Once she was stable, Anna was admitted to McLean Hospital, where
she was described as having had a "paradoxical" reaction to Prozac.
A nurse told her one of McLean's psychopharmacologists, Dr. Teicher,
had written about patients like Anna who became suicidal on Prozac.
She was put on a different type of antidepressant, which did not precipitate
the same reaction.
"Many research and case studies demonstrate a link between antidepressants
and suicide and other violent behavior"
Women were known to use less lethal means until the SSRl antidepressants
hit the market. But on Prozac and Paxil, women committed 40% of the
suicides - many were strikingly violent and clearly leaving no means
for rescue.
Because suicidal tendencies are a frequent characteristic of depression,
perhaps one of the most serious problems associated with antidepressants
is the potential for drug overdose. The potential for suicide caused
by the very medication prescribed to prevent it, is further enhanced
by the synergistic interaction of the antidepressives with alcohol,
barbiturates, and other central nervous system depressants. A glance
through the PDR indicates that the quantity and the magnitude of the
dangers associated with Elavil are equally present with the other antidepressants.
Just before Christmas Dr Stuart Donovan and colleagues published a
crucial article in the British Journal of Psychiatry. Of 2,776 patients
taking SSRIs who were treated at the Derbyshire Royal Infirmary over
two years. They found that if you look for a statistically significant
relationship between taking SSRIs and suicide by overdosing on them,
you won't find much. But they did find a relationship between taking
SSRIs and all forms of deliberate self-harm - including overdose, attempted
overdose, hanging, gassing, laceration, deliberate road traffic accidents,
head banging, swallowing non-medicines - much higher for SSRIs than
for the older tricyclics. "The relationship is so strong, Dr Donovan
says, that he firmly believes promotional material for SSRIs including
Seroxat [Paxil] should be changed immediately so doctors no longer
prescribe them to potentially suicidal patients thinking, mistakenly,
that by doing so they are protecting their lives." When Dr Donovan
sent the manuscript of this study to SmithKline Beecham [now GlaxoSmithKline]
(who partially financed the study along with Eli Lilly) before it was
published asking for comments. They did not reply.
There has been a study released focusing on the popular antidepressant
Paxil and its role in suicidal behavior in children.
GULF WAR VETERANS: Captain Joyce Riley, who has headed the battle
in exposing Gulf War Syndrome, has noted that approximately 80- 90%
of the Gulf War vets are now on or have been offered one of the SSRI
antidepressants. As a result many have had their lives turned upside
down with others committing suicide or murder/suicide.
One of the disadvantages of the older tricyclic antidepressants is
that they are much more dangerous when taken as an overdose. But a
very well kept secret, revealed by considering all the research, is
that the actual rate of death from suicide is higher in patients who
take the new antidepressants than in those who take the older tricyclics.
Even more important, twice as many people taking the new antidepressants
successfully committed suicide than did the people who took placebos.
The results of all the studies--published and unpublished--showed that
of every 1000 people with depression treated with one of the new antidepressant
drugs, 4.6 more committed suicide each year than would have if they
had been treated with a placebo.
How do serotonin boosters catalyze suicidal and violent impulses?
Does the phenomenon occur because of the drugs' stimulating, re-energizing
effects as with previous antidepressants? Or might something different
happen with these new drugs, as Teicher and Cole suggested in their
original report?
Nine clinical studies show: "SSRIs: Suicide Risk and Withdrawal
(Editorial)," The Lancet 361:1999, 2003. See also Gardiner Harris, "Debate
Resumes on the Safety of Depression's Wonder Drugs," New York
Times, August 7, 2003.
In another case, reported by Frederick Goggans and colleagues, in
Medical Mimics of Psychiatric Disorders, a 27-year-old executive was
hospitalized after attempting to kill herself by overdosing on antidepressants
prescribed by her psychiatrist. The woman's suicide attempt--her second--followed
a year of psychotherapy that had failed to relieve her fatigue, cognitive
problems, and despondency. She was distraught that her suicide attempt
was unsuccessful, and told her doctors that she would probably try
to kill herself again.
