In a week where Ireland has seen several young people die by suicide, we had the usual rush for answers to a growing problem, which it seems, no-one can fix. Certainly the Government are pretty useless at tackling the suicide ‘issue’ and numerous newspaper articles, however well-meaning, are not helping. An ‘Irish Independent’ article this week regarding depression in teenagers states: “Most experts are in agreement that for young people in crisis, medication, in the form of Prozac-type drugs from the SSRI family, prescribed by a GP, can be helpful.” What? Which experts? I would like to know precisely who is recommending SSRIs for use in teenagers? Why are they not named and shamed in the article? Actually, why would any well-researched article not refer to the black-box warning or the EU recommendations regarding the prescribing of these drugs to teenagers?
Ten years ago the Irish Medicines Board put out a fairly stark warning regarding the prescribing of SSRIs in children: “The Irish Medicines Board today confirmed that Selective Serotonin Reuptake Inhibitors, (SSRIs) are not and have never been licensed for use in children (under 18 yrs) in the treatment of Major Depressive Disorder (MDD) in Ireland. The IMB is fully aware of the review undertaken by the UK expert group, details of which were announced today and wishes to re-emphasise that SSRIs are not recommended for use in the treatment of MDD in children in Ireland, as the risks of treatment with certain SSRIs are considered to outweigh the benefits of treatment in this condition.”
In 2008 the Psychopharmacological Drug Advisory Committee (PDAC) voted 6:2 that the warnings of SSRI induced suicidality be upped from under 18s to age 25. It also advised that labelling needed to address the 25-30 age group. The PDAC concluded: “Overall the conclusions reached by the FDA in its review were consistent with that of the UK/EU review. Both reviews concluded that young adults may be at an increased risk of suicidal behaviour when treated with antidepressants. The FDA discussions on an explanatory hypothesis highlighted that even in older adults the possibility that in SSRIs may increase risk of suicidal behaviour cannot be ruled out.” The Eu recommendations can be viewed here, which includes the different drug induced suicidality risk where Citalopram fares worst, doubling the suicide risk.
The same ‘Indo’ article heavily relies on quotations from Dr Tony Bates of ‘Headstrong’. On the Headstrong website Dr Bates pays tribute to his ‘good colleague, ally and friend’ Patrick McGorry, who recently resigned as a Headstrong board member. McGorry (born in Ireland) is an Australian psychiatrist who will retain an ‘advisory’ role within Headstrong. He is well known for his ‘early intervention’ trials, which have been fiercely criticised by mental health experts. His many conflicts of interest, including financial support from various pharmaceutical companies, such as Astra Zeneca, Janssen Cilag, Lilly, Pfizer and of course Lundbeck, certainly didn’t help McGorry’s cause. American mental health lobbyist David Oaks stated in a Time magazine article ‘Drugs before diagnosis‘, that McGorry’s trial was ‘one of the most bizarre and counterproductive human experiments on young people I know about’.
As recently as 2011, according to the ‘Sydney Morning Herald‘ McGorry “aborted a controversial trial of anti-psychotic drugs on children as young as 15 who are ”at risk” of psychosis, amid complaints the study was unethical. 13 international health experts lodged a formal complaint calling for the trial not to go ahead. They were concerned children who had not yet been diagnosed with a psychotic illness would be unnecessarily given drugs with potentially dangerous side effects.”
It seems to me that ‘Headstrong’ should clarify its position regarding McGorry’s
drugging ‘early intervention’ programme. It also seems to me that while the writer is entitled to her opinion, the indo article is highly dangerous, and quite possibly negligent, to advocate for the use of SSRIs in children without addressing the EU suicide warning. While the writer asks some good questions, such as, “How would we know if a teenager was feeling overwhelmed by academic expectation, online bullying, family breakdown, pressures at home, or simply the everyday drama of growing up?”, a pill which can double the risk of suicide, is not the answer. Extreme caution should be advised when even the Irish Medicines Board admit (albeit with ‘certain’ SSRIs) that the risks when prescribing SSRIs in children, outweigh the benefits.
If this article is factual and ‘Most Experts’ are truly recommending the use of SSRIs in children, the European Medicines Agency and the Irish Medicines Board are not doing their job properly.