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Son of Wind
Quad Bikes Revisited
Forum Medication
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If you have experienced any side effects while on antidepressant medication and would like to tell us about it send us a confidential email

Useful information
Read the full Public Health Advisory issued by the FDA on the dangers of using antidepressants.

Visit for various useful lists of side-effects, lawsuits, articles and support sites.

Prozac Backlash
Prozac Backlash
By Joseph Glenmullen
This is a guide to the safe treatment of depression and other psychiatric problems. This text documents the side-effects associated with serotonin-boosting medications, and it indicates through research that there is a link between these drugs and suicide and violence.

Visit Dr Joseph Glenmullen's website

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Your antidepressant your problem?

Date : 18 July 2004
Producer : Odette Quesnel, Nicola de Chaud
Presenter : Derek Watts
Researcher : Bernadette Cook
Genre : Medical and Health

Derek Watts (Carte Blanche Presenter): “It’s certainly not news [that] millions of people around the world pop anti-depressants.”

Patient 1: “As long as it keeps me out of that place where I was before because if I had to go back there I don’t think I would make it again.”

Patient 2: “Without it I just stayed in bed. I couldn’t even get up.”

Dr Joseph Glenmullen (Psychiatrist, Harvard Medical School): “It’s supposed to raise your serotonin levels and that’s what makes you happy - like when you exercise and stuff.”

Derek: “In the United States alone almost two hundred million prescriptions are handed out every year, but popularity doesn’t make a medicine risk free.”

Dr Glenmullen: “The bottom line is that we don’t know how these drugs work, we don’t know exactly what their effects - both therapeutic and side effects, are in the brain. And that’s one of the problems - to be giving millions and millions of people drugs for years and years, decades, when we don’t fully understand what they do and what the long term risks are.”

Dr Joseph Glenmullen, a Professor at Harvard Medical School and practicing psychiatrist, believes that while anti-depressants work for most people, they can drive some patients to suicide and violence.

Dr Glenmullen: “I prescribe the drugs. I’ve had many patients say that they work, they help them, that they made them less suicidal. But I’ve seen a small percentage of patients… and it’s significant because we’re talking about a lethal side effect… who become worse. They become agitated, they become restless, they develop a pre-occupation with suicide that they did not have before they went on the drug. It’s relentless. It’s very clear it’s the drug. When you stop the drug it goes away.

Across the Atlantic, another very vocal medical expert is calling for extreme caution when prescribing anti-depressants.

Dr David Healy (Psychopharmacologist, North Wales University): “If they are not the right drug for you they can cause a range of problems. They can make you suicidal. They can throw you into a state of mental turmoil.”

There are few people in the world who know as much about anti-depressants as Dr David Healy, a prominent psychopharmacologist from North Wales University.

Dr Healy: “What you have got to realise is, by ‘mental turmoil’ we mean a state where people are having thoughts and impulses that they’ve never had before; thoughts of harming themselves, or harming others.”

Of this there is mounting anecdotal evidence from all over the world.

Son of a suicidal patient: “Within eleven days of being prescribed the Prozac, my father awoke in the early hours of the morning, placed a pillow over my mother’s face and suffocated her.”

Patient: “I started getting more restless, agitated. That then became the problem… like a nightmare.”

Mother of a suicidal daughter: “Her symptoms of depression seemed to worsen after the Prozac, and she committed suicide a few weeks after she started.”

They are pointing fingers at a family of anti-depressants known as SSRIs. Dr. Healy put this class of drugs under the microscope when he conducted clinical trials on healthy people.

Dr Healy: “These included GPs, consultant psychiatrists, senior nurses, all of whom were healthy, and senior, and what was seen when people were on the wrong drug for them [was] that they went through a stage of mental turmoil, on to becoming frankly suicidal.”

In fact his study showed that one in five healthy volunteers suddenly had thoughts of killing themselves. Alarming clinical evidence, but Dr. Glenmullen says it’s no reason to give anti-depressants the boot.

