SSRI Induced Suicide

On 20 March 2008, I arrived home from work to find my only child, 17 year old Toran, had hanged himself. Toran had been prescribed the antidepressant fluoxetine 15 days earlier, despite having no diagnosis of any mental disorder.

Within 20 minutes of my son being pronounced dead, I spoke to the duty Coroner and asked him to ensure that the inquest investigate the role of fluoxetine in his death. Having witnessed his adverse reactions to the drug, there was no doubt in my mind that it was the cause of death.

Toran’s medical file includes an entry the next morning to ‘note Maria’s grief reaction in blaming mental health services for Toran’s suicide.’

Was this a grief reaction? Did my immediate assessment that my son’s suicide was antidepressant-induced have any basis in fact? Could a drug prescribed to 11% of all New Zealanders really cause people to take their own lives? The desire to understand how my bright, healthy, popular and dearly loved son could take his life, was the beginning of a quest which has consumed me for almost four years.

The data I gathered was both deeply disturbing and profoundly painful. New Zealand, according to the OECD, has the highest rate of youth suicide in the developed world. Shockingly, this rate is twice that of the US and Australia and five times that of the UK.

The Child and Youth Mortality Review Committee in New Zealand reports that more young people die of suicide than of all medical causes combined and that 10% of the deaths of our 10-14 year olds are suicides. Suicide deaths in New Zealand are double the number of road traffic  fatalities.

During a lengthy inquest, three years after Toran’s death, mental health services argued that Toran’s suicide was caused by major depressive disorder not fluoxetine. This is despite the fact that a team of mental health experts who reviewed his case 14 days before he died found he did not have depression or any other mental disorder. Could this be true? Could Toran have had an undiagnosed mental disorder severe enough to cause him to end his life but undetectable by his friends, family and two psychiatrists?

US born and NZ based ‘suicidologist’ Annette Beautrais asserts that 90.1% of those who die from suicide are mentally ill, with mood disorders the most common disorders in suicide victims.

Given New Zealand’s youth suicide rates, did this mean that New Zealand children are twice as mentally disordered as their American and Australian peers and five times madder than children in the UK?  It appears not as the NZ Ministry of Health estimate that 47% of New Zealanders will meet the criteria for a mental disorder during their lifetime is consistent with the prevalence rates in the US, Australia and the UK.

Male suicides in NZ outnumber female suicides three to one and according to NZ research, female secondary students are twice as likely as male (males 9.0%, females 18.3%) to report levels of depressive symptoms that are considered to be serious and in need of professional assistance. If depression is so strongly correlated with mental disorder, and girls are more likely to suffer depression,  why do boys in New Zealand complete suicide three times as often as girls? Is this because depression in boys is less likely to be treated? Not according to the Mental Health Commission who report that males account for 59% of children and youth who accessed secondary mental health services.

If boys are accessing secondary mental health services more frequently than girls, why are they completing suicide at such high rates? Are our state of the art services provoking rather than protecting against suicide? The Annual Report of the Director General of Mental Health it is clear that mental health care is strongly associated with suicide. The Director General reported in 2011 that the rate of suicide for those who had been in contact with mental health services during the previous year was 21 times the rate of suicide of those who did not receive mental health treatment. Specifically, the rate of suicide in service users was 206 per 100,000 while that of non-service users was 9 per 100,000. If 90.1% of these people had mental disorders, why were those accessing services 21 times more likely to kill themselves than those not accessing services?

Intuitively, one would suspect that those accessing services had more serious disorders and that this would account for their higher suicide rates but the diagnostic information provided by the Director General in his 2007 annual report would suggest otherwise. Information on the diagnosis of those who ended their lives under the care of mental health services showed the largest diagnostic category was ‘other.’ Depression (18%), Schizophrenia (11%) or Bipolar (9%) combined resulted in fewer suicides than ‘other’ which presumably includes a range of ‘minor’ DSM-IV diagnoses and, importantly, those with no diagnosis at all.

The key difference between these populations is not their diagnosis but their contact with mental health professionals. New Zealand data shows the The majority (75%) of those who die by suicide have contact with primary-care providers in the year prior to death, and one third have contact with mental health services.  In the final month before death, 49% of suicide victims have contact with mental health services.

 

Mental Health treatment in New Zealand employs medication as a first line treatment, despite the fact that antidepressants are not approved for use in children under 18 years in and our regulator’s advice that the risks outweigh the benefits of prescribing these drugs to children and adolescents.

