Eight professors attack
Eight professors of psychiatry, including UCC Professor Timothy 'Ted' Dinan, had a letter published in the Irish Times on Monday 19 October criticising Dr Michael Corry's public exposure of the dangers of antidepressants. We reprint the text below:
A controversial statement has been made about this, both in the print media and on television, namely that antidepressants cause homicide, which we wish to rebut.
There is no scientific evidence whatsoever that antidepressants cause homicide, as has been so definitively stated. This contention is not only inaccurate but it is also potentially dangerous and irresponsible.
First, unfounded claims such as this may cause those with severe depressive illness, who need antidepressants for continuing wellbeing, to discontinue their treatments, with potentially tragic consequences.
Second, it may deter those who need such treatments from coming forward for appropriate help.
Third, this unfounded statement will further stigmatise those with mental illness if individuals taking antidepressants are now feared as potentially dangerous and homicidal. Indeed the reality of prejudice against people with mental health problems has been recently highlighted in a study carried out by St Patrick's University Hospital.
Finally, it is within the bounds of possibility that the erroneous belief that antidepressants induce aggression and homicide could impact on access disputes in family courts if parents needing such treatments are cast as a danger to their children.
We regret that greater restraint was not exercised in the coverage of this sad event and we unequivocally recommend that the relevant media outlets follow the wise counsel of the Irish Association of Suicidology when dealing such sensitive issues. — Yours, etc,
The 'wilfull ignorance' of our leading teachers of psychiatry
Madam, — Like Dr Orla O'Donovan (Letters, 22 Oct) I am astonished by the intervention of the eight professors of psychiatry in respect of the Clancy/Creane tragedy.
As Dr O'Donovan indicated, the scientific literature is replete with studies establishing a clear link between the use of SSRI antidepressants and similar drugs and self-harm, suicidality, aggression, hostility, mania and other induced behaviour; the word 'hostility' being used in this context to embrace all kinds of violent thoughts and actions, including the terminal hostility of homicide.
Dr O'Donovan cited the study by Professor David Healy et al, which is important in the present instance because it starts from a conservative position and carefully explores the medico-legal problems arising from the use of these drugs.
I am astonished that all eight professors of psychiatry whose letter you published on Monday 19 October publicly profess ignorance of this important area of study in their field. These eight people have enormous authority; they are responsible for the training and education, and ultimately the graduation, of thousands of psychiatrists into our health services, not to mention the psychiatric component of GP training. Yet they deny that their drugs of choice for both their medical specialism and for GPs in treating depression can impel violent and aggressive behaviours.
There are many, many more peer-reviewed studies showing clear and irrefutable links between this generation of antidepressants and violent ideation and behaviour, too many to list here. Is it not only astonishing, but also potentially dangerous, for the leading lights of psychiatric education in this country to be unaware of this literature, or to dismiss it out of hand as they appear to do?
Perhaps they are taking the word 'cause', which they used in their letter, in the same sense as the tobacco industry used it for several generations to deny that smoking and cancer were linked, and to avoid the serious questions about risk and benefit which hang over the equally aggressively marketed SSRIs and SNRIs.
Let us have no chilling of the essential public debate on the role of these drugs in the case of Sebastian Creane and Shane Clancy — if there is any such chilling or stifling of debate, the sure result will be to leave the door open to another such tragedy.
Corry responds to the
Here is the text of Dr Michael Corry's letter to the Irish Times, emailed 22 October 2009.
Madam, — It is with my duty of care in mind that I have to point out that the eight professors of psychiatry who signed the letter on the subject of antidepressants and homicide (19 October) clearly do not read the literature with respect to the dangerous side effects of antidepressants. It is hard to understand how this can be so, but it patently is so, and this gap in their knowledge is dangerous, given their position as the lead teachers of thousands of graduates into their profession.
In their collective stance they have attempted to undermine my opinion, as expressed in recent media coverage, which linked antidepressants to serious adverse side effects such as aggression, hostility, extreme agitation, manic elation, hallucinations, psychosis, self-harm, suicide and — in susceptible individuals — homicide.
Much has been written in the scientific literature on the subject of SSRI-induced violence. For example, the 2006 study 'Antidepressants and Violence: Problems at the Interface of Medicine and Law' by Professor David Healy et al in Public Library of Science Medicine (PloSMedicine) and 'Suicidality, Violence and Mania Caused by SSRIs: A Review and Analysis' by Dr Peter R Breggin in the International Journal of Risk & Safety in Medicine. Both papers can be read on wellbeingfoundation.com at this address (http://tinyurl.com/yjmogpd), where they have been reproduced as a public service and to educate those who need to learn.
Both of these, and many others I can cite, unequivocally demonstrate using scientific methods not only the links between SSRI use and various forms of violence and hostility, but the mechanisms of these links.
