The dark side to the 'happy pills'
As a result of anxiety, stress, phobias and depression, 300,000 Irish people take anti-depressants. There are fears they can be a prescription for self-mutilation, suicide and even murder. Eddie Lennon reports on...
Depression is the affliction of our time. There are all sorts of reasons why people get depressed, including redundancy, a broken heart, bereavement, sudden disability, financial difficulties, sexual and domestic abuse, bullying at school/work, dashed expectations and broken dreams.
According to the Irish College of General Practitioners, four in 10 Irish people become depressed at some point.
And some 300,000 Irish people are taking anti-depressants, says Irish Patients Association chairman Stephen McMahon. The drugs are prescribed mostly by GPs.
An estimated 80% of anti-depressants prescribed here are SSRIs (Selective Serotonin Re-uptake Inhibitors). They include drugs like Seroxat, Prozac and Cipramil. Manufacturers claim SSRIs boost the brain's levels of serotonin, the body's natural painkiller, lifting people out of depression. Much of the allure of SSRIs is the belief that they target the biological roots of depression.
But there's a dark side to the so-called 'happy pills' that have taken Ireland by storm. As evidence of their dangers becomes increasingly compelling, there's a huge groundswell of concern among medical experts that not only do SSRIs not work for many people, but they can be a prescription for suicide, self-mutilation and even murder.
Many medical experts say the most popular medical answer to the unhappiness caused by adversity is worse than the hellish state it's prescribed to treat. They say the distressing and sometimes fatal side-effects and withdrawal symptoms of SSRIs are a chemical time-bomb ignored by doctors and flatly denied by pharmaceutical companies.
Irish doctors are in the firing line from their own colleagues for unwisely and dangerously over-prescribing SSRIs. The war of words is reaching fever pitch.
The stakes are enormously high: Irish people's health and lives are on the line. So are doctors' reputations and the financial health of the multinational drugs companies whose billion-dollar earnings are boosted by the huge success of SSRIs.
The case against SSRIs has been building with relentless force. The US Food and Drug Administration says that from 1997 to 2002, the six most popular SSRIs were suspected of triggering 3,309 incidents of suicide, attempted suicide or hostile, violent behaviour in America. Suicidal or aggressive behaviour were reported in children who took the drug, more than twice as often as among adults who did.
Irishman David Healy is Visiting Professor of Medicine at the University of Toronto and Director of the North Wales Department of Psychiatry. He has written two books on SSRIs and is a leading international expert. Three years ago in Wyoming a 60-year-old doting grandfather went on a shooting spree, killing his wife, daughter and granddaughter, and then himself, after taking Paxil, the US brand name for Seroxat.
He had been depressed but had no history of aggression or suicidal behaviour. He had been taking Paxil for two days, and he had consumed just two tablets. Dr Healy was an expert witness in the case, taken by the victims' relatives against Seroxat's manufacturers, GlaxoSmithKline (GSK).
He had previously tested SSRIs on a group of healthy volunteers and found that when people took an unsuitable SSRI, they experienced mental turmoil, and two became very suicidal. When Dr Healy got access to GSK's archives, he says it appeared that information about Seroxat had been manipulated. "In the original trials, it looked like there was up to eight times' greater incidence of suicidal acts with Seroxat than on a placebo (dummy drug).
"When Seroxat came on the market, GSK said it wasn't addictive. But in the mid-'80s healthy volunteers took Seroxat for two weeks and on withdrawal were left depressed and anxious and one committed suicide."
Two years ago BBC's Panorama investigated Seroxat. The BBC was inundated with unprecedented feedback. The 68,400 calls and emails offered vivid stories about suicide, domestic violence, addiction, self-mutilation, paranoia, homicidal fantasies and attempted murder.
The Irish Advocacy Network lobbies for better treatment for Irish people with mental difficulties. Its chief executive, Paddy McGowan, says his network has received reports from 200 Irish people about violent impulses while taking SSRIs.
"Their violent feelings towards themselves and others happen while taking SSRIs and coming off them. Most had no such feelings when they first went to their doctor feeling depressed. The withdrawal symptoms are sometimes much greater than the original problem. Many people become depressed again and feel they need to go back on the drug. Some take 17 months to come off SSRIs."
Tom O'Dowd is a GP and Professor at Trinity College Dublin's Department of Public Health and Primary Care. "The side-effect that frightens me most is the suicide element. When I prescribe SSRIs, I always discuss that with my patients. Some are already predisposed to suicide. I give it to them for a week. You have to see them every seven days till their suicide compulsions are gone. The drug disinhibits people. We all have an inhibition against harming ourselves. SSRIs seem to weaken that inhibition."
Dr Healy estimates, based on results from clinical trials, that 20,000 people in America have committed suicide, over and above the number who would have done so if left untreated.
