Newspaper and internet articles, Shanes story.

Ireland’s over-prescribing disaster.

Ali Bracken
Ali Bracken

In 2009 following Shane’s death, a ‘Tribune’ journalist ‘Ali Bracken’ decided to find out whether antidepressants were being over-prescribed in Ireland. She presented to 5 doctors with symptoms of mild-depression and was shocked when 4 out of 5 prescribed her an antidepressant. The article ‘A Pill For Every Ill’ can be viewed here. So what has happened in the last 4 years. Has the over-prescribing of potentially dangerous drugs been curtailed in any way? Nope, in fact it’s actually got much, much worse.

In the last few weeks, a young journalism student ‘Niamh Drohan’ posed as a mildly depressed student in Waterford. This time sheNiamh Drohan visited 7 GPs as part of her investigation; all near Waterford city. Sadly, all 7 prescribed her an antidepressant. Her article ‘Depressing Truth about Treating Depression In The Young’ can be viewed here. What is all the more shocking this time around, is that 3 prescriptions were issued for one month supply, 1 was for two months, 1 was for three months and 2 were for six months. Can you believe that? Two doctors prescribed a 6 months supply of a potentially fatal amount of drug, to a depressed person that they had only just met? Why not just give her a gun and play some Russian Roulette with a young girl’s life? Idiots!

So why are Irish doctor’s prescribing so recklessly? The National Institute for Health and Clinical Excellence (NICE) guidelines  recommend that doctors “Do not use antidepressants routinely to treat mild depression because the risk–benefit ratio is poor…” Another NICE review stated that the benefit of antidepressant medication compared with placebo in mild to moderate depression may be minimal or nonexistent.

What about the Irish Human Rights Commission who recommended, among other things, that doctors/psychiatrists are to give an ‘oral explanation of risks/side-effects of SSRI’s in advance of prescription, together with relevant written information’ and that a ‘level of monitoring and ongoing supervision is required when SSRI’s are initially prescribed’. I don’t think that equates to ‘here’s a script, now have a nice day young lady and don’t take them all at once’.

Considering Shane had access to 6 weeks of poison Citalopram and had a toxic-to-fatal level of same in his system when he died, how many horses could a 6 month supply kill? This dangerous over-prescribing is heading for disaster. As Dr Phil would say; how’s that working for ya professor? Rising suicides and increased prescribing… sometimes 2+2 really does equal 4.

IHRC Recommendations.

NICE guidelines.

NICE Review Consultation Doc.

Newspaper and internet articles, psychiatry

Sundance Diagnostics, a genetic test pre-suicide

Sundance Diagnostics<- Click on the picture to go to the Sundance website.

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Did you know that there could soon be a test which will enable doctors to establish whether a person will react badly to antidepressants? An American company, Sundance Diagnostics, is in the early stages of developing a Genetic test for Prescription Drug Side Effects. This test, if successful, will establish whether a person is at risk of Suicide and Violence before (not after) being prescribed an antidepressant.

This from their website:

“Sundance Diagnostics is working to develop the world’s first genetic safety tests to predict a patient’s risk of antidepressant-induced suicidal thinking or behavior. There is a strong need to make pharmaceutical drugs safer for patients—especially when those drugs have serious side effects and are being sold to millions of people. Sundance is using the most advanced genetic technologies to develop its safety tests to predict a patient’s risk. The goal is to save lives, improve treatment, increase patient confidence in treatment, and reduce the cost of treatment.”

CEO Kim Bechthold, referring to the fact that over 90% of school shooters were on psychiatric drugs, stated “The importance of genetic tests to curb the risk of suicide and risk of acts of violence has been heightened as governments and communities search for effective ways to halt tragic mass shootings.”