While the FDA had cleared the drugs, my colleagues continued to describe
some cases in which they appeared to have caused severe reactions--agitation,
paranoia, psychosis, suicide, and violence--in a small number of patients.
Rumors within psychiatric circles held that the FDA panel of outside
experts had been flawed, beset with conflicts of interest and deeply
divided on the issue of Prozac's safety, in spite of the impression
given to the public. Could it be true that a majority of the panel
members had conflicts of interest? Had the vote not been unanimous?
Was the panel so divided that one-third of its members pressed for
a warning and changes in the guidelines for prescribing antidepressant
drugs? What was one to believe?
"Studies show that Prozac, in particular, plays an especially
large role in suicide and other violent behavior"
Treatment emergent suicidality with Prozac has been demonstrated
to be two to three times higher than any other anti-depressant. (Jick,
et al., antidepressants and Suicide)
It is apparent that the proportion of people taking fluoxetine and
committing suicide is higher by an amount to be of concern to medical
examiners and also to health care providers. The present report provides
evidence that suicide has occurred more frequently in patients taking
fluoxetine than in those taking tricyclic antidepressants, the possibility
that fluoxetine has induced the idea of suicide must be considered.
When you understand these problems, it is not surprising that twelve
years after Prozac was approved, people were again raising the issue
of Prozac-related psychoses, suicides, and violent acts. Recent books
such as Prozac Backlash, and The Antidepressant Era have made headlines
by citing studies suggesting a connection between Prozac and such reactions.
A May 2000 story at Dr. Koop Health News began, "The question
of whether Prozac, the most-prescribed antidepressant, can make some
patients more likely to commit suicide just won't go away, despite
repeated and categorical rebuttals by the drug's manufacturer, Eli
Lilly and Co. Based on his experience as a suicide counselor and investigator,
Dr. Ronald W. Maris, director of the Center for the Study of Suicide
at the University of South Carolina, is firmly convinced that a risk
exists."
Dr. James W. Long in his discussion of Prozac in THE ESSENTIAL GUIDE
TO PRESCRIPTION DRUGS 1992 explains, "A review of relevant literature
on this subject reveals that the development or intensification of
suicidal thoughts during treatment (regardless of the severity of depression)
has been documented repeatedly for many antidepressant drugs in wide
use. It is apparent that suicidal thinking may emerge during treatment
with any antidepressant. " And Fava and Rosenbaum state in a letter
to the JOURNAL, OF CLINICAL PSYCHIATRY, in November 1991 that "..emergence
of suicidal ideation or behavior has been observed with many antidepressant
pharmacotherapies."
He prescribed the medication Prozac. One month later, after taking
this medication, she committed suicide by hanging herself. What was
so strange about this unsuspected action was that she was not behaving
like a person who was depressed or suicidal. At first we discounted
the significance of this story. Unfortunately, emotionally disturbed
people sometimes commit suicide whether they are taking an antidepressant
or not. But in February 1990 an article appeared in the American Journal
of Psychiatry that shed a new light on this case history. Physicians
associated with the Department of Psychiatry at Harvard Medical School
reported on six patients who suddenly developed an "intense violent
suicidal preoccupation after 2-7 weeks of fluoxetine [Prozac] treatment." It
would be disastrous if an antidepressant medication actually produced "obsessive,
recurrent, persistent, and intrusive" thoughts of suicide. This
may be a rare occurrence, but the Harvard psychiatrists warn that people
who feel fatigued and restless or sleep much more than usual may be
at higher risk.
In the early 1990s most doctors did not know what to make of the Prozac
scare. Psychiatrists had long recognized that in the early weeks and
months on any antidepressant, patients are at increased risk to act
on suicidal impulses. Over the course of just a few weeks, antidepressants
can jump-start patients, reinvigorating people who have been without
energy for some time. The newfound energy provided by an antidepressant
can suddenly enable a patient to act on suicidal or violent urges.
Classic papers dating as far back as the 1930s describe the risk with
amphetamine antidepressants. For decades pharmaceutical companies and
drug proponents adamantly denied the phenomenon, but by the 1970s,
when strict limitations were imposed on prescribing amphetamines, their
ability to trigger suicide and violence had been firmly established.