Firstly, I'd like to thank everyone who worked hard to get this review to the table. The list is extensive, you all know who you are.
This post is dedicated to three warriors who were active within the prescribed harm community, they all recently died by prescription drug-induced suicide.
Thank you for fighting the cause:
Jo Dennison
Kata Balint
Shelley Johnson
This post is in two parts. Part one is about the recent PHE review regarding the evidence for dependence on, and withdrawal from, prescribed medicines in the UK. Part two is about the current suicide 'expert' in the UK, Prof. Louis Appleby, and the president of the Royal College of Psychiatrists, Wendy Burn. Both parts are intertwined, one is about dependency, the other is about self-harm fatalities. I'll also be calling upon the current suicide prevention minister, Nadine Dorries, to carefully consider the serious issues raised here.
Report of the review of the evidence for dependence on, and withdrawal from, prescribed medicines.
Today is World Suicide Prevention Day and Public Health England (PHE) released a public health evidence review of available data and published evidence on the problems of dependence and withdrawal associated with some prescribed medicines.
Coincidence?
PHE review expert reference group members included Yasir Abbasi, Navjot Ahluwalia and Louis Appleby.
Abbasi has received honorarium for advisory board meetings or travel and accommodation for conferences from Indivior Pharma, Martindale Pharma, Bite Medical Pharma and Mundi Pharma.
Indivior market and manufacture Opioid addiction treatment drugs. Martindale, now known as Ethypharm, manufacture a whole host of drugs, including, but not limited to, painkillers. A Google search of Bite Medical Pharma shows no such company, but Bite Medical Consulting do exist. It appears as though they are a communications company. Safe to say that this means they ghostwrite. Some of their clients include Abbot and Lilly, both drug companies who market and manufacture brand and/or generic antidepressants. Mudi manufacture and market addiction medicines.
Ahluwalia carries out expert witness work and is the Executive Medical Director and Consultant Psychiatrist for Rotherham, Doncaster and South Humber NHS Foundation Trust
Appleby is a Professor of Psychiatry who leads the National Suicide Prevention Strategy for England and directs the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. More about Appleby later.
The Review
The review covered many aspects of prescription drugs, in particular, the withdrawal and dependency problems people face when trying to come off them. There was, however, a mixed message for the SSRI family of drugs.
Benzodiazepines, z-drugs, opioid pain medicines and gabapentinoids are associated with a risk of dependence and withdrawal.
Antidepressants are associated with withdrawal
PHE found that dependency exists on benzos, z-drugs, opioids and gabapentinoids but not antidepressants (SSRIs).
The 152-page review includes a definition of dependence. PHE writes:
Are SSRIs addictive or do people become dependent upon them, or is it neither?
On withdrawal, PHE defines it as: Physiological reactions when a drug or medicine that has been taken repeatedly is removed.
I'm still confused.
Confusion aside, it's nice to see they recognised the daily stigma patients, former patients and drug safety advocates face on a daily basis whenever they publicly share their adverse experiences withdrawing from SSRIs.
The recommendations made by PHE are as follows:
1 ~ Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal to support greater transparency and accountability and help ensure practice is consistent and in line with guidance.
2 ~ Enhancing clinical guidance and the likelihood it will be followed.
3 ~ Improving information for patients and carers on prescribed medicines and other treatments, and increasing informed choice and shared decision-making between clinicians and patients.
4 ~ Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines.
5 ~ Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines.
(1) You don't have the data, the drug companies have it. You will never be allowed to see any of the raw data.
(2) You cannot guide if you don't have the data
(3) Where will this information come from?
(4) Improving? This would imply that support is already in place and just needs tweaking. It isn't. It never has been!
(5) Research is meaningless without the raw data
For what it's worth, recommendations are meaningless words. I've written about this terminology before, it gives people false hope and allows those in charge to continue as they were, so to speak. It's not a law, it's not a rule, it's not punishable if prescribers fail to adhere. Call me cynical, but I dare say meaningless recommendations also serve to help systems stall buy some more time to avoid real action.