Maria has written a great article on the MIA website about this. Unbelievably, she mentioned that she was offered a blood test to assess any risk for her cat pre-operation but not a test for her 17 year-old son Toran who died by a Fluoxetine/Prozac induced suicide. I could argue forever that a ‘drug-induced suicide’ is not suicide but that’s for another day. In her article Maria debated whether this test would in fact give the impression that antidepressants actually work for some people and she didn’t want to give people false hope. She answers that one perfectly, as usual. My thoughts on that one slightly differ with others. If you or anyone else is on an antidepressant and feel that the drug is helping, whether it’s the placebo/smartie effect or not, why fix what’s not broken? It’s when the drugs don’t work and cause awful adverse-effects such as suicide and homicide, that I do have a big problem. Informed consent, which you don’t get in Ireland, is my problem. If a person is pre-warned of the possible adverse-effects as recommended by the Irish Human Rights Commission, at least that person will have some chance of survival. In Ireland, people do not get that chance. Considering that this test is being developed in America at huge expense and, if successful, will be used worldwide, what will Ireland’s excuse be? That there is no point ordering a test which will solve a problem that doesn’t exist?

What surprised me most was the comments under Maria’s article, where some people opined that this test might actually make things worse. I hadn’t actually thought about that, and while there are some valid and understandably differing opinions, if this test is successful, in my opinion the pros will definitely outweigh the cons. Or in psychiatric language, in this case (unlike with antidepressants), the benefits will definitely outweigh the risks!

Maria’s Article.

Sundance Press Release 3-11-13 A (3)

I, being a natural cynic, had a few questions which I needed to be clarified. I put them to Kim and her scientific advisor, Peter Tolias, Ph.D,…

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I’ve been enquiring about suicide tests and read a lot about the STAR*D trial. What happened to the hints of a Pharmacogenetic marker from the STAR*D study that you initially referred to?

Dear Leonie,

This is Peter: The STAR*D study itself was the largest and most comprehensive study ever performed that studied drug-induced suicide risk, however, the technology that was available to be used at the time to examine markers only allowed them to study a small fraction of the human genome.  In spite of this, several new markers were identified that could ultimately be useful as a component of a broader genetic test.  These STAR*D markers, plus additional markers we hope to be discovered by Sundance, need to be confirmed in an independent study before a test is ready for the clinic.  Sundance intends to initiate a clinical trial for confirmation just as soon as the sequencing study is completed.

Your press release mentioned Whole Genome Screening (WGS) being an advance on Genome Wide Association Screening (GWAS). Will WGS really tell more than GWAS would?

This is Peter; Absolutely, because whole genome sequencing means identifying the complete sequence of a patient’s genome rather than a fraction of a percent identified by GWAS.  (10 million compared to 3 billion base pairs in the haploid genome (or 6 billion nucleotides), roughly 300 times the information)

How soon do you intend to have this genetic testing ready for distribution, months, years, decades?

Leonie, this is Kim again.  The sequencing portion of our work and the confirmatory study can take from 12 months to 18 months.  Sometimes a study actually has to be redone, resulting in more time.   If the sequencing is successful,  and if all else goes well, we could have a laboratory-developed test for physicians in 18 months in the U.S.  If we seek FDA approval, it will require at least another year.  FDA approval is not required in the United States however. For approval in Ireland, we will submit our initial confirmatory study results.  If the authorities require the type of studies that are required for FDA approval, it will take additional time.

Newspaper and internet articles, Our story., psychiatry, Random

Kathleen Lynch; Minister with responsibility for mental health?

Self-explanatory letter to the minister with responsibility for the Mental Health of Irish citizens. Tough job, but someone’s got to to it!

I would have thought that if experts were warning that SSRI’s were causing suicide, then something would have been done yesterday, not tomorrow. Didn’t Enda Kenny say if he was elected that his primary concern would be the people suffering with mental health issues? Well he was elected. These drugs can cause a person to kill themselves. Do something about THAT Enda. At the very least issue a warning to doctors because they seem to be unaware. This of course is not helped by the Irish College of Psychiatry, who protect their own interests by denying that the drugs can harm, and woe-betide anyone who contradicts that ridiculous stance. Anyway, please excuse my natural sarcasm when dealing with these people, who are allowing these drugs to continue to harm, can’t promise it wont happen again!