 

The Coroner found that Toran’s care by mental health services was deficient. Our regulator found that fluoxetine was the most likely cause of his suicide. Their assessments of the circumstances leading to Toran’s death, having reviewed the evidence align with mine – the difference is that they cannot be dismissed as a grief reaction.

 

15 COMMENTS

  1. I a so sorry for your unimaginable loss.
    I don’t think the SSRI-suicide connection is well understood. It’s important not to overreact to what might simply be a temporal correlation, rather than a cause-effect assumption, as there are huge confounding factors here, not the least of which is that SSRIs are often first prescribed when someone is severely depressed and thus most prone to suicide. Those first week weeks into antidepressant treatment need to be well monitored, as depressive symptoms will usually not have yet subsided, yet irritability can increase. There are also theories that SSRI’s can “activate” (i.e. treat anergia) before antidepressive effects kick in, thus giving a depressed person more energy which can possibly be channeled towards self-destructive aims.

    Something to consider. Many depressed patients commit suicide several weeks into beginning psychotherapy, yet I don’t see congressional hearings looking to put a “black box” warning on psychotherapy. We just have to be careful about correlation and causation, i.e. understand that they’re not one in the same.

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    • Kevin, I don’t think the main thrust of Ms. Bradshaw’s argument was a temporal correlation; rather she provided very excellent data regarding the use of SSRIs in undiagnosed or folks diagnosed as “other”, not severely depressed people as you mentioned. Not only that, but she clearly states that not only did this bright, healthy, popular and dearly loved young man’s family AND friends not perceive that he was severely depressed, but two psychiatrists did not believe that either. Your suggestion that antidepressants act as a motivator for people who may have been SO depressed they could not act is one I have heard from the professional community for a decade, yet never have I heard of a single story that bears that theory out,(and I have heard thousands of stories) or seen a single citation or even a hypothesis that holds adequate evidence that such events are anything more than very rare. DO you have any citations for your statements? I would like to see the one about psychotherapy & suicide rates. It is painful to think that the ‘treatments’ we have been providing and using for decades are not only ineffective but dangerous as well, but it is a story that must be told if we are to evolve our thinking to a more productive behavioral health system and achieve some positive outcomes, rather than continue to create a disabled population of folks who experienced emotional distress, then were told they have a chronic disease and must receive life-long treatment, don’t you think? After all, it was not that long ago that yanking out people’s teeth & intestines was the sure cure for mental distress- I look forward to looking back on these days & times years from now and shaking my head in wonderment at the things we conjure up to help people who are sad.

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    • Having performed a quick Google search, I would be led to believe that you are the same Kevin Nasky that goes by the Twitter handle @USMCShrink. If this is in fact true, you would know better than anyone else the detrimental effects that psychiatric meds have on people as being a Naval Psychiatrist you would know the suicide rate of service men and women is exponentially higher than the general public. You would also know that the United States Military also has exponentially higher rates of antidepressant usage than the general population.
      As a psychiatrist you would also know that there is zero empirical evidence supporting the chemical imbalance theory, nor the treatment of depression with SSRI’s, Tricyclics, MAOI’s, Cocaine or Amphetamines.

      I find it quite intriguing that you have commented here with the rhetoric of either a drug company shill or at a minimum a man trying to defend a practice that he knows is corrupt.

      Maria was pretty clear that her son Toran didn’t even meet the diagnostic criteria for depression and yet after only being on Prozac for a very short time was driven to taking his own life.

      Tell me Kevin, would you recommend your teenage son, who didn’t meet the DSM criteria for a depression diagnosis, would you encourage him to take Prozac?

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  4. I have read this blogpost a number of times and I still have a number of questions. My main question is what was going on at Toran’s life at the time he saw a general practitioner 15 days before his death and was seen by mental health practitioners fourteen days before his death.
    What intervention could competent and compassionate professionals have made that would have addressed those issues? I am thinking that we need to produce a best-practice models for dealing with the problems of teenagers as even healthy, bubbly teenagers can have highly erratic behaviour at that time.

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  5. I am so very sorry for your loss. This is happening more and more
    with teens and even adults. Everyone should know that psychiatric
    medications are dangerous. They are not the answer. Great book
    to read on this is Robert Whitaker’s book, “Anatomy of a
    Epidemic”. Psychiatrist push pills because they and the Pharma
    industry make more money. They diagnose peoplewith things
    out of the context of their experience. The average “professional”
    will spend 15 minutes with a new patient and prescribe meds.
    Meds are not the answer in most cases. They are under studied
    and these shrinks don’t even know if they work or how and they
    consistently fail to disclose side-effects if they even know what
    they are.

