Here’s an interesting story from Australia, recently back in the spotlight.
From 1962 to 1979, psychiatrist Harry Bailey, MD, serving as chief psychiatrist at Chelmsford Private Hospital in New South Wales, practiced “deep sleep therapy,” which involved keeping people in barbiturate-induced comas for days or even weeks. Twenty-four of the individuals who received this “treatment” died while still in the hospital. Many more died or showed permanent brain damage after discharge.
According to Wikipedia, deep sleep therapy (also known as prolonged sleep treatment or continued narcosis) “is a psychiatric treatment in which drugs are used to keep patients unconscious for a period of days or weeks.”
Deep sleep therapy has a checkered history. It was first tried by Neil Macleod, a Scottish psychiatrist, at the turn of the twentieth century, but it didn’t catch on, and was soon abandoned. It was re-introduced in 1915 by Giuseppe Epifanio, an Italian psychiatrist, using barbiturates to induce sleep.
In the 1920s, the procedure was adapted by Jakob Klaesi, a Swiss psychiatrist, also using barbiturates marketed by the pharma company Roche. In Klaesi’s first publication on this matter, he acknowledged that three of the 26 patients had died during the study due to broncho-pneumonia or cardiac hemorrhages (here, pp 334-335). This is about 12%. Nevertheless, the method achieved some popularity in the ’50s and ’60s and was used by William Sargant in the UK and Donald Cameron in Canada, both considered eminent psychiatrists: Dr. Sargant was president of the psychiatry section of the Royal Society of Medicine, 1956-57, and was a founding member of the World Psychiatric Association. Dr. Cameron was president of the American Psychiatric Association (1952-53), Canadian psychiatric Association (1958-59), American Psychopathological Association (1963), Society of Biological Psychiatry (1965), and World Psychiatric Association (1961-66). He has been criticized for administering electric shocks and drugs without consent and for his role in the development of psychological torture techniques. (here)
In 1972, Dr. Sargant co-authored with Eliot Slater and Desmond Kelly An Introduction to Physical Methods of treatment in Psychiatry (Edinburgh: Churchill Livingstone, 1972). Here’s a quote from the text, taken from the Wikipedia article on Deep Sleep Therapy:
“Many patients unable to tolerate a long course of ECT, can do so when anxiety is relieved by narcosis … What is so valuable is that they generally have no memory about the actual length of the treatment or the numbers of ECT used … After 3 or 4 treatments [without narcosis] they may ask for ECT to be discontinued because of an increasing dread of further treatments. Combining sleep with ECT avoids this … All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs and ECT [which] together generally induce considerable memory loss for the period under narcosis. As a rule the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given. Under sleep … one can now give many kinds of physical treatment, necessary, but often not easily tolerated. We may be seeing here a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anaesthesia in surgery.”
One can only wonder what the “many kinds of physical treatment necessary, but often not easily tolerated” entailed. The Wikipedia article on Dr. Sargant is not flattering, e.g.:
“Sargant used narcosis (sleep treatment) to overcome a patient’s refusal of electroconvulsive therapy, or even deliver it without their knowledge.”
“There were, however, several deaths.”
Harry Bailey, the Australian psychiatrist mentioned earlier, was apparently inspired by Sargant’s methods. They remained in close contact, and reportedly even vied with one another to see which could keep a patient in the deepest coma (here).
Deaths and Deep Sleep Therapy
“Deep sleep therapy was…practised (in combination with electroconvulsive therapy…and other therapies) by Harry Bailey between 1962 and 1979 in Pennant Hills, New South Wales, at the Chelmsford Private Hospital. As practised by Bailey, deep sleep therapy involved long periods of barbiturate-induced unconsciousness. It was prescribed for various conditions ranging from schizophrenia to depression to obesity, premenstrual stress syndrome and addiction.” (Wikipedia)
“Twenty-six patients died at Chelmsford Private Hospital during the 1960s and 1970s. After the failure of the agencies of medical and criminal investigation to tackle complaints about Chelmsford, a series of articles in the early 1980s in the Sydney Morning Herald and television coverage on 60 Minutes exposed the abuses at the hospital, including 24 deaths from the treatment [deep sleep therapy]. That forced the authorities to take action, and the Chelmsford Royal Commission was appointed. The Citizens Commission on Human Rights, co-founded by the Church of Scientology and Professor of Psychiatry Emeritus Dr. Thomas Szasz in 1969, was an advocate for victims…” (Wikipedia)
Additional details of these matters are set out in a document titled “Deep Sleep Tragedy,” authored by the Public Interest Advocacy Center, an Australian non-profit association.
