressant he had been prescribed, they have ‘genuine fears’ it may have been an SSRI – pointing to claims that in rare cases they can contribute to extreme violence, murder and suicide. The article concluded with the following:

For Ms Winfield, the SSRI theory, while not proven, is the most plausible. “Nothing else explains it,” she said. “This was a lovely man whose family was everything to him. I don’t know when the depression set in, but I’m really sad it hit him so hard and I’m sure the medication was a part of it.”

So, before a drug-induced annihilation is dismissed out of hand, be informed, before, BEFORE, BEFORE it happens to someone you love. As many of us will attest to, dead is irreversibly dead and no amount of blame or vindication will bring our loved ones back. One point that is never fully addressed – while medics invariably blame an underlying, undiagnosed, mental-illness – why do so many families insist otherwise and not use this relatively ‘get out of jail free’ card?

For expert information in prescribed drugs, see Professors David Healy and Peter Gøtzsche, and RxISK.org.

Roll up! Roll up! The ‘latest’ antidepressant research is out – ‘Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis’. The revelations by Cipriani et al are indeed startling. The drugs known as ‘antidepressants’ are actually supposed to work. Imagine that? Drugs that have been around for many decades and prescribed in their millions (mostly blockbusters), are thought to work – despite decades of controversy, black box warnings and many, many deaths.

As you might expect, the headlines were indeed wondrous. An Irish Times article provides the headline ‘Antidepressants work for treating depression, study finds’. While the article didn’t provide an author, a tweet by a Times Journalist shared the article, along with the message ‘I take anti-depressants and yes, they work. No shame in saying my brain doesn’t just make enough serotonin’. Jeez – back to the whole feckin serotonin fairytale again. Ireland really needs a medical journalist that can interpret the actual science – move along dears, no Robert Whitaker here..

According to the BBC, The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”. Not surprisingly, the Irish College of Psychiatry also got in on the act, stating this ‘Important research which will also hopefully reduce the stigma around the important place antidepressants can have in the treatment of debilitating depression and reducing misery caused by it to circa 350 million people globally’. No doubt they have evidence for this massive cohort of serotonin-deficient depressives? Or better still, evidence that the drugs they have dished out so liberally over many decades actually work? Clearly, no amount of stigma or controversy should get in the way of prescribing – not even images of our dead loved ones. Sure, aren’t we far too sensitive altogether?

Parking the sarcasm, there were a few chinks of light in the media. I particularly liked a piece by Peter Hitchins from the Mail On Sunday, who wrote –

“We were told last week that researchers had ‘the final answer to the long-lasting controversy about whether antidepressants work for major depression’. I very much doubt it. Not only did the study (of old research, much of it paid for by the drug companies themselves) show very limited success for these pills. We are only just beginning to scrape the surface of what I suspect may be one of the biggest drug scandals of all time. If anyone insists to you that all is well, ask them this: have they had access to the drug companies’ own full testing records?”

Indeed, according to Irish scientist, Dr David Healy – “The Cipriani paper discussed today is junk. It is based on ghostwritten papers with no access to the data. No one – not MHRA or FDA have had access – none of the notional authors of these papers have had access – none can let an independent expert see what the data shows.”

Peter Gøtzsche, co-founder of the Cochrane Collaboration was equally clear. He stated –

“This huge systematic review (Cipriani et al 2018) does not add anything to the knowledge we already had about depression pills. Briefly, the effects as estimated on the Hamilton scale are very similar to those reported in a another huge meta-analysis in early 2017 (Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis… We have done such an analysis based on clinical study reports of placebo-controlled trials we have obtained from European drug regulators (submitted for publication). I will not reveal the details before our results have been published, but our results are very different from those shown in the Lancet paper. The use of clinical study reports is crucial. The manufactures had excluded patients from their analyses, which we were able to include. This is generally not possible for the type of systematic review done by Cipriani et al. So, these results are also flawed and should not be trusted.”

Is it possible that the current debate on whether these drugs actually work or not (however idiotic that may seem considering the enormous number of prescriptions), is being done intentionally to take the spotlight off the emerging issue of antidepressant addiction? Despite vast evidence to the contrary, it seems medics are still largely blind to antidepressant addiction. Nevertheless, a report by the World Health Organisation listed three SSRI antidepressants among the highest-ranking drugs for which drug dependence had ever been reported (fluoxetine, paroxetine and sertraline). Notably, the WHO report found that using differing terminology, such as replacing ‘withdrawal-syndrome’ with ‘discontinuation-syndrome’, caused conceptual confusion. The report specifically stated that this was intentionally done to avoid associating SSRIs with dependence.

This Cipriani study, despite adding nothing new to science, may effectively be just another distracting hand at work. Nothing that scientists like Professors Healy and Gøtzsche can’t dismiss with relative ease, I’d imagine. Although, whether that will be reflected in the headlines, is anyone’s guess. As balanced as our chemically imbalanced minds?

