The hidden dangers of SSRIs
Nuria O'Mahony knows all too well about the dangers of SSRIs: her husband died of SSRI-induced suicide. Here, she makes a plea for tighter regulation and a new regime of responsible information to protect the public
We deserve to know the truth about the safety of our prescription drugs. Consumers have a right to expect full and impartial information about the potential risks and adverse effects of prescription medication in Ireland. This information is essential to make informed decisions about treatment, weighing up the real risks as well as the real benefits. This is not happening at present with the SSRIs (Selective Serotonin Reuptake Inhibitors).
Dialogue, communication, information, empowerment, counselling, love, concern, compassion, friendship, human comfort/contact, community solidarity, listening, nature, enlightenment, family, exercise, meditation, religion, attention…. This is not the language that it is in use around the treatment of depression today, and I have to ask: why not?
We need strong, resilient communities. The human soul can overcome most of their problems without needing to reach for the medicine cabinet. Time heals, and time devoted to the service of each other nurtures our communities and our people.
The quick fix for emotional pain inevitably ends up denying both the social and spiritual dimensions of our sorrows. Emotional suffering (grief, fear and despair) is not a sign of mental disorder or illness. It is a universal fact of life.
Because we are vulnerable, life hurts. We are not here to be free of pain. We are here to have our hearts broken by life. To learn to live with vulnerability and to turn pain into love. The emotion we used to call "despair", for instance, has been redubbed ‘clinical depression', a biochemical disorder that should be treated with medication. Untrue!!! These drugs, the SSRIs do not cure depression (they might alleviate some symptoms — if you are lucky), as nobody knows what causes depression and for some the "cure" is worse than the disorder.
"The pharmaceutical industry would like us to believe that SSRIs can safely treat depression, anxiety, and a host of other mental problems. But this ‘cure' may be worse than the disease!!" (Professor David Healy)
These drugs (SSRIs) can produce in patients exactly what they supposedly treat. The unproven chemical imbalance hypothesis, that chemical shifts in your brain are responsible for depression, is just that, a hypothesis — and it is unproven. Nobody knows the normal levels of serotonin in a live brain. Patients are being seriously misled. No abnormality of serotonin in depression has ever been demonstrated. This is a fact, but you wouldn't know it from what you're told.
And even if a biochemical imbalance were found in some depressed patients, this would not necessarily mean that it was the cause of the problem. This is almost like saying that someone whose headache is relieved by aspirin has an aspirin deficiency. Even in diabetes, where there is a proven blood sugar imbalance, only 10 per cent of patients have conditions severe enough to require insulin. What if doctors (endorsed by pharmaceutical companies) tried to make all diabetics dependent on insulin? Or if, paradoxically, insulin could raise sugar levels as well as lowering them? Very few diabetics would survive — and it would be a great scandal in the treatment of the condition. So are the SSRIs to depression. Further, the term antidepressant itself is misleading because it implies a definitive treatment for a definitive condition, neither of which is the case.
Suicide is something anyone contemplating using an SSRI finds hard to envisage happening to them. My husband was one of those people — he died of SSRI-induced self-killing in 2003 (the medication played a major part in his death), 13 days after starting the course. Not the first, not the last. Being a knowledgeable psychiatric nurse and nurse tutor, he thought the SSRIs would make him feel more motivated and less tired, so he could tackle his problems more efficiently. He did not expect the medication to solve his problems, but he knew all the potential benefits of these drugs. But he knew not even half of the potential risks.
And part of the reason he didn't know was that the pharmaceutical industry is in the habit of concealing adverse information, so much so that the US legal system has now begun to prosecute them. For example, in New York: see here
As the US FDA and Health Canada warnings on these tablets state:
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility (aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and paediatric patients being treated with antidepressants. There is concern that such symptoms may represent precursors to emerging suicidality (my emphasis).
Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.
Families and caregivers should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behaviour, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Physicians should inform patients and caregivers about the benefits and risks associated with treatment with SSRIs and should counsel them in its appropriate use.
Physicians are advised to discuss the following issues with patients for whom they prescribe SSRIs and ask them to alert their physician if these occur:
Clinical Worsening and Suicide Risk: Patients and their families should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, other unsual changes in behaviour, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Symptoms such as these may be associated with an increased risk for suicidal thinking and behaviour. All patients being treated with antidepressants for any indication should be observed closely for clinical worsening, suicidality, and unusual changes in behaviour, especially during the intial few months of a course of drug therapy, or at times of dose changes.
Ideally, such observation would include at least weekly face-to-face contact with patients or their family members or caregivers during the first 4 weeks of treatment, then visits every other week for the next 4 weeks, then at 12 weeks, and as clinically indicated beyond 12 weeks. Additional contact by telephone may be appropriate between face-to-face visits."
So it seems from this that the use of SSRIs might be justified in severely depressed patients but the benefit/risk ratio is poor for mild to moderately depressed patients, who are most at risk. So informed consent and close monitoring are paramount.
Why has the Irish Medicines Board opted for keeping the Irish public and health care providers in the dark? This is causing preventable harm to happen. The present system of regulation and pharmaco-vigilance needs to change, as it is failing consumers.
The present Minister in charge, John Moloney TD, chaired the Oireachtas Joint Committee on Health and Children which reported in 2007 on 'Side Effects of Pharmaceuticals'. He signed the Eighth Report, which recommended among other things that the Irish Medicines Board should be broken up, with a separate organisation to conduct post-licensing pharmaco-vigilance, or safety. It also recommended that direct funding of the IMB by the drug companies, as at present, should end, and that both organisations should receive ther funding directly from tax revenue.
Neither of these important recommendations has been implemented. Only small and cosmetic changes have occurred.
I call on Minister Moloney to implement the changes he so vigorously supported as the chairman of this Committee. He has the power, he's in favour. He should act.
The time is always right to do what is right
Our lives begin to end the day we become silent about things that matter.
— Martin Luther King, Jnr
Nuria O'Mahony is an emergency nurse at Cork University Hospital. She holds a Higher Diploma in Critical Care / A&E, and a Diploma in Health Studies with Distinction