This week the BBC aired a Panorama documentary titled ‘A Prescription for Murder’ which has stirred some much-needed debate on the mind-altering effects of SSRIs. The very-astute presenter Shelley Jofre is known for tackling ground-breaking medical-related issues, including ‘Who’s Paying Your Doctor‘ and ‘The Secrets of Seroxat‘. (Due to the circumstances surrounding my son Shane’s death, I make a brief appearance in this documentary. )
As expected, the documentary caused a huge furore, with many defending the antidepressants drugs they take ‘that don’t cause them to become murderers’, accusing Panorama of being irresponsible and increasing the stigma of mental illness. Indeed, psychiatrists came out in their droves with their usual defense of psychotropic drugs, with seemingly no concerns whatsoever of adverse effects – or of their profession’s incestuous relationship with the pharmaceutical industry. The possible stigmatization of the people who suffer from serious and well-documented adverse effects of these prescribed drugs never entered the debate.
Anyway, watch the documentary and see what you think. I will say what I have always said – My lovely son would still be alive if he hadn’t gone to the doctor, whose fateful decision to prescribe citalopram for heartache proved fatal. 17 days after being prescribed the drug, following a series of red-flags that the drug was causing havoc, Shane was dead.
Citalopram is an SSRI antidepressant, sold under the brand names of Cipramil in Europe and Celexa in the U.S.
Sertraline, the SSRI that James Holmes was prescribed, is sold under the brand names of Lustral in Europe and Zoloft in the U.S. It was interesting to hear Delnora Duprey speaking on the programme; In 2001, three weeks after he was prescribed sertraline, Delnora’s grandson Christopher Pittman shot and killed both of his paternal grandparents. Then there was David Carmichael, whose account of his time on Paroxetine (Seroxat/Paxil), leading to the death of his young son, is equally harrowing.
Since their inception and without exception, all the SSRI drugs have been implicated in suicides and extreme violence, including homicide. With drug-company reports of ‘self-harm and harm to others’ and regulatory warnings of suicidality, violence, mania, akathisia, worsening depression, severe withdrawal, long-term sexual dysfunction, birth defects, depersonalization, etc., the stance that these drugs are safe for all is no longer tenable.
Strange to be writing about someone who’s alive, but a nice change all the same. A survivor, who knew? Sorry, sarcasm – you can take the girl outta Sallynoggin…
Gareth O’Callaghan is a well known Irish author, radio presenter and mental health activist. He has written numerous books on depression, including the popular A Day Called Hope: A Journey Beyond Depression. Recently, he has spoken out about his experience on the SSRI Citalopram (aka Cipramil/Celexa), the same drug my son Shane was on for 17 days before his death. Why he has decided to bare all now, I don’t know, but I’m just glad that he has. Gareth said that he followed Shane’s case avidly “..not only because of the huge media coverage it received, but also because I too took citalopram many years ago. I can identify with the Akathisia (restless, aggressive inner anxiety) that Shane suffered as a result of the drug. I could really frighten people here if I was to explain in detail what Akathisia does to the mind. Thankfully I had a chance to stop taking the tablets. Shane didn’t”.
I should say that this is not news to me – I spoke to Gareth some years back; he’s a nice, friendly and very honest guy, who pulls no punches. He can be heard on 4FM every weekday afternoon here.
Akathisia (from the Greek for inability to sit) is a widely misunderstood and underestimated adverse effect of taking a drug, usually an SSRI antidepressant or a benzodiazepine. Coded in Patient Information Leaflets (PILs) as ‘inner restlessness’ and ‘restless leg syndrome’, it has been described by some survivors as the ‘worst experience ever’, a feeling of ‘inner torment’ where ‘death would be a welcome release’ and seems ‘the only, very welcome option’.
Wendy Dolin, who I had the pleasure of meeting in Copenhagen, described how her husband Stewart died while suffering with akathisia – 6 days after he was prescribed Paxil/Seroxat. She has set up MISSD, a blog specifically to warn of the dangers of akathisia –
“On July 15, 2010, (six days after beginning the medication), following a regular lunch with a business associate, Stewart left his office and walked to a nearby train platform. A registered nurse who was also on the platform later reported seeing Stewart pacing back and forth and looking very agitated. As a train approached, Stewart took his own life. This happy, funny, loving, wealthy, dedicated husband and father who loved life left no note and no logical reason why he would suddenly want to end it all. Neither Paxil nor the generic version listed suicidal behavior as a potential side effect for men of Stewart’s age.”
A recent post on MISSD reports a personal experience similar to Gareths here. David Healy also explained akathisia in his coroner’s report for Shane’s inquest here. Short excerpt below –
There is good evidence that akathisia can exacerbate psychopathology in general, and a consensus that it can be linked to both suicide and violence. A link between akathisia and violence, including homicide, following psychotropic drug use has previously been reported.
What surprises me with Gareth’s post, is that while he is telling of his awful experience and has many supporters, some people have taken offence where there is none intended. There are quite a few ‘how dare yous’. It seems that while it’s perfectly acceptable to be MedicatedAndMighty, it’s not okay to be UnMedicatedAndMighty and talk of a bad personal experience with prescription drugs. Surely his story is equally important? A selection of the comments below:
you’re doing more damage by labelling those who need help
I am going to unfollow u I have had enough of your one sided beliefs
Please don’t make people feel bad If they need it after bereavement etc.
Giving drugs for bereavement is surely part of psychiatry’s problem but one I won’t go into here (See works of David Healy, Robert Whitaker, Peter Gotzsche, Peter Breggin, etc). It should be noted that akathisia is not always fatal but monitoring is crucial. If it occurs in the early stages of taking a prescription drug, it can occasionally wear off (but not always). If it develops later, it’s less likely to wear off.