Psychotherapist Dr Terry Lynch, author of Beyond Prozac, says up to a third of Irish people who take SSRIs stop taking them because of their side-effects. "Some find SSRIs helpful. But many notice less interest in sex and have diminished sexual performance. Since SSRIs are stimulant-type drugs, some people experience anxiety, decreased sleep and weight loss. A very worrying side-effect is akathisia (restlessness leading to tension and panic), which has driven people to kill themselves."
Although drug companies insist millions of people take SSRIs without problems, and that any suicidal thoughts are due to their depression, increasing evidence contradicts this. Internal documents from Eli Lilly, manufacturers of Prozac, the world's most popular SSRI, show that in 1990 the company's scientists altered records on doctors' experiences with Prozac, changing mentions of suicide attempt to 'overdose' and suicidal thoughts to 'depression'.
Three years before Prozac got the green light from the US Food and Drug Administration (FDA) in 1987, the German government refused to approve the drug, based on studies showing that previously non-suicidal people who took Prozac had three times the rate of suicide and suicide attempts than those who didn't take the drug.
In 1991 the FDA concluded a link between suicide and Prozac hadn't been proven. But last year it issued a warning, urging close monitoring of potentially suicidal behaviour during Prozac treatment. It also asked the manufacturers of 10 anti-depressants to put stronger labelling on SSRIs, warning about suicidal risks.
Britain is reviewing the safety of SSRIs after reports that some patients turn violent or suicidal while taking the drugs. Court cases are ongoing against SSRI manufacturers in Britain, Canada and several US states by people alleging physical and psychological withdrawal symptoms. In Ireland claims against one SSRI manufacturer are understood to have started.
Some people are finding SSRIs a chemical prison. Dr Lynch says: "Doctors claim SSRIs aren't addictive because people who take them don't want more of them. In my experience over the past seven years, over 50% of people coming off SSRIs suffer anxiety, emotional upset, shakiness, dizziness, agitation and shock-like sensations in the head. They've such difficulty coming off SSRIs, they often decide to stay on them."
Patricia Casey, consultant psychiatrist at the Mater Hospital and Professor of Psychiatry at UCD, says some GPs are wrongly prescribing SSRIs. "SSRIs don't work for negative life events, which resolve themselves with time. I'm as likely to take people off an anti-depressant as I am to put them on one. We've mistakenly assumed everybody with a depressed mood has a chemical depression. It's not always the same thing."
Dr Healy says SSRIs help about half the people who take them, but make many others more anxious, violent or suicidal and physically addicted. "We can't trust articles in (leading medical journals) any more, as an increasing number are written by the pharmaceutical companies and ghost-written so they end up with the names of the most senior people in the field on them. But they don't represent the reality of clinical trials, which shows these drugs don't work that well."
Dr Lynch says: "GPs are diagnosing depression by asking people a few questions and putting them on anti-depressants. That's an almost primitive approach. Human distress is being repackaged as chemical depression. GPs are really out of their depth when dealing with emotional distress."
Dr Michael Corry, psychiatrist at Dublin's Institute of Psychosocial Medicine and author of the book Going Mad, says psychiatrists are equally to blame. "I've prescribed SSRIs only three times and discontinued them because my patients had side-effects. Many people say SSRIs make them feel like a walking corpse. Even those who think the drugs are helping them say 'I feel weird'.
"Depression is wrongly treated because of the notion of a chemical imbalance. Serotonin levels can't be measured. We don't even know if it's the main neuro-chemical involved in depression because there are hundreds of these chemicals."
"Depression is a normal emotional response to someone's life experience," says Dr Michael Corry. "Making someone realise they've good reason to feel depressed incredibly empowers them. Otherwise, we're degrading what it is to be human. We need to be humanising, not chemicalising, life's problems."
Dr Eamon Shanahan of the Irish College of General Practioners says GPs often have no choice but to medicate people suffering from depression, given the lack of counselling services, particularly for medical card holders.
Dr James Reilly, president of the Irish Medical Organisation, says SSRIs aren't addictive and treat depression effectively. He denies GPs are systematically over-prescribing SSRIs.
"Irish doctors are in denial," says Dr Lynch. "We're letting our patients down by failing to educate ourselves about anti-depressants. Five or 10 years from now, the true story about SSRIs will have emerged. Questions will be asked why nothing was done to alert people about the dangers."
We asked GSK, makers of the drug Seroxat, if there is a direct link between suicidal or violent behaviour and taking Seroxat, whether the drug has distressing withdrawal symptoms, and whether it is difficult or distressing to quit. The company did not answer our questions directly but referred us to the 'patient leaflet' that comes with the drug.
We put the same questions to Eli Lilly, makers of Prozac. It said: "Prozac has only rarely been associated with 'discontinuation or withdrawal syndrome' symptoms such as dizziness, pins and needles, headache, anxiety and nausea."