Akathisia Awareness Rolls Out on The Tube

New adverts on the London Underground fuelled a Twitter storm about akathisia and related psych drug harms. The campaign is sponsored by MISSD, a non-profit that raises awareness of akathisia. MISSD was founded in 2011 by Wendy Dolin after the tragic death of her husband, Stewart, who died six days after taking Seroxat (called Paxil in the US). Akathisia isn't a garden variety "side effect." Akathisia can precipitate your death. 

The current campaign consists of more than 1,000 train posters informing passengers that antidepressants and antipsychotics can cause akathisia which can cause self-harm, violence, and suicide. It's fitting that these adverts are on the Tube, given that both akathisia and the London Underground System have been around for more than 100 years. Tube trains rolled out in 1863, and akathisia was first identified in 1902. Yet, judging by recent tweets, it seems that several psychiatrists have been asleep longer than Rip Van Winkle when it comes to akathisia awareness. (More on this below.)

More importantly, the Tube is an appropriate place for these posters because Tube stations close to psychiatric hospitals tend to have a higher incidence of suicide (Farmer et al., 1991; O'Donnell and Farmer, 1994). Suicide prevention charities, like the Samaritans, are probably aware of this since they also run Tube adverts. It's quite poignant then that these adverts, rigorously scrutinized by the advertising company's review team that works closely with Committees of Advertising Practice (CAP), are running on the Tube. 

Spot the Difference 

The original Tube advert MISSD submitted to the advertising review team/CAP is not the same as today's advert. You can spot the differences below. 

Original Poster

CAP Approved Poster 

MISSD has run mass transit adverts in the US without ever needing to change the copy for approval. But the UK's rules and regulators are different from those in the US. If MISSD didn't make the changes, these akathisia awareness posters would never run on the Tube. The changes include:

1. Target antidepressants and antipsychotics by explicitly naming them;

2. Add the word "rare," and;

3. Remove the phrase "Nobody is immune to akathisia." 

The specific mention of antidepressants doesn't bother me. SSRIs harm thousands of people, and SSRIs often induce akathisia. Withdrawal akathisia is also one of many components people can experience when suffering from Protracted Withdrawal Syndrome. 

But what does trouble me is baseless censorship by the powers that be. We'll never know who comprises the advertising review team/CAP. Are medical professionals reviewing the adverts? If so, what institutions are they from, and do they have financial or ethical conflicts of interest with the pharmaceutical industry?  

Many different drugs do cause akathisia. Psych drugs aren't the only culprits. Could the advertising review team/CAP explain to these moms why the akathisia risks posed by Roaccutane are less worthy of publicizing?

While they're at it, maybe the advertising reviewers can also explain what research they used to insist on the word, rare. Most logical people would not state that 50% and 80% are rare occurrences.

While MISSD prefers their standard advert that runs in the US, the non-profit decided it was better to run the current London campaign, which directs viewers to MISSD.co for more info, than no England awareness campaign. I agree. Medical organizations, suicide prevention charities, and many doctors have worked to keep akathisia risks in the dark. (Kind of like the recent sodium valproate story, a controversy that broke a few days ago yet has been known by British drug regulators for many years.)

Twitter Storm and Feigned Concern 

The majority of tweets sparked by the MISSD advert supported the awareness campaign. One advocate on Twitter who supports MISSD's mission did share her discomfort regarding the word "violence." But honest discussions about iatrogenic harms should include violence when it is a drug-induced effect. The parents of these 22 children who died in a school bus crash in Switzerland could share their thoughts on SSRI-induced violence. So, too, could the surviving relatives of these ten families. 

I suspect pharma has settled SSRI homicide cases out of court, but we'll never hear about those. However, one case that was made public was against GSK (then SmithKline Beecham). Donald Schell, 60, took two Paxil tablets before shooting his wife, their daughter, his granddaughter and himself to death on Feb. 13, 1998. A jury returned the following verdict:

Speaking of pharma brings me to this photo taken by Professor Anthony David, who saw MISSD's poster when he was riding on the Victoria line. David tweeted the adverts are "not helpful and should be removed." 