Read Gareth O’Callaghan’s post on akathisia below; It’s well worth a read..
This is a true story. It is called personal experience. It happened to me. In hindsight it relates to probably the most terrifying month of my life and I would like to write about it here for the first time. It happened 16 years ago.
If you would prefer not to read how an antidepressant can destroy a human mind, and even kill, then I suggest you stop here. Otherwise please read on. It’s also worth remembering while you’re reading this that there have been hundreds of suicides in Ireland so far this year. Many of these people could still be alive if they had been told the truth about these drugs before they had been prescribed.
I have written here on a few occasions about a condition – a body and mind reaction – called ‘Akathisia’, which is directly caused by antidepressant medications. I would like to explain more about this dangerous reaction this evening and what it really is, as very few people have ever heard of it. And it is one of the most dangerous and severe side-effects of these drugs.
In 2000 I was diagnosed with depression and prescribed citalopram (aka celexa, cipramil), a drug that – to the best of my knowledge – arrived in 1996. It was still brand new. These days we now know it is also extremely dangerous as I will explain in a moment. Despite all the damaged lives it has caused and the many deaths it has been responsible for, it is still one of the most frequently prescribed antidepressants from a range of drugs known as SSRIs (selective serotonin re-uptake inhibitors). Why, if this drug can induce death, is it still widely available?
Back then we knew nothing about what this toxic drug was capable of doing because it was basically still being tested. 16 years ago most of us might agree that our education about mind-altering drugs was scant and strongly influenced by the medical profession. Consequently very few of us were prepared to share our experiences like we are today because we knew no better. We were led to believe this was ‘the cure’.
The SSRIs have for years been marketed around a shocking blatant lie, namely that a chemical brain imbalance causes depression. Back then, 16 years ago, I thought (as a result of buying into this myth) that this drug would rebalance my brain chemicals and cure my depression. If only I had known back then what I know now.
I was told that the drug would take between three and five weeks (maybe six) to really ‘kick in’. I was told to be patient. So I reminded myself each day through this anxious misery and baseline unhappiness that I was feeling that I would eventually see the sun again and appreciate the life I had forgotten existed. I waited. And waited. And then after about seven days my life changed. Something truly shocking and off-the-scale of understanding started to happen.
I started to feel more anxious, in a stomach-knotted nauseous kind of way. My heart started to beat faster and I felt like I was losing my grip on reality. My first panic attack happened in a packed shopping centre on a busy Saturday afternoon. I lost the plot. I felt like I was having some sort of seizure so deep inside me I couldn’t control my rational self.
I told my two young daughters that we needed to get back home as quickly as possible. They couldn’t understand why I couldn’t explain why we needed to go home. I was cracking inside very quickly, sweating, trembling, palpitating, even crying. I was losing all sense of reality in a way that was terrifying me. How I managed to drive home that day is still something I can’t bear to think about.
Once home I went upstairs to a room which I had converted into a small office years before, closed the door and started to cry. The crying became a full-scale panic attack and I ended up lying on the floor hugging my knees trying to stop the awful sensation of severe agitation that was tearing me apart inside.
Eventually it eased; but then the pain in my knees became so bad I had to get up and walk around. It wasn’t normal walking; it was pacing. I paced around the house, often sitting down to rub the pain out of my knees, and then standing and pacing while scratching my face and squeezing my abdomen to stop the horrendous agitation that was tearing at my gut. It was so deep inside me it was tearing at my gut with a hidden pain I couldn’t reach.
In the days that followed, the aggression I felt would play horrible games with my mind. I couldn’t be around sharp instruments, or walk near water. I found it increasingly difficult to cross busy roads, or to be in a crowded place for more than a few seconds. Panic struck me randomly. I was afraid to drive my car so I stopped driving. But most of all the desire – the irrational, unwanted, terrifying need – to kill myself was never far from my mind. Death would stop this pain but I didn’t want to die, I kept thinking. My brain was in a state of meltdown. The nightmares and the sweats were truly shocking.
I lasted for three weeks on citalopram. On the 22nd day I rang my doctor. I told him I couldn’t take it anymore. I explained to him what was happening and he was shocked. I am lucky to have a very good doctor. Many people are not so lucky.
If reading about my experience here has upset you, then please let me emphasise that this was never my intention. This may not help you but I hope it might help someone who is reading this tonight and possibly going through this awful ordeal.
I made a promise to myself years ago that I would be totally honest with myself. If I can’t be honest to me, then I definitely can’t be honest with you. My writing comes from an honesty that believes in justice and support for others who are coming through what I have come through.
I know so much more these days about mental health and what heals, and also what doesn’t. I knew nothing back then. I started to educate myself when it dawned on me just how close I had come to harming myself seriously.
Unfortunately unless you have a good doctor you probably won’t be told what you need to hear and do. That is just not acceptable. If your doctor is a dickhead, get a new doctor – simple as that. If your psychiatrist is more interested in spoofing than in healing, then leave the room.
Akathisia, we are told, is usually a ‘mild reaction’ to SSRIs. Let’s be honest here. Mild is an understatement. For many people who start these drugs, akathisia is a life-threatening condition that needs to be more fully understand by both patient and doctor.
Most psychiatrists play it down because they know that three of the most popular drugs that they claim to be suitable and ‘safe’ to take for depression, that they increasingly peddle as a cure (the same drugs they include in many of their speculative, dodgy concoctions) cause akathisia: FACT.
These three drugs are Prozac (fluoxetine), Seroxat (paroxetine), and Cipramil (citalopram/celexa).
