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Mini Edition29 September, 1999
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Is Prozac the trigger for suicide?
Drug giant's bid to block disturbing new research

A SECRET campaign was waged by drugs industry giant Eli Lilly to suppress reports suggesting that Prozac could make some people suicidal.

Documents seen by The Express show that the company's executives made "protect Prozac" top priority in the face of adverse criticism. They feared that the company would go out of business if there were reports in Britain linking the drug to suicide.

Prozac is the world's best-selling drug for the treatment of depression, eating disorders and pre-menstrual tension. It is used by half a million people in the United Kingdom.

Scientific opinion is divided on whether Prozac can induce suicidal tendencies in some patients. Eli Lilly has always argued that there is no credible evidence to support the theory. But documents released in a US court case earlier this year reveal that the firm was highly sensitive to reports on possible dangerous side-effects.

THE young office worker had suffered one of the shocks of life that nobody could be prepar-ed for. Three weeks before her wedding, her partner died suddenly and inexplicably of a heart attack.

It sent Ramo Kabbani, now 32, into a spiral of despair. Ten months later, still sobbing uncon-trollably in the night, she sought medical help and was prescrib-ed a number of anti-depressants. None worked. So eventually she, like 38milli-on people across the world, began taking Prozac. Its effect was extraordinary.

"I went on an un-natural high. I belie-ved the whole world should be on Prozac. I was euphoric," said Ms Kabbani, of Manchester. "I lost my inhibitions and started doing bizarre, out-of-character things like spending 3,000 on credit, knowing full well that I couldn't pay it back."

But nobody had warned her of what was to come. After six weeks she became suicidal, literally overnight. "I was suddenly obsessed with killing myself and took an overdose of pain-killers," she said. When this failed, she planned further attempts and even started to arrange her own funeral.

She said: "I had an inner restlessness. I couldn't settle. I had no peace. I would go to bed thinking about ending my life. I'd sleep - sometimes for days - and dream about it, then wake up still thinking about it."

Her suicide attempts became calculated. "I'd tell the family I was going away so I would not be found," she said. "Then I'd take a cocktail of drugs which I thought would kill me.

"But I would vomit or go into a deep sleep for days. I'd then feel a complete failure because it had not worked. I tried taking cocktails of drugs in different ways - even with milk to line my stomach and stop me being sick."

When drug overdoses failed, she thought of other methods. She recalls: "I would spend hours working out which multi-storey car park I could jump from without being seen. I went into my loft to find rope to hang from the hot-water tank. I weighed up whether it would be strong enough to take my weight and decided it wouldn't."

Incredibly, she survived. After realising that her obsession with suicide may have been connected to Prozac, she took herself off it. Suicidal thoughts disappeared within a few months.

Her experience is not unusual. Dr David Healy, a psychiatrist at the University of Wales College of Medicine, believes hundreds in Britain have committed suicide while on Prozac.

"The drug affects different people differently," he said. "Some have restless moods. They can't sleep, sit down or concentrate. Their minds are constantly racing." Suicide can be seen as an escape from this agitated state, it is argued. At the same time, Prozac releases a person's inhibitions and can make them less likely to pull back from taking their own life.

S uch possible side-effects have been known by the drug's manufacturer, giant American pharmaceutical company Eli Lilly, for more than 20 years but it always dismisses them.

It argues that cases such as that of Ms Kabbani are merely anecdotes. Its own research has never found strong evidence to link Prozac with suicide.

Documents revealed by The Express today show that the firm has spent years attempting to quash debate on the drug's potentially lethal consequences.

There are no warnings about suicide on the leaflets inside Prozac packets. In the UK a circular is sent to doctors saying there have been reports that the drug causes suicidal thoughts but no "causal" relationship has been established. Earlier this year Dr Healy presented data claiming that suicide rates are six times higher among depres-sed people who take Prozac.

He said: "Not only do Eli Lilly fail to warn people properly, they deny the link between Prozac and suicide. When anyone draws attention to it they rubbish them in the way tobacco companies rubbish the link between smoking and cancer."

There is no doubt of the importance of Prozac to Lilly. Last year world sales of the drug were worth almost 2billion. It has become the universal cure for depression and eating disorders such as bulimia. It was recently licenced in the UK for the treatment of pre-menstrual tension.

The company is keen to preserve the drug's reputation as the anti-depressant with the fewest side-effects but it is facing some 200 court cases in the US alleging a link between Prozac, suicide and aggression.

The first case has already been held. It centred on a Californian who stabbed his wife to death and impaled himself on a kitchen knife soon after being prescribed Prozac. His family argued that Lilly was responsible because it failed to warn patients of such side-effects.

The case failed and the family is appealing. But a number of disclosed internal documents from Eli Lilly were put into the public domain for the first time. They show that the company's executives were aware of a number of reports linking Prozac to suicidal thoughts and attempts.

When a report linking Prozac to suicide was published in an American scientific journal in 1990, the company became de-fensive. In an internal memo that year Lilly's top scientist, Dr Leigh Thompson, referred to safety worries of UK doctors.

It read: "I hope Patrick (head of Lilly's operation in the UK) realises Lilly can go down the tubes if we lose Prozac and just one event in the UK can cost us that". In another memo Thompson wrote: "Anything that happens in the UK can threaten Prozac worldwide. We are expending enormous efforts fending off attacks because of (1) relationship to murder and (2) inducing suicidal ideas."

T he Express has obtained six confidential letters Lilly sent to its sales representatives. Each refers to research on the possible association of Prozac and suicidal behaviour. The letters instruct reps not to mention this research to doctors. One explains: "These iss-ues (suicide) are not part of our current marketing plan."

A Lilly scientist in Germany wrote to the head office in 1990 questioning why he was being asked to report cases of suicidal thoughts as "depression". He added: "I could not explain to a judge, to a reporter or even my family why we would do this."

The company line is consistent. Its says the US Food and Drug Administration and the UK Committee on Safety of Medicines cleared Prozac of in-ducing suicide in the early 1990s. It says suicides are caused by depression, not the drug.

This will not stop legal action against the company. Graham Ross, a Liverpool solicitor, is investigating six cases in which patients or their families believe that Prozac is to blame for loss of life or a terrible adverse reaction. He said: "We have expert evidence to show Prozac caused suicide."

  • Express investigation team: Lucy Johnston, Jonathan Cal-vert, David Connett and Michael Gillard.
    Express Newspapers Ltd
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