My Take on Panorama's 'The Antidepressant Story'

 

On Monday, June 19, the BBC's flagship current affairs programme, Panorama, broadcast the long-awaited, and much anticipated 'The Antidepressant Story'.

Living, as I do, in Central America, it's difficult to watch British TV, especially live broadcasts. With the help of a useful app, however, I didn't fret too much.

While most of Britain settled down at 8pm on Juneteenth, the time difference here meant a 2pm viewing here for me.

I watched with my partner, who also has an interest, given her daughter died at the hands of antidepressants.

Many, reading this, will know I've been banging the drum for over 16 years regarding the safety and efficacy of SSRIs so watching this hour-long special saw me (internally) go through a range of emotions. It's only now, some three days after it aired, that I'm able to write about it.

My main focus has always been about the withdrawal effects of SSRIs and also their propensity to induce suicidality. Although 'The Antidepressant Story' covered the withdrawal issue they never delved into the suicide link. I totally understand why as this has been covered four times (brilliantly) by the Panorama team during the first ten or so years of the 2000's (Links at the foot of this post)

I watched with interest as they covered PSSD. For me PSSD is a confusing acronym, at first glance it looks like PTSD, an invented disorder that promotes the use of psychiatric drugs. If an experienced old fella like me, who's researched these SSRIs for many years, finds this confusing, I have to wonder if the same can be said about the general public?

The two acronyms are very different though.

PSSD is Post-SSRI sexual dysfunction, a condition caused by the use of one or more serotonergic antidepressants that persists despite the cessation of antidepressant treatment. PTSD is Post-traumatic stress disorder, an apparent "mental health" condition that's triggered by a terrifying event.

Although I agree many suffer when recalling terrifying events, I refuse to give it a mental health label. PTSD first appeared in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll) published by the American Psychiatric Association, a manual used by psychiatrists, such as the ones who appeared (for balance) in 'The Antidepressant Story', namely Wendy Burn and Prof David Nutt. More about them later. 

The Antidepressant Story kicks off with Audrey Bahrick, a patient who tells her story about reading about Prozac and its beneficial properties. She was going through a sticky patch at the time and thought Prozac would give her the lift that she needed. After taking it, Bahrick felt "confident and energized", adding, "I loved being on Prozac."

Another patient, Trish Matthews, also tells her story. Trish was training as a nurse in the 1990's and found the pressure of training whilst trying to manage her homelife, she became stressed and struggled to manage her daily life. She went to her doctor and was prescribed an antidepressant. She believed, after reading various articles, that her stress was brought on by a chemical imbalance. 

Drug company adverts, such as the one below, were flooding TV stations across the US and New Zealand (The only two countries that allow Pharma Drug To Consumer advertising)

It wasn't long before those adverts turned to print so other nations, such as the UK, could read about an apparent serotonin deficiency and how to treat it.

It was genius marketing by the drug industry but it was pure fiction, a fiction that was lapped up by the likes of the Royal College of Psychiatrists and its members. They never once questioned it. They could now prescribe en masse and give a reason, albeit fictional, why they were prescribing.

The chemical imbalance myth has been debunked so many times over the years. That I'm still writing about it baffles me. It's ingrained in society, moreover in rooms with pens and prescription pads. It's cult-like and many who are hanging on to this claim are part of that cult.

Back to Bahrick and Matthews

As the show progresses we learn that Audrey Bahrick and Trish Matthews both started to experience the dark side of the SSRIs they were prescribed.

"I was immediately sexually numb, within a day (of taking Prozac) my genitals were numb", Bahrick said.

Trish Matthews had been taking her prescribed SSRIs for 18 months and felt she was now better so decided to cease taking them. This is when her problems began. "Within 24 hours I felt absolutely dreadful", she thought her 'depression' was coming back. She rang her doctor who told her, "you have to go back on them."

Withdrawing from SSRIs can mimic the symptoms of why you were put on them in the first place. Prescribers are, largely, unaware of this as are those who take them.