29/06/2012

Dear Minister Lynch,

It is now almost two months since I, my husband, Professor David Healy and Pathologist Declan Gilsenan met with you in Leinster House. They each spoke of their concerns regarding the adverse-effects of antidepressants, indeed Prof Healy informed you that drug induced death are the leading cause of death within the mental health field. Declan Gilsenan spoke about his experience with autopsies and his intuition that SSRI’s are causing suicides. He thought at the very least that the statistics on suicide should be collated for investigation.

You replied that you would have to report back to James Reilly and would be meeting with the College of Psychiatry also. It seems that neither Professor Healy or Declan Gilsenan has heard anything back from you despite offering their services to help put a stop to future tragedies.

The Irish Human Rights Commission has investigated these drugs and has made important recommendations for practitioners. Sinead Lucey, who dealt with this investigation, has assured me the investigation is on-going and she will not stop till this issue is taken care of. I left you her number after the meeting: xxxxxxxxx

IHRC Recommendations….

(i)   Discussion of alternate therapies

(ii)  Referrals for counselling/psychiatric review

(iii) Within medical practices seek to ensure the same doctor deals with the person at all stages if at all possible;

(iv)  Oral explanation of risks/side-effects of SSRI’s in advance of prescription, together with relevant written information;

(v)   Guidelines regarding prescribing SSRI’s from initial stage through ongoing treatment;

(vi)  Level of monitoring and ongoing supervision required when SSRI’s are initially prescribed

(vii) Maintenance of adequate consultation notes; and

(viii)The necessity to obtain a full patient history before prescribing SSRI’s

If we were talking about the side-effects such as nausea or diarrhoea I could understand the delay, but considering we are speaking of people’s lives here, I do not understand. Filibustering regarding this topic is not acceptable. This is a matter of life or death. How many people have died by a drug-related suicide or homicide in the two months following our meeting? Future deaths are in your hands and as you are the Minister with responsibility in this area, I for one, will be holding you accountable.

Regards,

Leonie Fennell

cipramil (celexa) stories,, lundbeck, Newspaper and internet articles, Our story., Shanes story.

80% of suicide victims were in touch with GP… How many % were prescribed an SSRI?

Here’s another interesting Article in the Irish Examiner entitled “80% of suicide victims were in touch with GP”

The Article states that the National Suicide Research Foundation (NSRF) looked at 190 cases of suicide in Cork City. The NSRF found that more than 80% of people who died by suicide had been in contact with a GP or mental health service in the year prior to their death. Full Article here. Dr Ella Arensman said the findings indicated a potential within GP practices to pick up on signs of depression at a very early stage and to identify signs of self-harm and suicide.

Is the NSRF completely missing the point? Why did the research not include ‘how many of these suicide victims were prescribed SSRI’s, which can come with suicide/homicide side effects? Not to mention that one of the listed side effects of these supposed antidepressants is depression.

In another Article by The Examiner, published in December, entitled ‘Suicide warning over some anti-depressants’ the paper reported that, requested by us, The Irish Human Rights Commission (IHRC) had written to the Medical Council, requesting that patients are informed that certain anti-depressants can cause suicidal thoughts as a potential side effect. The IHRC is also urging ongoing supervision when the drugs are prescribed. The anti-depressants are known are SSRIs, and popular brands include Prozac, Zoloft, Lexapro Paxil and Celexa.
The Article also mentions Shane’s Inquest where; “Dr David Healy, the professor of psychiatry at Cardiff University in Wales, told the court that behaviour such as suicidal or violent thoughts or actions, seen in some patients prescribed SSRIs, arose from the drugs and not from the patient’s condition.”  Article here.