These drugs are believed to play havoc with the brain neurotransmitter norepinephrine, which under normal conditions is secreted in response to stress. It is associated with levels of insomnia, anxiety (panic), and aggression (and violence).
Research has shown that these drugs make people ‘more prone’ to suicide (and aggression) during the first few weeks of starting to take them. So many people suffer silently from akathisia. Ask any of these people if they were experiencing these awful side-effects before taking the drugs and they will tell you most likely they were not.
A deep sense of loss of interest in life, a deep-rooted unhappiness, a feeling of morbidity … these are all feelings of depression; but unfortunately often the very drug that is taken to counteract these feelings creates a violent emotional storm that many psychiatrists (and doctors) blame on the depression – not the drug.
Psychiatry is not going to change its attitudes to SSRIs. The pharmaceutical companies who developed these drugs need psychiatrists and doctors to keep selling them. Big Pharma has too much to lose. They don’t want you to find another way of healing your life. They want you to be as depressed as you possibly can be. Otherwise their profits drop because they can’t peddle their drugs. (And that’s beginning to happen.)
If a young person dies while on their drug, they blame the so-called illness, not the toxic drug. Depression is a multi-billion euro business. The second biggest exporter out of Ireland is antidepressants.
Maybe you haven’t experienced anything like what I have just described. If so, you are one of the lucky ones. If you have any doubt or bad feeling about the medication you take, or have started to take, then go straight back to whoever prescribed it to you. Demand honest answers to your questions. You are paying a lot of money. In return you are also demanding respect.
If they tell you that you are “blowing it out of all proportion” (as one young man told me he was told by his doctor), or to “stick with it”, as others have been told, or if they tell you they know best, then change your doctor. Get someone who genuinely wants to help you. It might just save your life.
Today I attended the inquest of Jake McGill Lynch, which concluded with the Coroner returning an open verdict. Firstly, amid all the legal argument, there was an infinitely more important factor; Jake..
In 2012 Jake was diagnosed with aspergers syndrome; he was just that ‘little bit different’ ye see. He was a little too intelligent; too good; too kind; too perfect to be perceived as a ‘normal’ disruptive adolescent. I often wonder why psychiatry gets to define what is ‘normal’, considering the lack of any scientific tests to determine otherwise. Are we not all individuals with traits that others would see as abnormal? Are our strange and weird traits not what makes us likable, or even unlikable? Sure, Jake liked routine and things to be in order, a place for everything and everything in its place – not a bad trait I’d say, but nowadays it’s ‘diagnosable’. This extraordinarily intelligent young man was diagnosed, labeled forever, for being just that little too perfect.
Jake was an articulate, handsome young man. He had an online girlfriend, loved to play with his Lego and like ‘normal’ 14 year olds, spent hours on his beloved Xbox. He had joined a gun club with his mam and idolized his big brother and little dog Charlie (equally). He loved his native language and was a fluent Irish speaker.
Jake was primarily a happy camper with few problems, apart from feeling a little anxious on stressful occasions. He was attending a counsellor to help with his feelings of anxiety. When the counsellor decided that Jake didn’t need any more sessions as he was “the happiest she had ever seen him”, she referred him to a psychiatrist. His mam thought that this referral was in order to sign Jake off. Inexplicably, instead of signing Jake off, the psychiatrist prescribed Jake an SSRI Fluoxetine (aka Prozac), to ‘help with his exams’. Neither his mam or dad were given a patient information leaflet (PIL) or any information on side effects – suicidality or otherwise. Therefore, they were not told that SSRIs, including Prozac, doubled the risk of suicide.
Jake’s medication was doubled after a week, without seeing the prescribing psychiatrist. He became increasingly restless and had a meltdown in school which was totally out of character. 46 days after his prescription for Prozac, Jake’s parents found him on the floor of his bedroom – he had shot himself in the head with his legally held rifle. He was rushed to hospital but declared dead a short time later.
The psychiatrist had previously testified that she prescribed Jake with Prozac ‘to help with his exams’ because he had had ‘a meltdown’ while doing an Irish exam. This off label prescribing is truly shocking, but what is worse is the fact that Jake’s ‘meltdown’ occurred 5 days AFTER he was prescribed Prozac, not before. Why would a doctor get this so wrong? Is covering their own backsides more important than revealing the true circumstances surrounding the death of a 14 year old child? Do Jake’s parents not deserve to be presented with all the facts, not a cover-up? The HSE’s barrister spends a lot of time in the Coroner’s Court – he’s obviously very good at what he does. Personally I think an apology would be far cheaper. Jake, the 14 year old child in the middle of all this, seemed to get overlooked in copious legal argument.
The Irish drug regulator, HPRA, states that ‘Prozac is not for use in children and adolescents under 18’ here. The HPRA further states that if Prozac is prescribed off-label to a child over 8 (Sweet Jesus) with ‘moderate to severe major depressive disorder’, that it should be offered only in combination with psychological therapy. JAKE DID NOT HAVE DEPRESSION! In 2005 the Committee on Human Medicinal Products, CHMP, advised that SSRIs ‘should not be used in children and adolescents except within their approved indications – not usually depression – because of the risk of suicide-related behaviour and hostility’. If prescribed off-label, the CHMP recommends that patients should ‘be monitored carefully for the appearance of suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment’. Why then was Jake’s prescription for 10mgs of Prozac doubled the following week, without even seeing the psychiatrist? I would not call that careful monitoring.