Dr. Glenmullen: “Medications come with risks, medications come with side effects. We can give them other drugs that counteract this side effect, but if you don’t warn people… that’s the real danger.”

Cecily Bostock never got that warning.

Sara Bostock: “I noticed changes almost immediately, actually and I was frantic because I thought it was the medication even then.”

Two years ago, Sara Bostock’s daughter Cecily was prescribed the American equivalent of Aropax for anxiety.

Derek: “Twenty-five-year-old Cecily Bostock grew up in this quiet home in San Francisco. She did well at school, excelled in the Arts and graduated from Stanford University.”

A musician, an artist, an all-round over achiever, Cecily sometimes had trouble coping with the pressure.

Sara Bostock (Mother of sufferer): “She was having a lot of trouble sleeping and she had racing thoughts, and she was over-analysing and she was overly sensitive… that is what prompted the prescription.”

Within three weeks of taking the SSRI, Sara says, her daughter became a totally different person.

Sara: The last two days she was just a complete zombie I have to say. She was just agitated, jumping at every noise and not making sense. I was very concerned. We were very close to Cecily. I just loved her deeply.

As concerned as she was, Sara could never have imagined the scene that confronted her one night in January two years ago when she got up to let the cat out.

Sara: “So I went into the kitchen and I turned the light on and she was lying on the floor. And I knew she was dead. And there was a knife on the floor by her and there was just a trickle of blood from her chest.”

Cecily had stabbed herself twice through the heart.

Sara: “I mean just unheard of for someone like this.”

Her death came about 20 days after she had started taking Aropax.

Sara: “Never made a suicide attempt… never had written anything suicidal in her journal. She loved us. It was just unreal! I’m sorry, but.”

Sara Bostock buried her daughter believing the anti-depressant medication had ultimately killed her.

Professor Christopher Szabo (Clinical Head, WITS [University of the Witwatersrand] Psychiatry Division): “I mean there could be a host of different variables that haven’t been factored in this scenario that we would need to look at.”

Professor Chris Szabo heads up the Psychiatry Departments at both Wits University and Tara Hospital in Johannesburg.

Derek: “Chris, so you are saying to just blame the drug in a case like that is irresponsible?”

Chris: “I think it doesn’t serve anybody’s purposes, and I think at the end of the day that would be simplistic. And yes, that might be irresponsible. When you’re treating a person who is depressed, forget the drug that you’re treating them with. You know that suicidality is always a possibility.”

Dr Glenmullen: “Yeah but again, if you’re well educated it’s very easy to differentiate in most cases underlying depression and suicidality from this side effect.”

Dr Glenmullen says suicidal thoughts could be the result of a well-documented condition called akathisia.

Dr Glenmullen: “They become very agitated; they want to jump out of their skin, and what they’ll say is they want to kill themselves to escape this severe agitation. That looks very different from someone who is depressed or suicidal.”

Sara: “I think she had akathisia. She had that agitation that is supposedly a drug-induced effect.”

Another possible factor, says Dr Glenmullen, is that some patients may not have the liver enzymes necessary to metabolise the SSRI anti-depressants.

Dr Glenmullen: “As a result, they might take a normal dose of the drug and have a sky high level of it in their body. And we believe now that some people are vulnerable to this side effect for that reason.”

Sara Bostock insisted on an autopsy to test for levels of Aropax - also called Paxil - in her daughter’s body.

Sara: “And she had a sky-high blood level… way above the therapeutic range. Clearly her system was not adjusting to the Paxil.

Cecily is one of a tiny minority. Dr Glenmullen estimates that one in a hundred people could develop suicidal thoughts as a result of their SSRI.

Dr Glenmullen: “It looks from the studies - and these are not precise numbers because the large scale systematic studies that you would need have not been done, but it appears about one percent of people. And that’s the best estimate that we have.”

Derek: “One percent?”

Dr Glenmullen: “One percent. But given that millions and millions of people are taking this drug, that’s an awful lot of people.”