In 2018, David was appointed Director and Sackler Chair of the new UCL Institute of Mental Health. The Sackler Trust is the "charitable giving" arm created by the Sackler family--the same family responsible for Purdue Pharma's "uncharitable taking" of hundreds of thousands of lives lost due to the company's illegal opioid promotion.

Given the immense harm the Sackler family yielded for profit, it's inconceivable that UCL continues its financial relationship with the Sackler Trust. Moreover, I can't help but wonder if David is proud to carry the "Sackler Chair" title? Is he also proud of all the other money he's taken from other pharmaceutical companies who prescribe the types of drugs that can cause akathisia? They include Janssen, Eli Lilly, and Novartis.

Judging from his tweet, it's challenging to believe David cares about akathisia awareness and prescribed harm any more than the universities that continue taking Sackler's blood money and advertising their crime family partnerships. 

David's tweet invoked many responses from akathisia experts by experience and families whose relatives died avoidable akathisia-induced deaths. The tweet has had more than 230 responses, 99% of which criticise David's proclamation that the adverts should be removed.

One of David's colleagues at UCL, Prof Robert Howard, opined the poster was "Uninformative, confusing and frightening." Howard added the defamatory comment, "There's generally some kind of grift accompanying this kind of health disinformation. Calling it secondary gain would be too kind."

For those who don't know, 'Grift' is slang for "a group of methods for obtaining money falsely through the use of swindles, frauds, dishonest gambling." (UPDATE AT END OF POST)

Howard also tweeted that MISSD's website has "a lot of disinformation," but when asked to point out what was disinformation, he failed to respond. Further, neither Howard nor David have ever explained why they feel the poster is uninformative, unhelpful, and should be removed. They also haven't suggested ways their profession can increase awareness of this critical adverse drug effect. Howard's defamatory comments remain on Twitter today. 

Another Psychiatrist, Robertas Strumila, really scraped the bottom of the barrel when he responded to David's original tweet with this:

Strumila, based in Montpellier, France, later deleted his tweet after a backlash of comments from the prescribed harm community, many of whom have experienced debilitating side effects from antipsychotics. Strumila has never apologised, and Howard and David have never condemned his tweet.

Former Royal College of Psychiatrist President Wendy Burn, also tweeted about MISSD's adverts. Burn criticised them and tweeted, "Most people don't know what akathisia is." 

Um, FYI: Awareness-raising means making people conscious of a problem or issue. This fact, however, seems lost on Burn.

There are four types of akathisia, one of which is actually called Withdrawal Akathisia. MISSD covered this when presenting to RCPsych's International Congress in 2019, a conference session in which Burn herself introduced MISSD to the audience. Withdrawal akathisia has also been discussed in medical journal articles and research papers. The onset of akathisia can start when the dose of the drug is increased or decreased or the drug is stopped. That Burn didn't know you can suffer from akathisia after stopping these drugs is likely one of the reasons she states she hasn't seen it in her practice. Maybe her time needs to be "carefully balanced" between Twitter and taking the 1-hour MISSD Akathisia 101 course that can help her better recognize akathisia.

That assumes, of course, that Burn and other doctors want to recognize and warn patients about akathisia and other adverse drug effects. Lest we forget that in 2020, Burn made a startling revelation to Equally Well UK, an initiative that states it seeks to promote and support collaborative action to improve physical health among people with mental health challenges. 

According to the field of psychiatry, psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions.

Answer me this, what can be more abnormal than one human failing to warn another human that a product may cause harm or, even death?

UPDATE: Prof Rob Howard decided to remove the defamatory post and has now issued a fauxpology on Twitter.

Bob Fiddaman

Poster Ad story in the media

Press Release - New Adverts on the London Underground Are Increasing Akathisia Awareness to Reduce Suicide

Express - Akathisia: Charity warns condition can be a rare side effect of anti-depressants

Telegraph - Should you warn about serious mental health issues in a Tube ad?

Remember, akathisia can be caused by many different categories of drugs, not just antidepressants and antipsychotics, but also antibiotics, anti-hypertensives and many others.

If you are a doctor, pharmacist, coroner, journalist, or member of the public, and you wish to learn more about akathisia, take the FREE online accredited course here.