What was particularly grueling for the family, was the 13 appearances in the Coroner’s Court, mainly for legal arguments over whether the family had a right to call an expert witness (David Healy). Not surprisingly the HSE barrister was vehemently opposed to David Healy taking the stand, stating that if he was allowed to be the family’s ‘expert witness’, they (the HSE) had an ‘expert witness’ who would say the opposite. I’m sure they had! The coroner refused the family’s request, referring to the limitations of the Coroner’s Act 1962 and the case of Eastern Health Board v Farrell, but said he’d have no objection to the family having an expert to ‘advise’ them on the day. By this stage Dr Healy was in the US, so Declan Gilsenan (retired assistant state-pathologist) came to the rescue and stepped in to advise Jake’s family. He has publicly stated “Based on my experience of doing postmortems on people where anti-depressants have been started fairly recently I would have concerns about the link to suicide”.
It is of particular significance, that in May 2012 Dr Gilsenan attended Leinster House with Dr Healy, warning that these drugs were causing many deaths and asking for an investigation to be initiated. Nothing was done – NINE months later Jake was given a prescription for Prozac and the cycle continued.
What was awful today, apart from hearing the circumstances of Jake’s death, was looking into the faces of his grieving parents. That familiar look of unbearable pain etched on their faces, the unbelievable loss of their son who had so much to give – all totally avoidable. Another Irish boy lost through psychiatric drugs and another doctor being permitted to recollect ‘facts’ that just don’t add up; another mom and dad left bewildered and lost; another year, another death and still our Ministers avert their eyes and do nothing. Shame on them and the Irish Government.
The coroner, having heard arguments for the rights and wrongs of prescribing Prozac in children, said that it was “beyond his capabilities to adjudicate on Fluoxetine” but could not ‘beyond reasonable doubt’ say that Jake intended to take his own life. He then rejected a suicide verdict and returned an open verdict.
Dia leat Jake. Ní dhéanaimid dearmad ort go deo.
The last word must go to Jake. It clarifies exactly what his family have been fighting for. In an e-mail the night before his death, he said (verbatim).. “The ‘anti-anxiety’ stuff is actually an anti depressant which they didn’t tell me. Probably doesn’t make much of a difference, but I feel like I’m drugged to the point that it suppresses everything bad until it suddenly spills out.”
The meeting was chaired by MP Jim Dobbins who has previously aired concerns about the pharmaceutical industry and its close involvement within academia, such as the case with Professor David Nuttcase Nutt here. I don’t really have an issue with Professsor Nutt, other than with his false declaration to the Nation (on BBC radio) that ‘it’s impossible to kill yourself with an overdose of SSRI antidepressants‘. Dr Ciara Kelly said the same thing here on Irish radio. Very dangerous propaganda!
Anyway, I’m rambling off the point again this morning. Suffice to say, as is usual, our trip did not always go as planned. We decided, as we were going to London for this talk, to bring the kids with us and maybe go to Legoland the following day. We had plenty of time as the flight was an early one and the talk wasn’t on until 2pm in Westminster. The Ryanair plane sounded decidedly dodgy, as if it was running on dirty fuel (haha, Tony will tell you I have a good mechanical ear) and unsurprisingly the pilot decided that we would have to change planes. This left us two hours behind schedule so the pressure was on, the kids were happily oblivious but the odds at arriving on time were stacked against us. In stepped my brother-in-law in his superman underpants in order to save the day and meet us in London Bridge. He took the kids to my sisters in Kent (where we were staying with 3 cousins, all girls and under the age of 3). This left us plenty of time to head to Westminster for the talk. Back on track.
There was nothing I could do about the frizzy hair at that stage but I thought I’d better change out of the tracksuit bottoms. I decided I would have to change into my ‘Westminster’ clothes in the toilet on the train. Yep, that sounds like a good idea you think? Thanks, I thought so too. The toilet doors were of the circular kind which we have here in Ireland too. There was a nice man sitting outside the toilet when I went in, who smiled at me and said hello; the English are so polite aren’t they? So I took the boots and tracksuit bottoms off and was standing in my underwear (thank God for small mercies) when the train jolted and I leaned backwards, for balance you understand. I leaned on the open-door button, which promptly left me standing in my knickers exposing myself to the poor man sitting outside. Frantic pressing on the buttons failed to close the doors for a lifetime of seconds, until the doors finally closed on the man’s shocked expression. I debated whether I could stay in the toilets until the man either got off or died from old age, whichever came first, but eventually braved the situation and departed from the toilet where I grinned at him in a stupid fashion. He couldn’t look me in the face and glanced quickly out the window. Oh well, nobody was arrested and Tony’s well used to my little accidents/incidences.
So having laughed our heads off all the way to Westminster, we finally made it with a half an hour to spare. After the talk was over, we retired to another room where a question and answer session took place. Jim Dobbins actually voiced what we all knew all along, that the pharmaceutical industry has the Government over a barrel and if the Govt were to sanction ‘industry’, they would threaten to take their business elsewhere, hence GSK et al having control in the UK. This is no doubt the case in Ireland where industries influence is palpable everywhere. If pharma can have such a huge influence over the UK Government, what chance do we have over here in our small country with a population of 4.5 million citizens and with a proven history of unscrupulously corrupt Ministers? You would have to wonder why Kathleen Lynch and James Reilly have done nothing about SSRI-induced deaths.
David Healy’s talk was brilliant as always. We also had the pleasure of meeting the lovely Brian of AntiDepAware and his equally gorgeous wife. We met with Bobby Fidd which is always a pleasure but who missed the chat afterwards having commandeered my poor husband to go outside for a smoke, and who subsequently both got lost.
The 3 gorgeous girlies under the age of 3 were hilarious, funny and little dotes. I don’t know how any household survives them, but I actually miss them already!
PS. The LegoLand experience was amazing and went without any major incident thankfully. All children accounted for, happy and alive, which is more than I can say for my eldest son’s involvement with Lundbeck pharmaceuticals and some uninformed Irish doctors.