Dr Mark Horowitz, a trainee psychiatrist, who also features in the show, was diagnosed with depression at the age of 21. 15 years later he tried to come off and experienced insomnia, panic attacks, dizziness, anxiety and low mood. He has not been taught about these effects of SSRIs at medical school or in psychiatry training. Horowitz, when reading the academic literature available to him, found that psychiatrists and academics at the institution he had studied at and others like them around the world had little helpful to say about withdrawal effects from antidepressants, they recommended stopping the drugs over 2 to 4 weeks, and reported that the symptoms were mild and brief. To date, Horowitz is still taking his medication.

Joanna Moncrieff, a practising professor of psychiatry and a part-time academic and author, says she was skeptical about these new antidepressants from the start. "My interest has always been in the role of drug treatment and whether they're as beneficial as we are, usually, led to believe that they are."

Pfizer, who are never out of the news these days, are briefly featured in the show. The Panorama team obtained a 'secret document' that showed how Pfizer execs wanted to play down the withdrawal issue. They also wanted to include claims about the chemical imbalance being a fact, they were declined by drug regulators but the chemical imbalance somehow made its way into the patient information leaflets that accompany SSRIs. With trickery, using wordplay, companies like Pfizer could set the 'chemical imbalance' promotion rolling by putting its main message amongst words like 'it is thought' or 'it may be'. Moncrieff was shown the document by the Panorama team, her reaction said it all, "Oh, my gosh".

Moncrieff has been instrumental in trying to debunk the chemical imbalance theory and in 2022, along with Benjamin Ang and Mark Horowitz, published a paper in the Science Direct Journal that found the field of psychiatry bears some responsibility for dissemination of the theory of the chemical imbalance  and associated antidepressant use.

This paper caused outrage amongst many leading psychiatrists and they took to Twitter not only to refute the findings but to target Moncrieff personally. I've watched it all unfold via my own Twitter account - it still continues today.

The Balance

As I mentioned previously, for balance Panorama asked two psychiatrists onto the show. The pharma conflicted Prof David Nutt and the former President of the Royal College of Psychiatrists, Wendy Burn.

As was expected both made claims that could not be backed up with evidence. Nutt opted to go down the emotive route with, "antidepressants have saved the lives of many hundreds of thousands of people”.

I find this claim astonishing and am bamboozled that it's rarely challenged by mainstream media or, indeed, programme makers such as Panorama.

As I wrote on Twitter, "If I believed listening to the Dixie Chicks whilst going through severe Paxil withdrawal saved my life, would this actually prove that the Dixie Chicks saved my life?"

Of course it wouldn't.

There is no scientific evidence that antidepressants save lives. Too many people are scared to challenge the narrative because many patients who believe this to be true will get emotional and throw hissy fits on social media platforms. Trust me, I have friends who think they or their kids' lives were saved by SSRIs. I cannot debate with them as it causes them obvious distress. 

Nutt knows this. He seems to be playing the system here, it's clever deception. Appear to have concern and show support whilst dismissing the likes of the patients that appeared in the show and millions of others who have suffered the darker side of SSRIs.

Burn didn't fare much better. Fidgeting throughout her (edited) interview, Burn said she personally regrets that severe and long-lasting withdrawal wasn't recognised sooner. "I can't really explain why it took so long, perhaps partly because of the overlap between relapse and withdrawal...I don't know, I can't really explain it."

What Panorama didn't show the public, because they probably didn't know, is an interview Burn did with Equally Well back in 2020. She told them that "when she was first trained she was told not to tell patients about side effects as it might dissuade them from taking medication."

The BBC didn't push Burn on why she has blocked or muted so many patients on Twitter who have reached out for help regarding withdrawal and PSSD issues.

Burn offered a personal apology on the show but it reminded me of Alan Partridge publicly apologising to Norfolk farmers. "If there's anybody watching who has gone through withdrawal and it wasn't recognized then I'm very sorry."

You'll notice she was making a personal apology here and not one on behalf of The Royal College of Psychiatrists, whose members with Twitter accounts are some of the most vile human beings I've come across regarding those injured by SSRIs. That's another blog though.

All in all, I thought the one-hour special did the job, it got the message across and, as predicted, infuriated many Royal College members on Twitter. Their anger was aimed at the apparent bias of the show. At no point did they show any empathy whatsoever to those harmed by the very same drugs they write prescriptions for. Targeting their cultish beliefs was deemed, it seems, unacceptable.