Voices from around the world confirm that for the other 99 percent, SSRI anti-depressants are a lifeline.

Patient: “I really don’t know what would have happened if I hadn’t been helped in that way.”

Patient: “I don’t know if that very next bag I had down[ed] would have been the end.”

Patient: “I felt like a totally different person.”

Professor Szabo believes without a doubt that, if correctly prescribed and carefully monitored, these drugs work.

Chris: “The truth of the matter is these are powerful medications, and it would be sad if a class of drugs is tarnished on the basis of a number of case reports, and the good that is done from these agents is lost.”

Derek: “Is it fair to say you’ve only experienced positive effects?”

Patient: “Yes, yes, well I am here.”

Chris: “There is no question that these drugs do have a positive impact, but you’ve also got to be aware that they’ve often got unwanted side effects.”

He doesn’t buy the contention that suicidality is one of them.

Derek: “So the counter argument is, every medication has side effects - even aspirin?”

Dr Glenmullen: “Absolutely. I prescribe these medications. This side effect… there’s a double negative here. This side effect is no reason to not prescribe anti-depressants, but you need to warn people.”

End of part one

Part two

Derek: “In March this year the American Food and Drug Administration - the FDA - issued an official warning of the increased risks of suicidal tendencies when taking anti-depressants.” They said that healthcare providers should be aware that worsening symptoms could be due to the underlying depression or might be the result of drug therapy.”

Derek: “This came after more than ten years of concerted efforts from a small group of doctors.”

Dr Glenmullen: “It’s very unfortunate that the warning wasn’t put in place in the early 1990s when there was strong evidence that the drugs were causing this side effect.

Of the ten American specialists who cleared the drugs of any links to suicide and violence back in 1991, seven now say that new information would prompt them to reconsider their decision - that according to the New York Times.

One of the loudest voices at the FDA hearings was that of Anne Blake Tracey, director of the International Coalition for Drug Awareness.

Anne Blake Tracey (Director, International Coalition for Drug Awareness): “When I stood to testify to the FDA on February 2nd, I said, ‘I am standing here before you at a meeting that shouldn’t be taking place because this move should’ve been made in 1991’.”

Derek: “Then would you admit that you are on a crusade in a way?”

Anne: “Yes, I’d admit to that.”

Anne is not a psychiatrist. She has a doctorate In Health Sciences and has made the study of SSRI anti-depressants a life’s work.

Derek: “Are you happy with the FDA warning as it stands?”

Anne: “I am glad that there is a warning. I believe that it should be a black box warning. I believe that it should be really bold, instead of included in the teeny tiny little print which they don’t give you a magnifying glass to read.”

In South Africa a magnifying glass won’t help you. The warning is not there.

Derek [addressing the Director of Corporate Affairs for Prozac manufacturer, Elli Lilly]: “Sipho, why aren’t the FDA warnings being carried locally?”

Sipho Moshoane (Director Corporate Affairs): “Derek there’s a process, which is a legal and regulatory process, that is followed.”

Sipho Moshoane is the Director of Corporate Affairs for Prozac manufacturer, Elli Lilly.

Sipho: “Typically, the Medicines Controls Council would approach a company and would say, ‘We have seen this, could you submit either extra data or change something?’”

Dr Frans Korb (Clinical Expert): “No directive[s] have come from the MCC in South Africa for all companies that produce anti-depressants to put that warning in.”

Elli Lilly’s clinical expert, Dr Frans Korb, may have to wait a while for that directive.

Derek: “When we first contacted the MCC in mid-June the Chair of the Council was in the dark about the FDA warning.”

The Medicines Control Council is South Africa’s FDA equivalent. It’s their job to protect the public and make sure that all medicines sold here are safe.

Derek: “For more than a month we’ve tried to secure an interview with someone from the MCC. They never flatly denied us, but also never managed to commit to a time. They promised us a written statement… we’re still waiting.