Dangerous behaviour and depression were never linked until selective serotonin reuptake inhibitors (SSRIs) were introduced in the 1980s and marketed on the hypothesis (yet to be proven) that depression is the result of a 'chemical imbalance' in the brain, namely of the neurotransmitter serotonin. Patients left their psychiatrists and GPs, prescription in hand, convinced that they had a disease, a kink in their brain which would somehow be straightened out, without any diagnostic blood tests or other evidence-base tests having been taken before the diagnosis was made, or follow-up blood tests to moniter the effectiveness of the 're-balancing' medication. No branch of medicine other than psychiatry would get away with such flawed 'science'.
Psychological distress is a valid human experience and no one is immune. It has a context, a time-line, and represents a legimate response to life's difficulties. Depression is an emotion not a disease. It is a reflection of loss, grief, broken hearts, chronic anxiety, panic attacks, sexual abuse, bullying, difficult relationships, financial problems, overwhelm, and the impact of having life fired at you point blank. To regard depression as a chemical imbalance, something pathological, is in my view deluded. It has, in reality, no basis in science; it takes away the need for understanding, compassion, healing psychotherapy, prevention, and in particular educational modules in schools based on wellness and human sustainability.
While the cost in human terms of the adverse side effects of antidepressants is immeasurable, the financial costs are not. Last year it cost the taxpayer €52 million to meet the cost of antidepressant medication prescribed to medical cardholders (one third of the population) plus another €30 million via the drug repayment scheme. What was spent by the rest of the population was not released into the public domain by the pharmaceutical industry. Ireland has the highest prescribing rates for antidepressants in Europe.
In my opinion psychiatry is hermetically sealed; a closed system with a dominant narrative which is voraciously increasing its hold on psychology and what constitutes psychotherapy. It has less and less to do with medicine and science, and more to do with dogma and ideology. It has become a fortress with a hair-trigger defence mechanism. Its dark horrific past still casts a long shadow over its current practices and discourse.
About the truth Arthur Schopenhauer wrote: "All truth passes through three stages. First, it is riduculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Thus it is with the truth about psychiatry.
Clancy case question mark over SSRIs — O'Donovan
Madam, — The tragic events in Bray last August that resulted in the death of two young men have raised vitally important questions about the possible side-effects of antidepressants, and about the knowledge that informs the licensing of medicines in Ireland. The answers to these questions offered by Kate Holmquist in her recent column (October 10th), and endorsed in a Letter to the Editor by a number of psychiatrists (October 19th), are wrong in at least three respects.
First, it is untrue to say there is no scientific evidence of links between anti-depressants and homicidal behaviour, and between anti-depressants and actual suicides. In an article published in September 2006 in the leading open-access medical journal PLoS Medicine, David Healy, Andrew Herxheimer and David Menkes conclude that "clinical trial and pharmacovigilance data point to possible links between these drugs and violent behaviours". They argued that while existing evidence suggests serious violence associated with antidepressant use is very rare, it requires urgent examination.
Evidence from clinical trials has led to regulatory authorities in some jurisdictions warning doctors about the risk of suicide to patients taking these medicines, and also the risk of violent harm to others.
Second, the dismissal of 'anecdotal claims' about serious side-effects of antidepressants is contrary to recent moves to recognise and value patients' experiential knowledge of medicines. Rather than trivialising patients' experiences of medicines, there have been repeated calls to value this 'consumer intelligence' and 'popular epidemiology' and to find ways of including it in drug safety research.
In a study published in the International Journal of Risk Safety in Medicine in 2002, a team of researchers led by Charles Medawar judged the collective weight of the patients' direct accounts to be profound as they uncovered previously unrecognised patterns of experiences coinciding with dosage increases and withdrawal of therapy.
Third, the claim that the Irish Medicines Board (the IMB) and other regulatory authorities do not rely on information produced by the pharmaceutical industry is incorrect. Decision-making about the licensing of medicines is based on pre-marketing clinical trials, and these trials are largely sponsored by the pharmaceutical industry.
Pharmacovigilance is seriously hampered by the under-reporting of adverse drug reactions (ADRs) by doctors. In 2007, the IMB received only 206 ADR reports from GPs, indicating that fewer than one in 10 GPs on average submit one ADR report a year to this voluntary reporting system.
Finally, in respect of Holmquist's reassurances about the IMB's independence, the funding of this agency needs to be considered. The 2007 report of the Oireachtas Committee on the Adverse Side-Effects of Pharmaceuticals noted that the existing funding arrangement whereby the IMB relies on fees paid by pharmaceutical companies "tends to put the drug companies in the position of clients of the IMB with the inference that the IMB has a corresponding obligation to meet its 'clients' needs". — Yours, etc,