Bob Fiddaman’s account of the meeting can be read here, while Brian’s can be read here.
Next week BBC’s Panorama team are tackling the issue of antidepressant use in pregnancy. The programme will be broadcast on Mon 1st july, entitled ‘The Truth About Pills and Pregnancy‘.
According to the UK Independent “The programme will broadcast an interview with Anna Wilson, whose son David spent the first five weeks of his life in hospital. A 20-week scan had shown that David had a heart defect and would need surgery immediately after being born. Anna had been taking the prescription drug Citalopram to treat her anxiety four years before her pregnancy began, and was told that she was safe to continue whilst pregnant. The show will feature interviews with Prof Pilling, who will say that GP prescription guidelines are about to be updated to take into account evidence suggesting a link with SSRIs and heart defects.”
A manufacturer contacted by the BBC denies any link to major foetal malformations (no prizes for guessing Lundbeck here).
Panorama spoke to eight mothers who had babies born with serious heart defects after taking a commonly used SSRI (selective serotonin reuptake inhibitors) antidepressant while pregnant.
An article on BBC News stated “Lundbeck, the manufacturer of Citalopram, said a recent review of scientific literature concluded that the drug ‘does not appear to be associated with an increased risk of major foetal malformations’.”
It seems that Lundbeck are lying again or there is a serious lack of communication between the various medicines regulators and the pharmaceutical industry. Below is an adverse reaction report logged with the Irish Medicines Board involving a baby born with a Cleft Lip, associated with the mother’s use of Citalopram.
What about the following, also reported as Citalopram induced? This particular report concerns the intrauterine death of an unborn baby due to ‘Citalopram exposure during pregnancy’.
Then there was our meeting in Copenhagen with the two Lundbeck goons. We asked if Citalopram/Escitalopram was a teratogen. Their answers (or non-answers) may surprise you…
Leonie Right, will I go on because there’s no point, we’re stuck at that one? Anyway. Do you think that it’s advisable to virtually bathe foetuses in Serotonin given it is now accepted this family of drugs are firmly associated with birth defects?
Dr. Madsen Virtually bathe?
Leonie Foetuses in Serotonin – pregnancy.
Tony Pregnant women.
Dr. Madsen I don’t know what you mean by virtually bathe
Leonie I’m talking about anti-depressants are known to cause birth defects. If you think so, would it not be better if women of child-bearing age were cautioned against, perhaps even contra-indicated from using this drug? Citalopram or Escitalopram?
Dr. Madsen Em, I think in…..
Leonie Your views?
Dr. Madsen In pregnancy?
Dr. Madsen Em, I think em, physicians need to double their efforts to make sure that there is a correct risk versus eh, benefit eh, assessment of the em, of any action.
Leonie Is Citalopram and Escitalopram a teratogen?
Dr. Madsen Em, meaning, what, what, what do you mean?
Leonie Can it cause harm to foetuses? Unborn babies.
Dr. Madsen Em, obviously, in order to have our compounds approved we have done em, a large number of pre-clinical trials em, and we are constantly monitoring and the eh, while the recommendation I believe throughout, is to be, be extra cautious when administering any eh, medications to pregnant women…
Leonie Can it cause harm?….. to unborn babies?
Dr. Madsen Anything can cause harm, can cause harm in any dose
Leonie So yes it can.
Dr. Madsen depending on dose
Em, why if it can cause harm, is this not clearly, clearly stated on the packaging and information leaflet?
Mr. Schroll Do you talk about the patient leaflet or do you talk about the SPC, the label that the Doctors use in order to prescribe the medication?
Leonie I’m talking about a pregnant woman that goes down and gets it in the chemist. Is it on the patient information leaflet?
Mr. Schroll In the patient leaflet it says you have to talk to your Doctor….
Leonie And what does it say in the Doctor’s leaflet?
Mr. Schroll That he has to be extra cautious. I think that if you go to the… to, to the Irish home page, I believe it is like that, it’s like that in Denmark and elsewhere. If you go to the medicines agency authorities
Mr. Schroll the medicines agency authorities you can see what is in the checks that the Doctors and that is up to them to decide…..
Leonie So you are passing the buck back to the Doctor again.
Mr. Schroll I think when it’s prescription medication, yes. If it was eh, eh,
Leonie And will they be told that it can harm their unborn baby?
Mr. Schroll Sorry?
Leonie Will the pregnant woman be told that the drug can, can harm her unborn baby?
Mr. Schroll It would be part of the discussion to talk about the risks and the benefits and that would be up to the Doctor.
Leonie It would be up to the Doctor to tell them that the drug can harm their unborn baby?
Mr. Schroll Eh, now, you’re talking…..
Leonie It’s not up to Lundbeck, no? It’s up to the Doctor to tell the woman that the drug can harm their unborn baby?
Mr. Schroll To be cautious, yes, yes.
The Irish word ‘amadáin’ springs to mind. I could think of a few English ones too but think I’d better refrain. The Panorama programme should be excellent viewing as usual, particularly with Shelley Jofre as reporter. She did the previous expose concerning GSK and Seroxat suicides. I can see her putting Lundbeck in their place.
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 she 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.
Ina 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 weekregarding 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 discussionson an explanatory hypothesis highlighted that even in older adults the possibility that in SSRIs may increase risk of suicidal behaviour cannot be ruled out.” TheEu 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.
I have written an article which appears in the ‘health and living’ section of the Irish Independent today; here.
The writing is all mine this time, so for anyone who doesn’t agree; it’s all my work and I stand by everything I said. There was a paragraph missing to do with antidepressants and miscarriages; I feel this is very important so I’ve left it in here. All stats were verified by Prof David Healy.