However, Glaxo Smith Kline, the makers of Aropax, seem to have a hotline to MCC bosses

Dr Navin Singh (Medical Director of GSK): “We have proactively communicated to them our action on this and what we intend doing.”

But, Medical Director Dr Navin Singh insists their talks with the MCC are secret.

Derek: “But was the essence of your letters the fact that the FDA has insisted on a warning in America and we would like to put the same warning on our [South African] package inserts?”

Dr Singh: “I’ve said to you that those discussions are confidential. I cannot divulge any more than that.”

Derek: “But why is it confidential, when the contention is people could be dying out there because they take your drug?”

Dr Singh: “I disagree that people are dying because they’re taking our drug. There’s no reliable evidence that shows Aropax causes suicides, violence or aggression in patients”.

That’s the argument the company put forward in a legal battle on the other side of the world four years ago.

Donald Shell had taken just two Aropax tablets when he shot and killed his wife, daughter and nine month old granddaughter. He then turned the gun on himself.

The family believed Aropax turned Donald into a killer, and the jurors unanimously agreed. The court ordered that Glaxo Smith Kline pay out over six million dollars in damages. The company appealed the decision and then settled out of court.

Dr Singh: “This case is a tragic, tragic case. These sort of events do occur in the normal day to day events of the life of a depressed patient.”

Derek: “We’ve been through that. That argument has been thrown out, Navin. I mean it’s not a question of saying they were depressed anyway. The court found that the tablets caused this tragedy.”

Dr Singh: “I do not know enough about the case to comment on this substantively. However, I can tell you that there is no reasonable data that shows Aropax causes suicides, aggression or leads to such events.”

Dr David Healy was the expert witness for the family in that case. He had to get an American court order to gain access to Glaxo Smith Kline’s archives. In an extra-ordinary find, he discovered that the company already knew that Aropax could lead to mental turmoil.

Dr Healy: “It seemed clear that some people who went on the drug had no major problems, but equally clear that others that went on the drug became more restless, in a state of mental turmoil, complaining about dreams, nightmares and many things like this. These don’t seem to have been studied further in any great detail.”

It’s not the first time Glaxo Smith Kline has been accused of being less then transparent. In June this year, the New York State Attorney General filed a lawsuit against the company alleging that it suppressed results which showed that Arapax may not be effective for teenagers and that it could lead to an increased risk of suicidal tendencies.

Dr Singh: “That is not true. Those results were not hidden under the carpet.”

He says they were presented at a scientific meeting. However, an internal GSK document from the time clearly states that the company intended to manage the dissemination of the data in order to minimise any potential negative commercial impact.

Dr Singh: “All I can tell you is the company policy and the policy has it’s own intention to make sure that data that is relevant to the public is available to the public.”

While GSK talks policy, the British aren’t playing games when it comes to children and adolescents. In December last year, their Medical Controls Agency banned the prescription of anti-depressants for anyone under 18 [years].

But in America there is an alarming turn towards anti-depressants for kids. The fastest growing group of users are pre-schoolers aged from nought to five years and prescriptions for adolescents have more than doubled since the early 1990s.

Chris Allen (anti-depressant user): “I did not have a normal life any more. It was just doctors prescribing medicine like it was candy.”

When Chris Allen was 16, his sights were set on a career in professional basketball, but his emotional world was falling apart. So, his GP prescribed an anti-depressant.

Chris A: “I became a totally different person. I started getting into altercations with people at school and getting into fights. I never used to get into fights, I’m not the kind to fight, but things got out of hand real quick.”

He says that over a period of five years doctors put him on just about every ant-idepressant on the market.

Chris A: “It was common, especially in my high school, for kids to be on anti-depressants but it’s just weird, you know, because you think, ten to fifteen years ago kids probably just dealt with stuff like that.”

Derek [to Dr Glenmullen]: “Joe, it seems that anti-depressants are almost a cultural phenomenon?”

Dr Glenmullen: “They have become that. When you get ten percent of a population taking a drug, they certainly have been.”

In America 70 percent of anti-depressant prescriptions are written by GPs. In South Africa the picture is not that different.