Back in 2010, a jury at the inquest of Canadian teen, Sara Carlin, returned a list of 17 recommendations. Sara died a violent, akathisia-induced death after ingesting an SSRI known as Paxil in Canada, better known as Seroxat in the UK. These iatrogenic deaths from drug-induced delirium and self harm are typically labeled suicides by coroners. So it is possible Prof. Appleby and organizations purported to reduce suicides could recognize the loss of Sara today. But it is improbable that will happen given Sara's death doesn't help them promote more drugs ("treatments").
Today, nine years after Sara's death, guess how many of those 17 recommendations have been implemented?
None.
Nada.
Zilch.
Sara's death was a kick in the butt for me personally. It made me rethink why I became an advocate/activist. People are dying as a result of taking SSRIs and whilst withdrawal/dependency/addiction (delete where necessary) are important topics, I feel iatrogenic deaths also need to be immediately addressed.
The SSRI withdrawal issue will never be resolved as long as there is no alternative drug in the pipeline waiting to be promoted. In the meantime, the public will continue to be informed of recommendations that are little more than token gestures. These gestures may serve to keep some advocates quiet and give med organizations and rampant prescribers a break from public scrutiny and accountability. As I tweeted early this morning, barbiturates were viewed as having no problems until benzos arrived on the scene. Benzos were viewed as having no problems until SSRIs arrived on the scene. SSRI risks will be played down until a different class of drug arrives on the scene to take a lucrative centre stage.
Don't worry, folks, that may happen sooner than you think. A new way of administering depression treatment is already on the market. Spravato (esketamine) is used as a nasal spray to treat treatment-resistant depression (TRD)
TRD is basically a term used when all else fails or when the drugs a person is currently taking stop working. Janssen, the drug manufacturer, provided the FDA with modest evidence it worked and then only in limited trials. It presented no information about the safety of Spravato for long-term use beyond 60 weeks. Now get this, three patients who received the drug died by suicide during the clinical trials, compared with none in the placebo group. But hey, this never stopped the FDA from granting it a licence.
Come back to this blog of mine in 10 years and you'll probably see me writing, "I told you so."
Eventually, and if they have their way, drugs like esketamine will flood the market. Then, and only then, will prescribers speak out en masse about the terrible dependency SSRIs cause.
The Apple That Burns
Earlier I mentioned the three PHE review expert reference group members. The third, Louis Appleby, leads the National Suicide Prevention Strategy for England. He is failing on a grand scale.
A few weeks ago Appleby chastised a member of the prescribed harm community on Twitter. Appleby was soon joined by the Royal College of Psychiatrists leader, Wendy Burn in the condemnation of the website host of antidepaware. The website promotes awareness of the dangers of antidepressants and includes links to reports of inquests held in England and Wales since 2003. The antidepaware author lost a son to SSRI-induced suicide in 2009 and since the creation of the website, in 2014, has tried to make the public aware of the dangers that are, in the main, dismissed by prescribers.
Appleby and Burn were wrong to target a fellow-advocate, particularly given antidepaware has done more than what they have to reduce the ever-increasing rate of suicide in the UK. Many other advocates threw their support behind antidepaware. Appleby, the man who apparently takes all forms of suicide seriously, responded by blocking them. He even blocked parents whose children have died as a result of SSRI-induced suicide.
With this in mind, I threw out a question to both Appleby and Burn on Twitter, a straightforward question that neither has answered despite being asked by me in nine repeated tweets. I have also sent both an email, and both have failed to respond. Here's the question they refuse to answer, or even acknowledge: "Can SSRIs induce death by self-harm?"
One has to ask why Appleby and Burn are refusing to answer a simple, relevant question. Burn in the past has claimed how important informed consent is but when push comes to shove she cannot provide me, or the public for that matter, with an answer regarding whether SSRIs can induce death by self-harm. Instead, Burn's Twitter timeline has been full of Lithium promotion, cat photos, and Play-Doh images.
Both Appleby and Burn need to resign. Appleby's treatment of those who inquire about SSRI-induced deaths has been abhorrent to watch from the sidelines. Burn's failure in recognising the SSRI withdrawal problem also needs to be condemned, as does both of their silence stances surrounding informed consent.