Are they mad or what?
The Irish Independent have asked me to write this article; are they mad or what? ‘Mad’ is a word I am well used to hearing. Having lost my son in the ‘most’ tragic circumstances in 2009, I’m left as most mothers with a dead child are left: in cloud cuckoo land, extremely sad and just a little bit mad. In my case I’d say ‘more than a little mad’ but I don’t want to tar every bereaved mother with my madness brush. What is it with Irish people and their reluctance to talk about death and dead people? I have never heard so many people talk about the ‘dreadful’ weather; whatever you do, don’t mention that big fat elephant in the room. Most of the time I couldn’t tell you what day of the week it is, never mind what the ‘dreadful’ weather is like, but please feel free to talk about that big fat grey thing with the huge trunk; my son. He’s dead, not erased from existence, but don’t upset the ‘mad’ bereaved woman whatever you do! Say the wrong thing, by all means, but don’t pretend he didn’t exist and talk about the ‘dreadful’ weather! I can’t tell you how close some people have come to manual strangulation, simply by saying ‘it’s a lovely day’ or more likely ‘the weather’s terrible, isn’t it?’
Before I get shot down for using the ‘m’ word, I’d like to say that the so-called ‘mad’ people that I’ve met in the last three years are no madder than most of you, and definitely not I. Some of these people have been told that they have a ‘chemical imbalance’ of the brain; so in order to keep their brain functioning as it’s supposed to, they will need to stay on medication for the rest of their lives. These mad dysfunctional lot could teach the so-called ‘normal’ society a thing or two; mainly about kindness, compassion and a willingness to help others. They are also the ones who are shouting from the rooftops that the chemical imbalance theory is just that; a theory. For decades we were led to believe that depression was caused by low serotonin levels in the brain. There is no way, never has been, to measure serotonin in a person’s brain, and absolutely no evidence that low serotonin levels ever caused depression.
By way of background; my son killed himself and another young man in 2009. He was prescribed an approved SSRI antidepressant 17 days beforehand. I absolutely believe that these ‘mind altering drugs’ are killing people at an alarming rate. Professor David Healy (a world leading expert on these drugs) has said that the pharmaceutical companies, in a court of law, have no choice but to admit that these drugs can cause suicide. According to Professor Healy, “there are 20 more Irish suicides per year than there would have been and 20 extra Irish cases of violence per year that can be linked back to antidepressants.” So given that the SSRI antidepressants have been on the market for 20 years; that’s 800 extra cases of suicide and violence caused by antidepressants in this country alone.
The first major Case involving antidepressant induced suicide/homicide was in the US and involved a 60 year old man, Donald Schell. This man was put on Seroxat by his doctor, not for any mental illness, but for anxiety; yet 2 days later he shot and killed his wife, his daughter, his 9 month old granddaughter and then himself. The jury found that the drug had caused him to become suicidal and homicidal and found the pharmaceutical company liable, in that Case GlaxoSmithKline. There have been similar Cases since, the most recent in a Canadian trial where the Judge found that an antidepressant caused a 16 year old to kill his friend. The Judge (Justice Heinrichs) concluded that the teenager was no longer a danger and that at the time of the killing “his mental deterioration and resulting violence would not have taken place without exposure to Prozac.”Shane was sad, I know that; was that depression, no! Can these prescription drugs help with a broken heart or some other awful life experience? Can they un-break a heart or un-dead a loved one? No, but they can cause these terrible tragedies.
From the time Shane was prescribed these drugs, he became very restless, which was very unlike him. He seemed to find it hard to stay in the one place for any length of time. What I didn’t understand until later was that this condition is called ‘akathisia’ and is known to be the precursor to suicide and/or homicide. Akathisia is an adverse effect which can be caused by these drugs and is described as ‘inner restlessness’. People suffering from this condition have described it as ‘a living hell’ and also that they would do anything to stop this feeling, including death as a welcome release. My son went from being well respected and loved by his lecturers, friends and family, to a person capable of destroying his own life and that of another human being in 17 days. Whether people believe me or not, matters little to me, as I cannot win either way. I can tell you this though: I knew my son inside out, and if it could happen to Shane, it could happen to you.
The level of ‘antidepressant’ prescribing has never been so high and yet the suicide rate is rocketing. Join the dots here if you dare and please don’t argue the recession point; I’ve heard it already. We’ve come through the famine, oppressive English rule, Centuries of emigration and barefoot children; for goodness sake, get a grip! The suicide rate has never been so high and the barefoot children are long gone; presumably dead from old age and natural causes, not by their own hand. Each year there is (at least) one antidepressant prescription per year for every man, woman and child in Ireland. If these drugs actually cure people; how come we once had less than 1 per 1000 of us depressed, and now it’s more than 1 in 10? In the year 2010 the cost of medicines in the health service was €1.9 billion. Have we all gone mad? Why do we need €1.9 billion worth of medication every year; were we all born with inherent defects that only the (billion dollar) pharmaceutical industry can fix? Wake up and smell the pharma coffee when you take that statin this morning! Is that antidepressant you just consumed keeping you happy or can you remember either way? Without doubt the most medicated Country in the world is the US; would it surprise you to know that the life expectancy in the US has fallen below that of Cuba?
In the latest revelation within the mental health arena (Oct 2012), the British Medical Journal (BMJ) published a paper which showed that the risk of suicide (in the first year of treatment) for schizophrenia is extraordinarily high. For schizophrenia generally, you are 10 times more likely to be dead at the end of the first year of treatment than you were 100 years ago. Did you read that? 10 TIMES MORE THAN 100 YEARS AGO! Professor Healy (one of the authors) said “the actual risks of suicide (in the first year of treatment) were 100 times greater than those of the general population.”