Psychiatry is in a mess but I can't let General Practitioners (GPs) off the hook here either. For too long now, GPs have ignored the SSRI withdrawal and PSSD issues as have the British Drug Regulator the MHRA. This needs to change, and it needs to change right now!

I sat down with the MHRA 15 years ago to discuss the SSRI withdrawal issue, back then I had no Facebook or Twitter support groups to help me, nor did I have any interest from the BBC or any other network channel. I made the visit alone and sat with the, then, chief executive of the MHRA, Kent Woods, their Head of Pharmacovigilance Risk Management, Sarah Morgan, and their Communication Manager, John Watkins.

I thought I'd struck gold, sadly that wasn't the case. The problem still exists today and many patients who are prescribed these drugs will, no doubt, go through what I did, what the patients in the show did, and what many millions of people worldwide are having to endure.

With that said, if you want to become an advocate for SSRI safety, it comes at a price. Members of the Royal College of Psychiatry have labelled me 'a conspiracy theorist', a 'far-right sympathizer', a 'misogynist', amongst many other labels designed to keep me quiet. It's straight from the pharma playbook, folks!

I'm not alone, many other SSRI safety advocates have had their fair share of crap thrown at them as they strive for answers, many of whom who have lost loved ones due to SSRI induced suicides.

The Royal College of Psychiatrists were 'royally' kicked in the nuts with this Panorama offering. It's going to get a lot worse with the insults, the accusations, the muting and the blocking. Cults don't like their belief system tarnished.

Bob Fiddaman

Watch the 'The Antidepressant Story' on BBC IPlayer here.

Outside the UK, watch here

Previous Panorama SSRI coverage

The Secrets of Seroxat

Emails From The Edge

Taken On Trust

The Secrets Of The Drug Trials

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.

Top Psychiatrist Told: "Don't tell patients about side-effects"

An astonishing admission from Wendy Burn (above), the former president of the Royal College of Psychiatrists, has emerged on Twitter this past week.

Equally Well UK, an initiative which seeks to promote and support collaborative action to improve physical health among people with a mental illness, recently posted via their Twitter account that Burn, who is now a Clinical Chair of Equally Well UK, has openly admitted that during her training as a psychiatrist she was told not to tell patients about side-effects as it might dissuade them from taking their medication.

I put the following three questions to Equally Well UK:

1. Who trained Burn?

2. At what point in her career did she start to tell patients about side-effects?

3. Why did she decide to tell patients about side-effects?

All three questions went unanswered.

To my utter disbelief some people are praising her for her openness (see thread), in the main, it's other healthcare professionals who have probably never personally experienced horrific withdrawals from the drugs that Burn and other psychiatrists have prescribed over the years. Lest we forget those who have had to prematurely bury loved ones because they wasn't told these drugs could induce suicide. This, I feel, is being, somewhat, glossed over by those who are, seemingly, covering Burn in garlands.

I'll throw in another three questions for those.

4. How many people have died as a result of not being informed about a brain pellet's propensity to induce suicide?

5. How many of those were on Burn's watch?

6. What were the side-effects she was trained to keep away from her patients?

Not giving informed consent because you feel it will deter people from taking medication is no excuse for hurting those you are served to look after.

If Burn was trained to not give informed consent then others would have, no doubt, been trained the same way.

It's unknown whether Burn adhered to what she was taught, if she didn't then one has to ask why she is only raising this issue now given that she has been a psychiatrist for many years.

What's striking, to me at least, is Burn has failed to issue an apology, just as she failed to do so when, in 2018, she, along with colleague, David Baldwin, wrote an opinion piece for The Times, making the outlandish claim that "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."

She, after a public outcry, has since admitted she was wrong but it came with the caveat that she hadn't personally witnessed severe withdrawal in her own clinical practice. Makes you wonder if she was 'trained' to ignore severe withdrawal given her recent admission to Equally Well UK.

If getting brownie points includes an admission that you've kept hidden dangers, such as withdrawal problems and induced-suicide, away from patients then, surely, farmer Jones deserves points too for adding a 'HIGH VOLTAGE' sign to his electrical fence many years after people touched it and died. 

I despair. 

Bob Fiddaman

Two Psychiatrists Explain Akathisia

Remember the names, folks.