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  6. I was on AD’s as a kid and I remember how every one of them completely blew me out of my mind. My personality changed so much on each one that I’m certain it messed me up for life. Before the drugs I was a calm, quite and timid kid who just wasn’t paying attention in class. After a couple years of stimulants and an occasional neuroleptic, they put me on AD’s for some reason. Shortly after being on Prozac, I became extremely aggressive, I felt invincible, I taunted adults to fight me, attacked my teacher, fought with my parents, tortured the family pet to death, then eventually wound up in the hospital. Shortly after being taken off that drug, I went more or less back to normal – quite and timid. But everything I had done was blamed on my illness and that the drug, even though it was so blatantly obvious that the doctors had to convince my parents that the drug had actually “awoken” the underlying “disease” which would now need life long treatment. As the years went on, I had a couple more, albeit less serious, bad reactions to AD’s.

    My point is that ADs are mind bending. They change the way you think, feel and perceive. So of course they can take somebody who isn’t even mentally ill and make them suicidal, or homicidal, or anything at all. People who have a hard time understanding that are people who refuse to acknowledge that AD’s are in fact psychotropic drugs. They are MIND-BENDING!

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  8. On reading this article, my heart goes out to Maria. It has just been announced that Scotland’s suicide rate is about 80% higher than that of England. From two recent suicides of young men in the Inverness area, what concerned me was the fact that they had pleaded with their doctors to take them off these drugs (SSRI’s) because of the unbearable side-effects. in both cases, the individuals decided to end their lives because they could not take any more. I doubt whether their medication was even considered as a possible contributory factor to their deaths at the post-mortems, but I feel such factors should at least be taken into account, when investigating suicides.

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  9. Wow Maria. I am so sorry for your loss. You are such a brave person and amazing mother to have held the authorities to account for the cause of your son’s death. I am heartened by the Coroner’s finding that the drug was the most likely cause.

    There are a lot of people out there with experience of being on these drugs, but it seems there is often some excuse, by those with vested interests, to try to explain away the downsides of these drugs, often in terms of the sufferer’s assumed mental health problems. When you are in the grip of one of these drugs it is very hard to argue the case. I believe that there is significant benefit in ensuring that someone with mental health issues should have a strong advocate of their best interest in attendance with anyone who is administering psychoactive drugs as well, because the decisions that can be made at such times can have enormous implications and the sufferer is highly unlikely to be in a suitable position to make those decisions either due to a genuine underlying mental health problem or the unpredictable effects of psychoactive drugs.

    As a previous person noted – there is no proof of the serotonin hypothesis that the manufacturer’s of these drugs claim their drug can fix, yet no-one denies that these drugs are psychoactive or mind-altering and, by definition, will change your behaviour, feelings and personality thereby creating a ‘disturbed’ person in ways which, again no-one could deny, are unpredictable. My personal view, based on painful experience of depersonalisation, derealisation, inner torment, akathisia and other tortures over many years is that all psychoactive drugs should have much better, proven efficacy and only be used in situations where other therapy has failed. They should never be used as a first line in mental health. While psychological therapy may not prove effective in a given case it is, at least, a benign approach. I also maintain that personally I have found it much easier to practice psychological therapy techniques and see their benefits after ceasing psychoactive medication.

    There are also significant issues in stopping taking psychoactive drugs. The experience can be so traumatic that the sufferer’s behaviour through the process can be interpreted by ‘experts’ as further evidence of underlying mental health problems and so the horrors continue. There are also reports of people with long-term physiological problems long after discontinuation. I, for example, am currently trying to deal with peripheral neuropathy which I believe is caused by my long-term use of SSRIs.

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  10. I have a story I would like to post here If I am allowed.
    It happened in 1981
    BUT…
    In 2009 My Sister’s Sudden death, Suspicious Suicide, has finally been solved!
    Decades later the truth be told. My family now has closure to a huge loss in all our lives that should of never happened, and I know their are other families out there who still are in the dark about the LINK that has been made to these kinds of prescription drugs, and a loved one they have lost as well. 1950’s- the late 80’s is the timeline I am speaking of. I shall post my link to my story that now is public on The Drug Awareness site in the USA.
    Thank you.