A report published this month by ScotSID (Scottish Suicide Information Database) makes for very interesting reading. It specifically looked at deaths by suicide in Scotland between 2009-2015, the deceaseds’ contact with mental health services and more importantly, the psychiatric drugs that were prescribed to them beforehand. Interestingly, I remember (after Shane’s death) trying to find similar information in Ireland, only to be told ah sure, we couldn’t ask families such personal information. It just wouldn’t be right – and sure if the drugs were dangerous, no-one would prescribe them. You think? I’ll park the aul sarcasm there for now. However, contrary to the idea that psychiatric drugs are always safe, an article published this week in an Irish Newspaper told the story of 14-year-old Jake McGill Lynch who died following a prescription for fluoxetine (branded as Prozac). You can read the full story courtesy of the AntiDepAwares here. More information on the bold Stephanie (US and Irish interpretation of bold will suffice here) can be found in my previous blog.

It is important to note that in 2012, in a meeting with Kathleen Lynch (the then Minister for Mental Health), the serious dangers of psychiatric drugs were brought to the Irish Government’s attention. Notably, this was two years after Shane’s death and a full year before Jake McGill Lynch died. At the meeting, retired assistant state pathologist Dr Declan Gilsenan specifically asked for an investigation into all suicide verdicts to see what medications people were prescribed at the time of their deaths. He was concerned that SSRIs could be causing suicides – tragically for Jake, nothing was done.

Anyway, back to the Scottish report. The report notes that while psychiatric drugs are principally used to treat mental health conditions, they are also used for a number of other conditions – such as antidepressants for migraine, chronic pain, etc. It found that, prior to the deaths by suicide, the most common form of recorded contact with the health services was a prescription for a ‘mental health drug’ – 59% of those who died by suicide had been prescribed a psychiatric drug within the previous year, of which the majority (82%) was for an antidepressant. That is a truly scary statistic and one which disproves the widely held belief that ‘antidepressants save lives’. Indeed, it is argued that the opposite is true, that these drugs are causing far more harm than good and in fact, killing many unsuspecting consumers. Thus, the most recent study by Jakobsen et al concluded –

‘SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.

While we could learn a lot from this new report, the findings are not unique. In fact, a decade beforehand, a report by Swedish journalist Janne Larsson found that of the 1126 Swedish people who had died by suicide in 2007, 64% had been prescribed a psychiatric drug(s) within the previous year. Clearly, Dr Gilsenan’s request for an Irish investigation is long overdue.

Occasionally, the dead can indeed speak.

The Scottish report can be viewed here.

It always surprises me that while most medics admit that all drugs can have serious adverse effects, when there is an actual victim, consumption of the drug is often supposedly viewed as coincidental. Although antidepressant Patient Information Leaflets and drug regulatory warnings stress of an increased risk of suicidality and aggression when taking these drugs, the continuous victim-denial by the drug industry and leading Key Opinion Leaders (KOPs) is disheartening to say the least.

It seems there is another growing furore surrounding antidepressants; this time its their addictive nature, with consumers’ experiencing withdrawal effects at odds with medical professionals who continuously express that antidepressants do not cause addiction. An article today in the Limerick Leader expressed concerns on the high rate of antidepressant users. It quoted Irish TD (member of Parliament), Maurice Quinlivan, as saying: “People working locally here on drug awareness groups in Limerick tell me that it can be much harder to get young people off of these prescription drugs than heroin as it can be that addictive.” Similarly, on Sky News yesterday, Danny Lee-Frost, head of enforcement at the MHRA (U.K. drug regulator), clarified antidepressant-addiction in no uncertain terms, stating:

“The sleeping pills and antidepressants are a lot more dangerous – They are a lot more addictive, in fact they are highly addictive – That’s the reason why they are prescription only. That changes the game completely – People have committed [sic] suicide as the ultimate resort to try and get off as these are fiercely addictive once you start taking them.”  

Indeed, that the ‘newer’ antidepressants (SSRIs) can be highly addictive has been known for many years and per Peter C. Gøtzsche (Cochrane scientist):

“They surely are [addictive] and it is no wonder because they are chemically related to and act like amphetamine. Happy pills are a kind of narcotic on prescription. The worst argument I have heard about the pills not causing dependency is that patients do not require higher doses. Shall we then also believe that cigarettes are not addictive? The vast majority of smokers consume the same number of cigarettes for years.”

15 years ago Dr David Healy spoke of paroxetine withdrawal. He said:

“it was clear from early on that the company [GSK] had recognised that people who had been on this drug even for a relatively brief periods of time could go through withdrawal when they halt it. And they ran healthy volunteer trials to look at this further and found that in some instances up to 85% of the volunteers who had been on this drug for only two or three weeks had withdrawal problems when they halted.”

However, despite experts such as Gøtzsche, Healy and Lee-Frost leaving us in little doubt that antidepressants can indeed be addictive, there seems to be little consensus among medical professionals. Indeed, in Ireland medics have continuously denied that SSRI antidepressants are in any way addictive, with one Irish GP proclaiming on radio – “the drugs themselves are not dangerous, they’re not addictive, they’re not even dangerous at high levels of overdose”. (Notably, not only are SSRI antidepressants addictive, they can also be fatal in overdose; but that’s another story.) Likewise, speaking at a meeting hosted by the drug company Lundbeck, Professor Casey from the Irish College of Psychiatry, said “The outcome for those who get treatment is very good. It is also important to be aware too that antidepressants are not addictive”. 