On the left, we have Tyler Black, MD, Suicidologist and expert in emergency psychiatry. On the right, George Dawson, Psychiatrist, addiction psychiatrist, neuropsychiatrist, physician.

These two professionals have opened a can of worms on Twitter after claiming that they have both suffered akathisia. Miraculously, they claim, the akathisia was brought on by strenuous exercising!

This is a first, folks as every medical book or piece of literature regarding akathisia may have to now be re-written.

Up until their claims (Fig1), it was thought that akathisia was a condition caused by the adverse effects of treatment with many prescribed and over-the-counter drugs. To develop akathisia one can only ingest a drug, there is no other way of developing it. Dawson and Black's claims change all that.

Fig1

Dawson and Black's comments caused outrage amongst Twitter users, a selection of which are below.

Am I reading this correctly? Comparing physical stress to a drug induced Armageddon that lasts for months or years is like comparing a scratch on your finger to an arm amputation. Planet denial has been visited by these so called professionals. Unbelievable!

— Dr Ed White (@Reduxreloaded) February 3, 2020

They are trolling harmed patients. It is offensive and inappropriate for professions to do.

Professionals know perfectly well what akathisia is and know it is nothing like post-exercise restless legs.

— 🤦🏻‍♀️ Dogs Know Better (@dianamswancutt) February 3, 2020

Good grief. A great example of why (as I have mentioned) the name akathisia itself is a euphemism; needs to be changed. I’ve done massive amounts of workout in my life. Whatever stupidity those two were on about has ZERO comparison with the internal nightmare of EVERY cell at war

— Michele Buring-Honeychild🍀🦋🌸🌿✌️ (@MicheleBuring1) February 3, 2020

Not only they’re ignorant but this is super offensive for people who have experienced actual akathisia

— Ms Carnivore 🏁🥩 (@mscarnivore) February 3, 2020

As psychiatrists they certainly have vested interests in confusion and ignorance about akathisia. That’s their push. Or maybe they really don’t know what they’re talking about. Anyway, it’s offensive as hell.

— S Randolph Kretchmar (@MentalHealthLaw) February 2, 2020

One concerned patient advocate, Kristina Gehrki, whose daughter, Natalie, died an iatrogenic death brought on by akathisia, felt compelled to tweet The Royal College of Psychiatrists President, Wendy Burn, whose response did nothing but fan the flames.

Burn, as per usual, completely missing the point.

Shortly after the critiques of Dawson and Black's assertions that akathisia can be caused by exercise, Black somewhat retracted his statement with:

The Medication-Induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin (MISSD) reached out to Dawson, their tweet and his reply can be seen here.

Dawson's claim of being an expert in diagnosing akathisia and movement disorders is deeply worrying given his earlier claims that he developed 'acute akathisia' after strenuous exercise. How can one claim to be an expert in diagnosing akathisia when one falsely claims akathisia can be brought on through exercise?

It really is a wrong message to send out, particularly as exercise is often used to combat depressive episodes. By Dawson and Black claiming exercise can cause akathisia, they may be scaring people who want to use this route rather than a medicalised one. Quite why they have done this is anyone's guess.

Dawson and Black seem to be fully supported by the President of RCPsych, who, back in November endorsed Black's account to her followers, this too is deeply concerning. Burn's advice to Black, well, mute people, "You don't have to hear what they are saying about you."

What a wonderful legacy she is leaving behind!

There's nothing like a psychiatrist who ignores voices of those harmed by the very same drugs they've prescribed.

For more information on the **REAL** causes of akathisia please take the free, accredited Akathisia101 Course here.

Bob Fiddaman

PHE Review Dilutes SSRI Problem

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:

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.

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

What Help?

Help! I need somebody

Help! Not just anybody

Help! You know I need someone

Help!

Lennon & McCartney 1965

--

Oh, I get by with a little help from my friends

Mmm, I get high with a little help from my friends

Mmm, gonna try with a little help from my friends

Lennon & McCartney 1967

British newspapers were, once again, leading the way today with information regarding the latest brain pellet study that delivers a swift kick in the gonads to drug companies, regulators and prescribers.