Chris: “I would say there is a lot of prescribing of anti-depressant medication. It’s often been a concern of mine that the extent to which these medications are prescribed almost trivialises the condition of depression.”

Dr Glenmullen: “They’ve been advocated for people with no psychological symptoms at all to feel better than well. So that’s how you get such large numbers of people taking them

Professor Szabo is generally cautious when prescribing anti-depressants, but particularly when it comes to adolescents.

Chris: “My understanding of adolescent depression is that one always looks at more psycho social intervention as a first line.”

Chris A: “I could have snapped out of it on my own over time. I think I was just so confused all the time.

Confusion that he says nearly ended in tragedy.

Chris A: “It actually got so bad and I was so confused that at one point I was sitting in my room, I had a shotgun in my mouth.”

In that moment a friend walked in.

Derek: “You were seconds away from taking your life?”

Chris A: “Milliseconds. Had she not opened the door at that time, probably.”

Chris insists his medication led him to this extreme act.

Chris A: “That wasn’t me. Had I not have taken any of that medicine I’m fully confident that that thought probably would have never… well, I can’t say never crossed my mind, but it would have never been that real to the point where I had a gun in my mouth. It would have never escalated to that. Never.”

Again, most of the medical world disagrees.

Chris: “The truth of the matter is in medicine there are no absolutes, so I cannot sit here and say it’s impossible, that that would never happen, I think that that would never be the case. I think one has to be wary though of making a simple cause and effect, because one has to have an understanding of the nature of the condition where suicidal thoughts can emerge. Suicidal thoughts can be present, and not necessarily as a consequence of medication.”

Of this, Elli Lilly’s clinical expert, Dr. Frans Korb is convinced.

Dr. Frans Korb (Clinical Expert, Elli Lilly): “Specifically with Prozac the clinical trials have shown that the incidence of suicidal thoughts or suicidal idealisation is the same as placebo. So it shows that there isn’t an increase of suicidal thoughts.”

Derek: “But front studies have been done, university studies have been done, books have been written, saying just the opposite; that it’s not just a result of depression, it’s a result of the drug in a small minority.”

Dr. Korb: “Well that is always very difficult and I think the current situation with the FDA has actually made it very clear that suicidal idealisation or worsening of suicidal symptoms is actually due to the drug or due to the disease.”

Over at Glaxo Smith Kline, Dr Navin has no doubts whatsoever.

Dr Singh: “Firstly we disagree that Aropax causes suicide. There is no reliable evidence.”

Derek: “Surely you can only disagree if you’ve done the tests. My question is really, have you done the tests?”

Dr Singh: “We have done in our clinical trial program, and have looked at people from various sectors and there is no clinical evidence that shows that Aropax causes suicides, aggressive tendencies or induces patients’ homicide.”

Derek: “Will you be able to show me those studies?”

Dr Singh: “Our clinical research data is available for everyone who wants to look at them.”

Derek: “But surely you can’t show me the results of the tests?”

Dr Singh: “Our clinical trial results are available publicly. We have a policy where we declare all our clinical policy results.”

That’s policy, but still he couldn’t direct us to a single specific clinical trial.

Dr Glenmullen: Well, particularly the industry has tried to dismiss this side effect by blaming the victims, by blaming their underlying psychiatric conditions - particularly depression. However, many of [the] people who have gotten this side effect weren’t depressed to begin with. They’ve also tried to dismiss legitimate medical case reports as anecdotes. And lastly, they’ve tried to frighten the media and the public away from the side effects saying, ‘Oh these patients need their medication if you tell them about this you might scare them away from treatment’. Well let me tell you, to all patients there is nothing more scary than getting side effects, and not being told about it. And there is no room in modern medicine for that authoritarian approach with a side effect like this.”

SSRI anti-depressants continue to help millions of people worldwide.

** Under no circumstances should you discontinue medication without strict medical supervision.

IMPORTANT DISCLAIMER: While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.

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