When she sent Margaret’s Story to us, M had already written to Britain’s Suicide Czar, Louis Appleby. She got the following response:
Thank you for taking the trouble to contact me. I am so sorry to hear about the death of your son. Those of us who work in suicide prevention are always aware of the individual tragedies that lie behind our figures.
The problem of agitation in the early period of treatment with SSRIs has been known for several years, at least to psychiatrists. I think you are commenting on front-line A&E staff and if so, I suspect you are right, that many will be unfamiliar with the side-effects of SSRIs as they are not specialists in mental health. I have forwarded your note to my Department of Health colleagues who are preparing the final suicide prevention strategy – analysing the consultation responses has taken a lot of time and they are still working on this. I will also raise it when I meet the College of Emergency Medicine shortly.
As you will appreciate, one of our biggest concerns in preventing suicide is still the under-treatment of depression in primary care. One reason for this has been the reluctance of many depressed patients to take antidepressants. SSRIs have helped here because in general their side-effect profile is more acceptable than that of the older tricyclic drugs, and because taking them is usually a matter of only one tablet a day. However, SSRIs are not without their own risks.
Thank you again for writing.
With best wishes
The argument that we can’t warn because it will deter others from seeking help first surfaced at FDA hearings on Prozac and suicide in 1991 (see Pharmageddon). If there were any evidence that anyone’s life was being saved this might be one thing, but there is no evidence that suicide rates would be reduced if we got everyone who could be treated with SSRIs and related antidepressants onto them.
The data shows a net harm, even when FDA stripped the suicides and suicidal acts linked to withdrawal out of the picture in 2006. Adding withdrawal suicides back in makes the risk of treatment look even worse.
It’s difficult to see how Dr Appleby or others expect to get many more people on antidepressants than we now have. We have had 20 years of perhaps the most successful marketing campaign in history, a campaign that has even managed to persuade parents and doctors that pre-school children are depressed and in need of antidepressants. The vast majority of these and of anyone else who might be likely to end up on antidepressants are at a vanishingly small or no risk of suicide.
The biggest single reason people might not end up on an antidepressant in recent years is down to pharmaceutical company marketing of bipolar disorder and efforts to persuade doctors to prescribe anticonvulsants or antipsychotics rather than antidepressants.
Lets step back and ask what an antidepressant is. An antidepressant is a drug that gets through current testing procedures put in place by regulators like FDA. The current testing procedures are such that if two glasses of good red wine per day were put through the kinds of trials in the kind of patients that brought SSRIs on the market, the wine would show up as being just as “antidepressant” as SSRIs do. There might even be less evidence of suicide risk with wine compared to SSRIs, but whether less than or the same as SSRIs, if the argument were put forward that we must avoid warning about the risks of alcohol because we don’t want to deter others from getting started on it, what would we think was going on?
If there was a good reason to think that SSRIs could somehow reduce rates of suicide, despite the evidence, the failure to warn about the risks in order to increase the numbers likely to be put on the drugs comes close to a covert vaccination program. All will be treated in the expectation that more will be saved than lost as a result.
A curious vaccination program in that with a vaccine while some lose everyone stands to gain but in this case a majority of those being vaccinated have little or no conceivable gain. A curious vaccination program in that doctors aren’t actively on board with it. They are as much in the dark as to what is going on as everyone else, maybe even more so. They haven’t been told there is a good case to warn but we aren’t going to warn for fear of deterring you from putting as many people on pills as you can.
This under the radar “policy” appears to have come out of meetings between a few bureaucrats in FDA and company people in Lilly, over 20 years ago.
Louis Appleby’s letter to Margaret seems like a standard bureaucratic dismissal. Over 10 years ago, aware of some of the individual tragedies behind the figures and of company documents conceding the drugs caused suicide, I tried to engage with MHRA – the entire correspondence was posted on socialaudit.com and part is on healyprozac.com. I asked them to show me where I was wrong as I would feel a moral obligation to stop talking about the risks of SSRIs if there was evidence they did more good than harm. I met MHRA on several occasions but despite an open invitation to them to tell me where I was wrong was never given any information.
It makes no difference to a bureaucratic machine if Margaret and others write forever.
A Platonic Lie is when a ruler decides to keep the truth from his subjects in what he determines to be their best interests.