Also this week, to much fanfare it has to be said, Minister Reilly said a “very good deal” was made with the Pharmaceutical Industry, to cut the State’s drugs bill by up to €400 million. This he said would benefit patients and the taxpayer. Right; excuse the cynicism here but that’s €400 million over 3 years, which is equivalent to a saving of €133 million a year. What’s €1.9 billion divided by €133 million? The Pharmaceutical industry may find this as amusing as I do; laughing all the way to the bank.
It amazes me that drugs with adverse effects such as suicide, depression, aggression and birth defects can be licenced by the Irish Medicines Board and yet the ‘free will’ of the pubic to medicate themselves is taken away by the banning of herbal remedies. I doubt if my son would be dead as a result of consuming a large dose of ‘Echinacea’. While I realise that all prescribed medications come with side-effects, we in Ireland are not afforded the same level of warning that other countries are. For example, all antidepressants come with a black-box warning in the US which signify that these drugs can have serious or even life-threatening adverse effects.
Of course herbal medicines are not without controversy either; St John’s wort, which has similar properties to an antidepressant, was widely known in the farming community to cause miscarriage and birth defects in cattle. Farmers took steps to prevent this drug from coming into contact with their animals; yet pregnant women are afforded no such warning. 1 in 10 pregnant Irish women are on antidepressants, leading to about 40 extra babies with significant birth defects and 200 extra miscarriages each year. So in the last 20 years, antidepressants have caused birth defects in 800 Irish babies and 4000 miscarriages.
I’m not entirely stupid; I know that some drugs can save lives and there will be people who say “the drugs have saved my life”. Who will speak for the dead people though, do they have a voice? €1.9 billion worth of drugs? Surely I’m not the only one who thinks that this is the biggest wheeze of the 21th Century. The number of people requiring medication is increasing every year. Will we eventually face a world where the majority of the human race will be ‘a bit mad ted’ and will therefore be the new class of norm? It could be seen as ‘the’ miracle of the 21th Century, where the meds are cast aside as the now normal ‘mad’ people don’t need them anymore; let’s all embrace the madness. It would surely be interesting to see what subsequently happens to the pharmaceutical industry; spontaneous combustion? Or just a frantic scrambling to find a way to convince people that medicating the ‘normal’ is actually now in Vogue? The old tale of ‘be careful what you wish for’ springs to mind. Dreadful weather, isn’t it?
Last week Professor Healy spoke on RTE radio with Professor Veronica O’ Keane, consultant psychiatrist in Trinity College. The debate (podcast) centered on the ‘increased use of sedatives and antidepressants‘.
Professor O’ Keane stated that antidepressants are not addictive drugs, where-as Professor Healy said that they are indeed highly addictive and that it’s easier to come off benzodiazepines than antidepressants. Professor O’ Keane was ‘astonished’ at this ‘claim’ and gave a little snigger to show how absurd she thought this claim was.
Speaking on the long term use of antidepressants she said “Depression is not a condition that goes away; it’s a recurring condition and if people stop taking their antidepressants with this recurring condition, their chances of killing themselves are increased by two.” Professor Healy stated that it’s actually the drugs which increase the risk of suicide and violence and that “antidepressants come with ‘black box’ warnings in the US saying that they cause suicide.”
Professor O’ Keane then went on to say that “the black box warning that David is referring to is for under 24; there is no such warning for individuals over the age of 24 and in fact it reduces suicidal ideation in those over 65”. No mention of the black-box warning in this article where she states “Anti-depressants work in young people, in terms of alleviating suicidal ideation secondary to depression.” In the radio interview, she further went on to say “It’s very important that the public are aware, that the problem here is not antidepressants, the problem here is depression. Depression is the real killer.” Ah yes, it’s the person and not the drug.
Professor O’ Keane has been described as an ‘expert on mental health during pregnancy’. She stated here that “There is an idea that depressed women should struggle through pregnancy without help, and stay pure… But depression is a physical disorder and should be treated.” In a paper published in the British Medical Journal by O’ Keane et al, here, the study concluded that Untreated depression in pregnancy is associated with poorer maternal health practices and less favourable obstetric outcomes.
A letter regarding this paper was later published by the British Medical Journal, written by Adam C Urato, an attending Physician (Maternal-Fetal Medicine) at Tufts University, Boston. Dr Urato made some interesting points:
(1) I have several concerns regarding the recent “Pregnancy Plus” article entitled “Depression during pregnancy” by Veronica O’Keane and Michael Marsh. I am concerned with the content of the piece as well as the lack of transparency regarding the financial associations of Dr. O’Keane.
(2) In the introduction to the piece, the authors comment: “The case presented here highlights many of the key issues involved in the management of pregnant woman with depression, particularly the importance of active treatment.” Depression during pregnancy is a difficult issue and one that I deal with on a regular basis as a practicing perinatologist. Depression during pregnancy is very concerning, as is the use of antidepressants during pregnancy. Active treatment is usually with a selective serotonin reuptake inhibitor (SSRI) and there is much to be worried about with maternal and fetal exposure to these drugs. Antidepressants have not been shown to improve maternal or child health outcomes during pregnancy. And in various studies antidepressant use in pregnancy has been associated with increased rates of spontaneous abortion, congenital malformations, preterm birth, low birthweight, fetal death, seizures, neonatal withdrawal syndrome, persistent pulmonary hypertension of the newborn and a possible predisposition to psychopathology.
(3) The question many readers might have after reading a piece that emphasizes the importance of antidepressant medication use in pregnancy is whether Dr. O’Keane is being paid by the antidepressant makers.
