My attention was drawn recently to an Irish Catholic article involving Professor Patricia Casey, well known Irish psychiatrist and IONA Institute patron (conservative Catholic advocacy group). The article ‘Simplistic therapy approach to suicide criticised in new study’ was published in the ‘Irish Catholic’ and centers on a study published in the Irish Journal of Psychological Medicine. The study Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings is based on toxicology tests done post mortem and expresses the opinion that people dying by suicide were not adhering to their treatment (drug regime). The journal itself is the official journal of the ‘College of Psychiatry of Ireland’ – the same college which I have previously shown to engage in some dubious practices. While sending an ‘internal’ college e-mail to its members (regarding my son’s death where an antidepressant was implicated), it also forwarded the same literature to the drug company in question. While I have queried the ethicality of the latter with the college of psychiatry, no satisfactory answers have ever been forthcoming.
Leaving aside my possible subjectivity on the college’s questionable ethics, the article itself raises other relevant issues. Toxicology results post mortem are notoriously unreliable (Drummer et al 2004) and should not, as yet, be relied upon to conclude drug concentrations before death. I personally know of mothers who have lost their sons to antidepressant-induced deaths where the antidepressant escaped detection in toxicology tests. Two of these mothers vehemently objected and insisted on a re-test – in both cases the drug was eventually detected, once on the second time and once on the third time.
Firstly, as the basis of the study relies on toxicology results, the reliability of toxicology tests post mortem was not addressed in the study.
Secondly, even if these toxicology tests were 100% reliable, it raises other important questions – how is it that 1/3 of the people who died by suicide were taking their medication? Were the drugs at best ineffective or at worst a causal factor in these deaths? It is noteworthy that the suicidality warnings included in antidepressant PILs (patient information leaflets), were put there, not by any well-meaning intentions of the drug industry, but by order of the FDA (American Drug Regulator) and EMA (European Medicines Agency) following lengthy investigations.
Lastly, again in the case of the toxicology being 100% effective, how many of the victims were in withdrawal from these highly toxic drugs? Treatment-induced (and withdrawal-induced) suicide has been discussed in another study (Healy et al 2006). This possibility has led regulatory authorities to warn doctors about the risk of suicide in the early stages of treatment, at times of changing dosage, and during the withdrawal phase of treatment. Was ‘withdrawal’ a simple oversight on behalf of the original study authors?
It seems to me that the Irish Catholic and the IONA institute have bigger fish to fry – treatment of the living for example. Considering the current abortion debate raging in Ireland, it strikes me as strange that the pro-life IONA patrons have not addressed the issue of the widespread treatment with antidepressants in pregnancy. Speaking last year on the problem of assessing suicidal pregnant women, Professor Casey said “Who will offer her the first-line treatments (antidepressants and/or cognitive therapy) she so desperate needs?” That antidepressants save lives is not evidence based(Healy 2006) and problematic in pregnancy according to Adam Urato (personal communication, June 29, 2015), expert in Obstetrics & Gynecology and Assistant Professor at Tufts University School of Medicine. He stated –
“The antidepressants freely cross over the placenta and into the developing fetus (baby) throughout the pregnancy. They have significant harmful effects for moms and babies including miscarriage, birth defects, preterm birth, preeclampsia, newborn complications, and long-term neurobehavioral problems. These chemical compounds—what we call antidepressants—are made in chemical factories and they go from these factories, into the pregnant moms, and then into the developing babies (fetuses). Nowadays, with 5 to 10% of all pregnancies being exposed to these drugs, what we are basically witnessing is a large scale human experiment. The track record of what happens when we expose developing babies to foreign chemical compounds is not good. Chemicals have consequences for developing babies.”
Rather than focusing on dead people, the IONA Institute need to address treatment-induced fetal harm or it could be left wide open to accusations of hypocrisy. Suffer little children – a thorough investigation by the ‘Irish Catholic’ might be a good place to start.
Drummer O, Forrest ARW, Goldberger B, Karch SB, International Toxicology Advisory Group. Forensic science in the dock: Postmortem measurements of drug concentration in blood have little meaning. BMJ : British Medical Journal. 2004;329(7467):636-637
Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Medicine. 2006;3(9):e372.
Healy D, The antidepressant tale: figures signifying nothing?