The Sun and The Daily Mail ran with headlines, "‘Rare but serious’ risk of suicide for patients on antidepressants, new findings reveal" and "New health alert over antidepressants as study finds a 'rare but serious' risk of suicide for patients on pills."

The Mail's article was penned by Ben Spencer (Medical Correspondent for the Daily Mail), whilst The Sun's piece was written by Gemma Mullin (Digital Health Reporter for The Sun)

Whilst I'm always grateful to the British media for highlighting the suicide risk when taking brain pellets, I still get irked by journalists who take quotes from the Royal College of Psychiatrists on good faith.

Both articles feature a direct quote from Wendy Burn, who is President of the Royal College. Her quote seems to be the trump card played by spokespersons speaking on behalf of the industry but it is rarely questioned. This is where the mainstream media are failing. No pressing questions just an acceptance.

Burn's quote left me thinking that the media have almost come to accept the word of psychiatry as a congregation would of a priest delivering a sermon.

"It is vital that people prescribed antidepressants are monitored closely, made aware of possible side effects and know how to seek help if they experience them.", Burn proclaimed. This after Study leader, Dr Michael Hengartner, of Zurich University in Switzerland, said: "We can be confident that these drugs are producing an excess rate of suicides, beyond the depression itself." He added, "There is no doubt that this must be a response to the pharmacological effect of the drugs themselves."

Burn was never asked by either journalist whom patients should seek help from or, indeed, how, when one is feeling suicidal because of the inducement of akathisia, they can actually think straight, lift up a phone receiver and dial a number for help, on the proviso, of course, that there is such a number to dial. Quite how Burn and other spokespersons from the college get away with such comments leaves me bewildered.

In the past, Burn & Co have recommended that patients speak to their doctors. I find this perverse, don't you?

According to Burn's logic, those who have been prescribed brain pellets that are causing suicidal thoughts should go back to the very same person who prescribed them!

In 1978 more than 900 Americans – members of a San Francisco-based religious group called the Peoples Temple – died after drinking poison at the urging of their leader, the Reverend Jim Jones. Let's imagine for one minute if a spokesperson for a toxicology department had said back in 1978, "If you feel you have taken a substance that has caused you toxicity, we recommend you talk to the Reverend who will be able to help you."

Flippant of me yet you can't deny the facts here.

The media need to ask Wendy Burn exactly what plans are in place to help those suffering at the hands of these mind-altering brain pellets, be it those who are suffering severe withdrawal problems or those who are feeling suicidal because of them.

Wendy Burn is offering false hope to those she and her colleagues prescribe to. What she is saying is 'some people' may have difficulty but, hey, don't worry if you are one of those unfortunate souls who gets the urge to kill yourself "help" is just around the corner. The thing is, Burn and her colleagues have been standing on these street corners for years, first handing out the drugs, secondly, to send people to other corners when they complain of brain pellet withdrawal or feelings of suicidality. Sadly, all the corners are taken by her colleagues who are ready with their prescription pads to hand out yet more brain pellets to help with the suicidal thinking caused by the original prescription they handed out.

Quite why the media cannot see through her 'trump card' is beyond me.

Maybe one day a journalist with good investigative skills will probe the comments from the Royal College. You know, ask for evidence or perhaps the street address of any specialist in the UK who deals with brain pellet withdrawal and suicidality.

As I said at the top of this post, I'm grateful for the British media highlighting the risks of brain pellets but allowing throw away comments without following up those comments is poor journalism.

Wendy Burn blocked me on Twitter some months ago. Last week she had a change of heart and unblocked me. As I don't play to the tune of the piper, I immediately blocked her. I don't wish to correspond with anyone who will only address important issues when they are in a "good mood", least of all a President who, it has to be said, couldn't run a bath.

Maybe one day, the College will apologise to the families of all those who, through no fault of their own, have had to bury loved ones and suffer continuous heartache? I'm not holding my breath.

Michael P. Hengartner and Martin Plöder's study, Newer-Generation Antidepressants and Suicide Risk in Randomized Controlled Trials: A Re-Analysis of the FDA Database, can be read, in full, here.

Bob Fiddaman

Hashtag Backfires on Twitter

Wendy Burn: President of the Royal College of Psychiatrists

Twitter can be an effective resource for sharing research links, personal experiences and public opinions. It can also highlight the personalities of people with strongly held views.