Shortly, I'll be writing to the current suicide prevention minister, Nadine Dorries, to voice my concerns regarding Appleby and Burn. I've written to ministers before and they've been pretty useless in their responses. I don't expect Dorries will intervene but I have an ethical obligation to try.
Suicide Prevention Day is about prevention. By refusing to speak with safety advocates and the bereaved just because their children, wives, husbands, brothers or sisters died iatrogenic deaths does nothing to reduce suicides and increase awareness of adverse drug effects that precipitate these violent, avoidable deaths.
If you want to prevent something from happening, you cover all bases and not just the ones that suit your blinkered views. Shame on Burn and shame on Appleby for keeping me, and others, in the dark regarding informed consent. Informed consent is a basic human right. Without accurate info, there can be no real medical freedom of choice.
On a final note, I want to also condemn Wendy Burn's college in general. On the day when suicide prevention was the paramount message they tweeted the following:
Those online resources they refer to include medications that are associated with suicidal thoughts and suicidal completion. Shame on them.
If you think all of the above is just the rantings of a conspiratorial mad man then read how Wendy Burn and her colleagues treated a fellow psychiatrist when he brought to their attention the dangers of Seroxat, a drug, that after many years he is still trying to withdraw from.
"You’d think that my colleagues would be generally sympathetic. However, I have been marginalised, ignored and vilified as a troublemaker — and a leading member of the RCPsych even wrote to my employer questioning my sanity." ~ Peter Gordon, Psychiatrist
Full story here
Bob Fiddaman
The 152-page review includes a definition of dependence. PHE writes:
Dependence ~ An adaptation to repeated exposure to some drugs and medicines usually characterised by tolerance and withdrawal, though tolerance may not occur with some. Dependence is an inevitable (and often acceptable) consequence of long-term use of some medicines and is distinguished here from addiction.I'm confused?
Are SSRIs addictive or do people become dependent upon them, or is it neither?
On withdrawal, PHE defines it as: Physiological reactions when a drug or medicine that has been taken repeatedly is removed.
I'm still confused.
Confusion aside, it's nice to see they recognised the daily stigma patients, former patients and drug safety advocates face on a daily basis whenever they publicly share their adverse experiences withdrawing from SSRIs.
The recommendations made by PHE are as follows:
1 ~ Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal to support greater transparency and accountability and help ensure practice is consistent and in line with guidance.
2 ~ Enhancing clinical guidance and the likelihood it will be followed.
3 ~ Improving information for patients and carers on prescribed medicines and other treatments, and increasing informed choice and shared decision-making between clinicians and patients.
4 ~ Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines.
5 ~ Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines.
(1) You don't have the data, the drug companies have it. You will never be allowed to see any of the raw data.
(2) You cannot guide if you don't have the data
(3) Where will this information come from?
(4) Improving? This would imply that support is already in place and just needs tweaking. It isn't. It never has been!
(5) Research is meaningless without the raw data
For what it's worth, recommendations are meaningless words. I've written about this terminology before, it gives people false hope and allows those in charge to continue as they were, so to speak. It's not a law, it's not a rule, it's not punishable if prescribers fail to adhere. Call me cynical, but I dare say meaningless recommendations also serve to help systems stall buy some more time to avoid real action.
Back in 2010, a jury at the inquest of Canadian teen, Sara Carlin, returned a list of 17 recommendations. Sara died a violent, akathisia-induced death after ingesting an SSRI known as Paxil in Canada, better known as Seroxat in the UK. These iatrogenic deaths from drug-induced delirium and self harm are typically labeled suicides by coroners. So it is possible Prof. Appleby and organizations purported to reduce suicides could recognize the loss of Sara today. But it is improbable that will happen given Sara's death doesn't help them promote more drugs ("treatments").
Today, nine years after Sara's death, guess how many of those 17 recommendations have been implemented?
None.
Nada.
Zilch.
Sara's death was a kick in the butt for me personally. It made me rethink why I became an advocate/activist. People are dying as a result of taking SSRIs and whilst withdrawal/dependency/addiction (delete where necessary) are important topics, I feel iatrogenic deaths also need to be immediately addressed.