Professor O’ Keane has in fact listed her ‘Conflict of Interest’ as being with Eli-Lilly, creators of Prozac and Duloxetine (Cymbalta); Here. In another Article here, she said Prozac belonged to a family of compounds which represents ” one of the few major breakthroughs in the treatment of psychiatric illness in the past 40 years.”
Interestingly, numerous articles have been published this week regarding the dangers of antidepressants in pregnancy, including this one in the Irish Independent. This article quotes the same Dr Adam Urato: “Doctors are putting thousands of pregnant women and their unborn children at serious risk of harm by prescribing them anti-depressants, senior doctors are warning. Senior doctors say that ‘study after study’ shows the most widely used class of anti-depressant, called selective seratonin reuptake inhibitors, or SSRIs, cause pregnancy complications including premature birth and pre-eclampsia, which can both be fatal. Emerging research also suggests SSRIs can double the rate of autism in children, and increase the risk of lung and bowel diseases. The situation amounts to ‘a large scale human experiment’, according to Dr Adam Urato, assistant professor of maternal-fetal medicine at Tufts University, School of Medicine, Boston.”
So, who’s right and who’s wrong? I know who I’d believe. Professor Healy has coincidentally been saying for years that antidepressants can cause terrible birth defects in children “…even as the evidence accumulates that these drugs cause birth defects, double the rate of miscarriages, and cause mental handicap in children born to mothers who have been taking them.”
Considering Professor O’ Keane works in Trinity, the same College that Shane attended, it wouldn’t take much out of her day to speak to Shane’s lecturers. It would be interesting to hear her views on my son, who was loved and respected by his lecturers and who was known by them as ‘An Chroí mór’ (the big heart). Yet after 17 days on Cipramil, he killed himself and another. Maybe she’s so sure of her own opinion, that she doesn’t need to listen to us mere parents!
I receive e-mails occasionally from people looking for information on SSRI’s. Usually they’re from people with stories like mine with tragic endings but sometimes, just sometimes, there are nice stories of people who have survived their experience. Here’s one from a reader who would like to share; she wants to address the importance of an informed decision. Sadly, in Ireland, denial of the dangers of SSRI’s by the majority of the medical profession means that most Irish consumers will not be informed. I’m so glad that this one had a better outcome….
I needed to let you know that your blog and Shane’s journey have had a profound effect on me since the moment I read the first post. Knowing depression/anxiety and mental illness has run in my family I was very aware of the subject matter and read your blogs and links with due diligence. Little did I know that the knowledge I was gaining would play a part in saving my own son from the brink of despair and possible great harm. I live in America; my son is 21 and has been away at college for several years. He was doing terrific, grades were great, involved socially in great things, fund-raising for worthy causes, it seemed everyone loved him and he loved life. Then my mother’s instinct kicked in. I knew something had changed, he had broken up with a girlfriend (not a serious relationship), his grades were dropping and he was not as involved in social events as he had been. We lost several close family members and friends in the last few years, he took each loss badly. Then a friend of his died from a combination of illegal drugs. I heard my son break on the phone when I called to tell him the news. I travelled to him regularly, each time worrying more than the last, offering him “options” to leave college, to change his life, any support I could. I hesitated to advise him to take anti-depressions based on Shane’s story, and found lots of natural remedies/ over the counter stress relievers but none seemed to have any long term support. All the time he was a 3 hour drive away from me. It was nerve raking.
To cut a long story short, one day in April I got a heart wrenching call from my son. Thankfully a friend had recognized he needed help and brought him to a hospital. He had voluntarily checked himself in to a clinic to help him with severe anxiety/depression. He had been self-medicating with drink and anything he could to escape his personal pain.
After several conferences with medical/clinical staff and my son, it was highly recommended that he go on an anti-depressant. I spoke to his caregivers (privately) and explained my concerns. Here’s the shocker when I said “I am aware that SSRI’s can heighten anxiety and actually give the patient suicide and homicidal thoughts” the answer was immediate and blunt “ooh that’s only with people who have already had those thoughts before taking them”. I quickly responded with a ton of knowledgeable medical research quotes and cases (thanks to your blog) and told them of Shane’s journey. I could tell by the silence (it was a phone call) and immediate empathy that the social worker had learned something valuable from my words.
That being said, I knew my son needed help beyond hand-holding. His situation was real and serious and I had no doubt from my visits with him at the clinic that he was a suicide risk. So I advised him of the risks to taking SSRI’s, told him I would support him with in whatever he needed but I felt he needed full medical supervision while he started the medications. Thankfully he and his team agreed. To say his first week on the meds was the longest in my life would be an understatement. However I felt comforted by the fact that he was in counselling, being monitored closely and I prayed, crossed my fingers, and even asked Shane to look out for him! Within a week my son was a different young man. He starting talking in a hopeful manner, by week two he was calmer. Months later he is now off the anti-depressant (they had put him on the lowest dose possible), and he attends group therapy and has made changes to take a lot of pressure away from himself. He’s closer geographically now, and my mother’s instinct has relaxed (although I’ll always be on alert!). I knew in my heart he needed help both in meds and support. If it hadn’t been for you sharing Shane’s journey I know I would not have been so insistent he got the level of supervision, the lowest dose possible, nor the full support of follow-up. Depression is a real illness, and it needs more than a ‘happy pill’ to treat it. Thank you, from the bottom of my heart, for allowing me to be an informed Mother, I was scared, and did the best I could with what I knew. Just as you did. That’s all we Mothers can do. Thank you for giving us more information to make more informed decisions/give advice to our young adult children. I’ve already thanked Shane, so now it’s time for me to thank his Mum.