On May 1st Hattie Gladwell, a journalist and columnist, tweeted the following:

At first glance, I perceived this tweet as just another tired attempt to try and silence those who've been harmed by pharmaceutical products and prescribers. It appeared Gladwell was trying to imply those who take pharma products marketed for mental health are, somehow, stigmatized by others. While I don't buy this PR spin, I do believe organizations and media work together to silence and stigmatize drug safety advocates and those who share their own experiences of prescribed harm. While I don't know if Gladwell and/or her publication is supported by pharma money/resources, her tweet actually sparked a Twitter storm that spotlights the black hole of dangerous prescribing.

Reading some of the replies made my jaw drop as people started posting the various drug cocktails they currently take. I've included a few examples below and have redacted the tweeters' names because some of these people likely didn't consider possible issues surrounding such public proclamations.

The below tweet was retweeted by the Royal College of Psychiatrists President, Wendy Burn. Burn didn't offer any warning regarding the cocktail of drugs this tweeter was taking.

Any patient concerned about the interactions of drugs they are taking can visit drugs.com, a database whereby a user adds the names of multiple drugs they are on to see if the drugs interact with one another. There are many similar databases available on the internet.

Here is what drugs.com reports about the interactions of Lithium, Quetiapine, Venlafaxine, and Mirtazipine:

Source

The tweeter thanked me for bringing this to her attention and said she would speak with her doctor.

Many other tweeters, from public health and safety advocates to those who support the pharma/psych industry, joined the conversation by using the hashtag, #ITakeMedsForMyMental Health.

The Royal College President continued to retweet those tweets she perceived to support her whilst dismissing those tweets about adverse effects. I suppose this is Burn's prerogative and I can't blame her for trying to support her own field.

However, several of her retweets are cause for concern. Many of her retweets were from patients who are taking several different drugs that have major interactions. Burn continued to retweet them and some members of the prescribed harm community perceived Burn's tweets to be an exercise in goading.

I implored Burn to stop as, I felt, she was putting patients in danger by not pointing out the dangerous interactions among some of the drugs these tweeters were taking. She ignored my request and continued retweeting.

One such retweet had me perplexed.

For Burn to retweet this after her college, back in August 2017, finally debunked the chemical imbalance myth, is astounding.

RCP reaffirmed this again in June 2018

Burn also retweeted, seemingly in support of Paxil, a product known as Seroxat in the UK and one that is currently the subject of litigation in London. Paxil cases have been won and settled in the US with regard to causing severe withdrawal problems, birth defects and even death!

Understandably, Burn came under a lot of fire for retweeting in support of a chemical imbalance, particularly after her own college has twice debunked this marketing ploy.

Burn took umbrage to the criticism and bizarrely tweeted the following:

Many people responded to Burn to ask why she thought trying to educate people regarding drug interactions could be deemed threatening. She never replied. Some 24 hours later, Burn blocked me and many others.

Understandably, her refusal to engage in critical conversations about adverse drug interactions has enraged many service users.

Burn is no stranger to controversy. Back in February 2018, she, along with fellow Royal College member, David Baldwin, came under fire for stating publically that, "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."  (Image above)

This statement was in sharp contrast to a previous study ("Coming Off Antidepressants") carried out by the Royal College that showed at least 63% of respondents reported difficulties withdrawing from the SSRI drugs. 

When this was pointed out to her by drug safety advocate, James Moore, the college pulled the study from their website stating that it was "out of date". (Back Story)

Complaints were made to the college but they were quickly dismissed.

The Twitter controversy continues today and many are dumbfounded that the RCP president is not warning patients about the life-threatening drug interactions she is witnessing and then publicly communicating via her Twitter page.

In my opinion, the hashtag that started this debate was a good one. I don't believe people are being stigmatized because they take drugs, but the hashtag certainly publicized the serious problems posed by polypharmacy. This recent Twitter storm shows me that there is a lack of duty and care among many prescribers and their professional organizations.

Being blocked by Burn doesn't really bother me. But it does highlight how the president of RCP, and RCP itself, continues to put PR above patient safety.


Bob Fiddaman

Related

“what we believe in” by Peter J Gordon