I have mentioned before that I spoke to an Irish Pathologist who has serious concerns regarding the number of Autopsies he has carried out on people who have just started these drugs and within a short space of time, have gone on to commit suicide. At the time I was speaking to him he had just performed six autopsies, five were suicide victims; four had recently been introduced to SSRI’s. That amounts to: Of the autopsies he did on suicide victims, 80% were taking an SSRI…Coincidence or not?

I contacted the Central Statistics Office last year to find out exactly what number of suicide victims were prescribed SSRI’s before their deaths but was informed that it’s impossible to find out, as the subject is too ‘sensitive’ to broach with families. I think it’s high time we broached the subject.

This is an Article I found a while back, also in The Irish Examiner….

cipramil (celexa) stories,, Newspaper and internet articles, Our story.

IHRC Recommendations on SSRI Prescribing

IHRC (Irish Human Rights Commission)

Finally somebody is asking for changes in the way that SSRI’s are being prescribed by medical professionals in Ireland.

I wrote many letters and e-mails in the last 2 years regarding the care (or lack thereof) that Shane received from the medical professionals in the last month of his existence. I wrote e-mails and letters to, among others, the EMA, FDA, IMB, Lundbeck, Brian Cowan, Kathleen Lynch, Bertie Ahern, James Rielly, Dick Roche, Jan O’Sullivan, Liz McManus (before I found out she was previously married to John Mc’Manus, the GP in Bray who prescribed Shane a months supply of Cipramil), Barack Obama (always an optimist), the college of Psychiatry of Ireland and Mary McAleese.

Most of the replies I received were the usual apologetic but automated response apart from the IHRC.

After reviewing Shane’s medical records, Citalopram PIL’s, Professor Healy’s report, the statements from the doctors, my correspondence with the Irish Medical Council and their subsequent decision, the IHRC have decided to take some action…

The IHRC have written to the Medical Council requesting that, among other things, patients are informed of the potential side effect of suicide ideation with SSRI’s and for closer monitoring and ongoing supervision when SSRI’s are initially prescribed.

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Recommended IHRC Guidelines:

(i)

Discussion of alternate therapies

(ii)

Referrals for counselling/psychiatric review

(iii)

Within medical practices seek to ensure the same doctor deals with the person at all stages if at all possible;

(iv) 

Oral explanation of risks/side-effects of SSRI’s in advance of prescription, together with relevant written information;

(v)

Guidelines regarding prescribing SSRI’s from initial stage through ongoing treatment;

(vi)

Level of monitoring and ongoing supervision required when SSRI’s are initially prescribed

(vii)  

Maintenance of adequate consultation notes; and

(viii)  

The necessity to obtain a full patient history before prescribing SSRI’s

Though quite why the Medical Council have not done this already is beyond my comprehension! Then again, considering that the IMC see no harm in doctors prescribing a months supply of potentially lethal medication to a depressed person, would seem to show their level of understanding/misunderstanding of the dangers of these drugs.

The Irish Medical Council is a statutory body set up by the state; On their website it states “Our statutory role, as outlined in the Medical Practitioners Act 2007, is to protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among registered medical practitioners”.

Protect the public?

By allowing doctors to prescribe a months supply of potentially lethal SSRI’s with known suicidal side-effects to a first time patient; How are they protecting the next poor vulnerable patient who gets a months prescription of SSRI’s from their GP?

Whether the IMC will implement these changes remains to be seen, but the next time that some other unfortunate family raises this issue, the IMC won’t be getting off quite so lightly, as there will be a record of the IHRC’s letter recommending that changes are introduced.

“A medical practitioner who establishes that he followed a practice which was general and approved by his colleagues of similar specialisation and skill is nevertheless negligent if the plaintiff thereupon establishes that such practice has inherent defects which ought to be obvious to any person giving the matter due consideration” (Dunne (an inf.) v. National Maternity Hospital [1989] IR 91.)

https://leoniefennell.wordpress.com/2011/10/22/medical-negligence-in-ireland/

https://leoniefennell.wordpress.com/2011/10/10/update-on-our-complaint-to-the-irish-medical-council/