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| Tooker Gomberg |
In 2001 Tooker fell into depression which took him out of action for around 9 months - a year or so later he locked himself into a vault in Alberta Premier Ralph Klein's office and faxed out hand-written press releases on Klein's own letterhead, this was in protest at the Kyoto Protocol and global climate change.
In 2004 Tooker, who was now enduring another bout of depression, started taking antidepressants which, according to his bio written by his surviving wife, Angela Bischoff, "lead to increased anxiety and agitation, a common adverse reaction and potent predictor of suicide. After just five weeks on the drug, he was driven to end his anguish by jumping off the MacDonald bridge into the Halifax harbour. His bicycle, helmet, and suicide note were found on the bridge. His body has never been recovered."
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| Tony Scott |
Scott, who was the younger brother of Sir Ridley Scott (English film director and producer) had been taking an antidepressant at the time of his death.
Both Scott and Gomberg were prescribed the SNRi Remeron, (mirtazapine) a drug indicated for use in patients suffering with major depressive disorder.
Scott's autopsy report showed that he had a “therapeutic level of mirtazipine (Remeron) and zopiclone (Lunesta), a sleep-aid” in his system on the day of his death on August 19.
During the past year or so I have collected information [gained under the Freedom of Information Act] regarding suicides in New Zealand.
I asked for information on patients who died from suicide between 1 January 2007 and 31 December 2010 and a list of drugs they were taking at the time of or 6 months prior to their suicide.
Zopiclone appears a lot in the information provided to me, although in the main it was prescribed alongside a whole host of other psychiatric drugs.
In Auckland, just one of the many DHB's I contacted, there was a total of 31 suicides by patients under the care of Auckland DHB, of these 31 there were 10 on Zopiclone at the time of or 6 months prior to their suicide. That's almost a third!
In the UK, the British drug regulator, the MHRA, have received 1,451 adverse drug reaction reports related to Zopiclone use, of these 68 have been fatal. When we look at the adverse drug reaction to mirtazapine [Remeron] we learn that there have been a total of 2,728 reports filed to the MHRA, 87 of which are fatal.
This doesn't mean that 87 patients killed themselves whilst on Remeron, to look at the deaths one has to look further into the MHRA's drug analysis prints. [DAP's]
Remeron, it appears, is associated with 10 cardiac disorders that led to the patient dying, 18 deaths are listed as "general disorders" 13 deaths listed as "injuries", whilst 21 are listed as "psychiatric disorders".
Apart from cardiac disorders these explanations are rather vague, don't you think?
Digging a little deeper into the Remeron DAP we can see it get even more confusing.
Fig 1 shows that there were 3 deaths reported, 1 drowning and 13 "sudden deaths".
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| Fig 1 |
So, given that there have been 13 sudden deaths reported to the MHRA why then are the 3 deaths listed above not 'sudden'?
Are we to assume that the 3 deaths were prolonged deaths as opposed to sudden? I would have thought that any death is sudden, wouldn't you?
Again, I referred to the Merriam medicine dictionary, it defines death as "the irreversible cessation of all vital functions especially as indicated by permanent stoppage of the heart, respiration, and brain activity : the end of life."
It becomes even more confusing when we see there have been 12 adverse reactions reported regarding overdose. [fig 2] Overdose is, just like death, split into three categories, namely; intentional overdose, overdose and prescribed overdose. No deaths were reported for prescribed overdose but there was 10 reported for overdose and 2 for intentional overdose.
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| Fig 2 |
Are we to assume that 'overdose' actually means accidental overdose? If so, how can we determine whether or not an overdose is accidental? If 10 patients on Remeron died as a result of overdose then it could be deemed as suicide, could it not? It could also mean that these 10 patients overdosed not by their own choice, was it homicide then? Were these 10 patients killed by someone slipping large amounts of Remeron into food?
It's bizarre that the MHRA don't add 'accidental' given that they add 'prescribed' and 'intentional' to the other categories.
Remeron is considered to be relatively safe in the event of an overdose. [1] The figures from the MHRA database would suggest otherwise. 41 overdose and survived. 10 overdosed and died - I wouldn't call that relatively safe, would you?
Further into the DAP we learn that the 21 psychiatric disorders I mentioned earlier are all listed as 'completed suicide.' [Fig 3] So, is completed suicide a psychiatric disorder?
87 deaths attributed to Remeron in Britain alone, 21 of those deaths were by suicide but the MHRA, in what I can only describe as a cover your ass tactic, decide to mask these suicides by labeling them as "psychiatric disorders".
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| Fig 3 |
They fail to mention exactly what these psychiatric disorders were. One can only assume that anyone who takes their own life has a psychiatric disorder of some sort... I mean, it couldn't have possibly been the Remeron that caused these 21 patients, Tony Scott and Tooker Gomberg to take their lives, right?
The Remeron product monograph [Merck] treads carefully.
Adults and Pediatrics: Additional Data
"There are clinical trial and post-marketing reports with SSRIs and other newer antidepressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others. The agitation-type events include akathisia, agitation, disinhibition, emotional lability, hostility, aggression and depersonalization.
"In some cases, the events occurred within several weeks of starting treatment.
Rigorous clinical monitoring for suicidal ideation or other indicators of potential for suicidal behaviour is advised in patients of all ages. This includes monitoring for agitation-type emotional and behavioural changes."
Merck cleverly omit the brand Remeron from this important piece of information for the consumer. Other pharmaceutical companies use this tactic too. It's designed to lump all the group of antidepressants together, it's then the job of the Remeron rep to convince a doctor that Remeron is safer than the other antidepressants on the market, they do this with company written documents, lavish dinners, gifts and payments [disguised as consulting fees] for doctors.
You'll note that Merck also list emotional lability as an "agitation-type event."
I first came across the term "emotional lability" when I read through the infamous Paxil 329 study. GlaxoSmithKline used this term to hide the 5 attempted suicides that had occurred during the clinical trials of Paxil.
In fact, all of the agitation-type events Merck list for Remeron are precursors to suicide. Remember they are not talking about an illness here, they are talking about a drug that can induce these thoughts... something the MHRA adverse reports for Remeron fail to do.
Tony Scott and Tooker Gomberg both took Remeron, both killed themselves by leaping to their deaths. Family and friends will tell you that they were completely shocked by their acts.
Keeping an eye out... or monitoring patients on these drugs is nigh on impossible. Suicide is impulsive and these types of drugs inhibit emotion. Fear is an emotion inhibited by these drugs and if we, as humans, do not fear death then we will embrace it.
The makers of Remeron have a lot to answer for as do the makers of other groups of antidepressants.
Bob Fiddaman.
[1] Relative safety of mirtazapine overdose.
Velazquez C, Carlson A, Stokes KA, Leikin JB. - http://www.ncbi.nlm.nih.gov/pubmed/11757992