Don't worry, folks, that may happen sooner than you think. A new way of administering depression treatment is already on the market. Spravato (esketamine) is used as a nasal spray to treat treatment-resistant depression (TRD)
TRD is basically a term used when all else fails or when the drugs a person is currently taking stop working. Janssen, the drug manufacturer, provided the FDA with modest evidence it worked and then only in limited trials. It presented no information about the safety of Spravato for long-term use beyond 60 weeks. Now get this, three patients who received the drug died by suicide during the clinical trials, compared with none in the placebo group. But hey, this never stopped the FDA from granting it a licence.
Come back to this blog of mine in 10 years and you'll probably see me writing, "I told you so."
Eventually, and if they have their way, drugs like esketamine will flood the market. Then, and only then, will prescribers speak out en masse about the terrible dependency SSRIs cause.
The Apple That Burns
Earlier I mentioned the three PHE review expert reference group members. The third, Louis Appleby, leads the National Suicide Prevention Strategy for England. He is failing on a grand scale.
A few weeks ago Appleby chastised a member of the prescribed harm community on Twitter. Appleby was soon joined by the Royal College of Psychiatrists leader, Wendy Burn in the condemnation of the website host of antidepaware. The website promotes awareness of the dangers of antidepressants and includes links to reports of inquests held in England and Wales since 2003. The antidepaware author lost a son to SSRI-induced suicide in 2009 and since the creation of the website, in 2014, has tried to make the public aware of the dangers that are, in the main, dismissed by prescribers.
Appleby and Burn were wrong to target a fellow-advocate, particularly given antidepaware has done more than what they have to reduce the ever-increasing rate of suicide in the UK. Many other advocates threw their support behind antidepaware. Appleby, the man who apparently takes all forms of suicide seriously, responded by blocking them. He even blocked parents whose children have died as a result of SSRI-induced suicide.
One has to ask why Appleby and Burn are refusing to answer a simple, relevant question. Burn in the past has claimed how important informed consent is but when push comes to shove she cannot provide me, or the public for that matter, with an answer regarding whether SSRIs can induce death by self-harm. Instead, Burn's Twitter timeline has been full of Lithium promotion, cat photos, and Play-Doh images.
Both Appleby and Burn need to resign. Appleby's treatment of those who inquire about SSRI-induced deaths has been abhorrent to watch from the sidelines. Burn's failure in recognising the SSRI withdrawal problem also needs to be condemned, as does both of their silence stances surrounding informed consent.
Shortly, I'll be writing to the current suicide prevention minister, Nadine Dorries, to voice my concerns regarding Appleby and Burn. I've written to ministers before and they've been pretty useless in their responses. I don't expect Dorries will intervene but I have an ethical obligation to try.
Suicide Prevention Day is about prevention. By refusing to speak with safety advocates and the bereaved just because their children, wives, husbands, brothers or sisters died iatrogenic deaths does nothing to reduce suicides and increase awareness of adverse drug effects that precipitate these violent, avoidable deaths.
If you want to prevent something from happening, you cover all bases and not just the ones that suit your blinkered views. Shame on Burn and shame on Appleby for keeping me, and others, in the dark regarding informed consent. Informed consent is a basic human right. Without accurate info, there can be no real medical freedom of choice.
On a final note, I want to also condemn Wendy Burn's college in general. On the day when suicide prevention was the paramount message they tweeted the following:
Those online resources they refer to include medications that are associated with suicidal thoughts and suicidal completion. Shame on them.
If you think all of the above is just the rantings of a conspiratorial mad man then read how Wendy Burn and her colleagues treated a fellow psychiatrist when he brought to their attention the dangers of Seroxat, a drug, that after many years he is still trying to withdraw from.
"You’d think that my colleagues would be generally sympathetic. However, I have been marginalised, ignored and vilified as a troublemaker — and a leading member of the RCPsych even wrote to my employer questioning my sanity." ~ Peter Gordon, Psychiatrist
Full story here
Bob Fiddaman
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