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  11. MY INTENTION OF TELLING HER STORY IS NOT TO MAKE PEOPLE STOP, OR START TAKING MEDICATION, BUT TO RAISE AWARENESS ABOUT THE SIDE EFFECTS THAT THEY CARRY. in 2009 I PUT IT ALL TOGETHER..WHY? WHY? DID MY 25 YEAR OLD SISTER SUDDENLY TURN SUICIDAL?
    DECADES IN THE DARK…. WE WERE!!

    HAD WE KNOWN THE CONCEALED SIDE EFFECTS OF IMIPRAMINE
    MY SISTER WOULD BE ALIVE TODAY!
    SHE DIED SUDDENLY ON SEPT. 22 1981

    CLICK THE LINK BELOW, AND TRAVEL BACK IN TIME WITH ME,
    NOT KNOWING IT WAS THE LAST SUMMER I WOULD SPEND WITH MY SISTER LORI.

    THE SEASON CHANGED TO FALL TIME,
    IT WAS SEPTEMBER 22, 1981.
    I WAS JUST STARTING 8TH GRADE.

    WHEN SUDDENLY HORROR STRUCK,
    AND ALL OF OUR LIVES WERE CHANGED FOREVER.

    READ THE SUMMARY OF
    LORI’S STORY:

    http://www.drugawareness.org/casereports/pre-ssri-case-reports/suspicious-suicide-of-sister

    NOT KNOWING THE CONNECTION FOR ALMOST 3 DECADES WAS UNBEARABLE.

    NOW THAT I DO KNOW AND THE LINK WAS MADE… I AM MAD AS HELL.

    WHAT WOULD DO?

    Warning today:
    Imipramine and Suicides: Suggestions
    Your healthcare provider should monitor you (or your child) carefully when you are first starting an antidepressant.
    You should also be watchful for any signs of suicidal behavior. Contact your healthcare provider right away if you (or your child) have any of the following:

    Thoughts about death or committing suicide
    Suicide attempts
    Depression or anxiety that is new or worse
    Agitation, restlessness, or panic attacks
    Trouble sleeping (insomnia)
    Irritability that is new or worse
    Aggressive, angry, or violent behavior
    Acting on dangerous impulses
    Unusually increased talking or activity
    Other strange changes in mood or behavior.

    I WITNESSED ALL OF THE ABOVE..AS YOU HAVE READ IN HER SUMMARY STORY.

    NEVER LINKING IT TO SIDE EFFECTS OF THE PRESCRIPTION DRUG SHE WAS TAKING AT THE TIME!

    Pharmacosis:
    * The first descriptions of a drug causing suicide came in 1955. A few years later in 1958 and again in 1959 the problem was described with imipramine.

    * Treatment induced suicide became a prominent media issue in 1990 with a paper by Teicher and Cole.

    *It was not until 2004 that regulators and companies conceded that these drugs can cause a problem.
    ** There are now 38 drugs!**

    Emergence of intense suicidal preoccupation during fluoxetine treatment.
    Teicher MH, Glod C, Cole JO.
    Source
    Department of Psychiatry, Harvard Medical School, MA.

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  12. Hello,

    My name is Eric Gerber. In August of 2012, I lost my brother to suicide. He was not a chronically depressed person. In fact, everyone perceived him to be always happy, always on top of everything. He was having his share of life issues, but was basically getting along well, married with two young boys. Though we didn’t see each other as much as we would like to have, we were best friends.

    Two weeks before his death, he went to a psychiatrist who prescribed him Zoloft, Ambien, and Xanax, without instruction to seek help should he have any thoughts of suicide. There was no follow-up to see how he was handling the medication. As my research has shown me, SSRI drugs can cause an otherwise rational person to have irrational thoughts of suicide, turning off that internal mechanism that tells us that those thoughts are wrong, and in fact, give a person a feeling that suicide is perfectly rational.

    The doctor did not do anything to break official protocol. This is wrong. These drugs, while helpful to many, can be fatal to others, and there needs to be more oversight.

    As a way to call attention to this epidemic we face, I poured my heart in to writing a song for him, for all of us. My goal is to spread the word about the dangers of SSRIs. This song was both intensely painful and cathartic to write and record. I still have never performed it live. Please share this song so the message spreads.

    Here is a link to a website where the song can be both streamed and downloaded for free. Please consider linking to this song on your website. Thank you.

    http://www.folkalley.com/openmic/song.php?id=20729

    Sincerely,

    Eric Gerber

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