How can it be that addiction-denial is still commonplace when MHRA, Cochrane and psycho-pharmacological experts are expressing the opposite? And why? Adverse effect denial raises issues of consent and autonomy, neither of which are fulfilled if a consumer doesn’t know what he or she is consenting to. Indeed, rather than antidepressants being innocuously-sounding ‘happy pills’, per McHenry, 2006, attempts to reduce or discontinue SSRIs can cause ‘severe adverse events, such as jolting electric zaps (paraesthesia); confusion; headaches; vomiting; dizziness; nausea; worsening depression; insomnia; irritability; emotional lability, including suicidality, and agitation that, when severe, can resemble a manic episode’. All that, without even delving into the issue that most consumers will have antidepressant-induced sexual problems, ranging from vaginal-dryness to male-impotence.

Part of the problem stems from the word ‘addiction’, which medics seem to have an aversion to, especially when it relates to drugs they widely-prescribe. According to a 2003 WHO report on drug dependence, 3 SSRIs are ‘among the 30 highest-ranking drugs in the list of drugs for which drug dependence has ever been reported’ (to their drug-monitoring database). They are fluoxetine (Prozac), paroxetine (Seroxat/Paxil) and sertraline (Zoloft/Lustral). The report found that researchers used differing terminology to avoid associating SSRIs with dependence, such as replacing ‘withdrawal-syndrome’ with ‘discontinuation-syndrome’. Considering SSRIs such as fluoxetine (and sometimes sertraline) are prescribed in children and adolescents, it is crucial that the potential for harm is acknowledged.

Thus, Fava et al suggested that while ‘clinicians are familiar with the withdrawal phenomena that may occur from alcohol, benzodiazepines, barbiturates, opioids, and stimulants, they need to add SSRIs to the list of drugs that potentially induce withdrawal phenomena. The authors concluded that the term ‘discontinuation syndrome’ minimizes the vulnerabilities induced by SSRIs and thus, it should be replaced by ‘withdrawal syndrome’.

Pretty conclusive I’d say.

Oliver Hare, shown above, was a 22-year-old linguist, working in Shanghai. In February of this year he spent a week with his mum in Dubai before returning to his family home in England. Feeling a little lost and unsure of what his goals were, he was anxious about returning to China. His dad told him not to worry, that nobody would force him to go back, but Oliver was worried about the consequences if he didn’t return. The Daily Mail reported that he had previously visited his GP, who diagnosed him with depression and prescribed Citalopram (marketed as Celexa and Cipramil). Oliver started taking the drug this February.  Four days later, on Valentine’s Day 2017, Oliver hanged himself from a window in his family home. The Coroner recorded a suicide verdict, stating “In light of the mood of the deceased that has been described and the manner by which his body was found I am satisfied that he intended to take his own life.”

However, what the Coroner did not mention (or perhaps did not know), was that all SSRI antidepressants, including Citalopram, increase the risk of suicide. There was no mention of the black-box suicide warning that is attached to this drug in the U.S., for young people up to the age of 24. Nor of the European Medicines Agency suicidality warning for under 25s. Perhaps the Coroner was not aware that Citalopram is associated with more self-inflicted deaths than any other antidepressant in the U.K. It seems pointless that SSRI suicide warnings are provided by the various medicines regulators, yet doctors, psychiatrists and Coroners seem oblivious to the risk – and have rarely attributed a person’s self-inflicted death to these widely-prescribed drugs.

As Wendy’s case shows (see previous post), there is little doubt that age is irrelevant when suffering an adverse-reaction to an SSRI, including Citalopram – see here and here. My son Shane, like Oliver, was 22 when he died of a Citalopram-induced death in 2009 – he lasted 17 days on the drug. Incidentally, my friend who runs the AntiDepAware website also wrote about Oliver (here). His son wasn’t much older than Oliver and Shane when he was prescribed Citalopram. Within days of starting the drug, he also died unexpectedly, from SIBSID (a self-inflicted but SSRI-induced death).

At one stage I asked many like-minded experts for some SSRI quotes, which, for anyone who’s interested, can be viewed here. However, the last word goes to Mr. Dainius Pūras of The Office of the United Nations High Commissioner for Human Rights, whose talk for World Health Day was published last month – titled ‘Depression: Let’s talk about how we address mental health’. The talk concerned the current paradigm of excessive medicalization within mental health and the overuse of biomedical interventions (aka drugs). Among other things, he stated:

“The use of psychotropic medications as the first line treatment for depression and other conditions is, quite simply, unsupported by the evidence. The excessive use of medications and other biomedical interventions, based on a reductive neurobiological paradigm causes more harm than good, undermines the right to health, and must be abandoned.”