Here are some quotes from PIAC’s report:
“Patients were kept in a comatose state for days or weeks by massive doses of barbiturates. They lay naked on beds and were fed through tubes and were sometimes administered convulsive electrical shock treatment while in a coma.
“The treatment’s major proponent, Dr Harry Bailey, claimed deep-sleep therapy cured depressive illnesses and compulsive behavior such as drug and alcohol addiction.
“Other psychiatrists doubted the value of the treatment and were concerned about its risks. Dr Bailey and his small group of colleagues were the only psychiatrists [at Chelmsford] to use deep-sleep therapy with any frequency….”
“In 1980, the CCHR forwarded documents it had obtained from Chelmsford to the television program, 60 Minutes. The story 60 Minutes aired as a result of those documents was a powerful indictment of Dr Bailey and his colleagues and of government inactivity. The authorities were finally stirred to some action, but what followed was a lamentable series of bungles by different parts of the bureaucracy, which ultimately led to the striking out, 11 years later, of misconduct proceedings against the Chelmsford doctors because of this delay….”
“About that time, several inquests were held into the deaths of patients and a criminal charge of manslaughter was pending against Dr Bailey….”
“After further courtroom skirmishes, the Investigating Committee referred the complaints to the Disciplinary Tribunal, the body which de-registers doctors. After further delays, the de-registration hearing finally came on in June 1986. Dr Bailey had committed suicide in the intervening period.”
In the end, the plaintiffs’ case was dismissed on the grounds that the long investigative delays caused hardship to the psychiatrists (to the psychiatrists, mind), and that the plaintiffs should have pursued their own case when they realized that the government was being slow to act.
The Chelmsford scandal, as it came to be known, generated a great deal of discussion and shock at the time. Here are some additional matters that came to light through various investigations and reports.
“By 1979, when Bailey’s Chelmsford practice closed, at least twenty-four patients had died, others had committed suicide and many survivors suffered physical and mental complications arising from their treatment.”
“The veil of professional repute that protected Bailey began to unravel. From 1972 a Chelmsford nurse, Rosa Nicholson, documented treatment irregularities; she passed this evidence to the Citizens Committee on Human Rights, a branch of the controversial Church of Scientology. In 1978 the committee wrote to the attorney-general detailing the evidence of medical malpractice, and newspapers began to report their allegations. That year the suicide of the dancer Sharon Hamilton, a patient and lover of Bailey, and revelations that he was the beneficiary of her estate, further undermined his reputation.”
“A well-dressed, handsome and cherub-faced charmer, Bailey was charismatic, despite occasional drunken rages. A noted bon vivant, he was prone to exaggerating his achievements. Although he lapsed into periods of deep gloom, salved by drink and medication, he continued to assert that his methods were efficacious. He saw himself as a martyr, hounded by religious fanatics and ignorant critics.”
“Bailey revelled in the trappings of professional power and exploited the vulnerabilities of those in his care, having sexual relationships with a number of female patients and some employees.”
“In 1988 the Greiner government established a royal commission into deep sleep therapy. The commissioner concluded that events at Chelmsford were deplorable, and found evidence of fraud, obstruction of justice and serious medical negligence. He condemned all the doctors involved but concluded that Bailey was central and that without him there would have been no deep sleep therapy. The New South Wales parliament banned the treatment and enacted stricter regulations governing the admission and treatment of mental health patients.”
“Following the Aftermath of the Chelmsford scandal, severe reforms were needed with Psychiatry. The nature of Chelmsford as a private hospital meant that it did not come under the scrutiny of the public health system. Regulation of Chelmsford was thus slack, and there was no proper code of ethics within psychiatry at this time (Wilson, 2003). Slow progress took place after the scandal of Chelmsford had been exposed; there was reconstruction of a new complaints unit within the department of health services, which allowed members of the public a more direct and independent place to lodge their concerns (Swan, 1991). This was something that was severely missing in the heyday of Chelmsford as many patients had to use the media as a public forum to push for their voice to be heard. A code of ethics for psychiatry was implemented by the Australian and New Zealand College of Psychiatrists in 1992 (Wilson, 2003) and in 2010 medical professionals became lawfully required to report other medical professionals who practiced their medicine outside the normal accepted forms.”
“Changes to the laws and regulations were not implemented without resistance and fear from psychiatry circles. Many professionals were afraid that rules implemented in the aftermath of Chelmsford may be over reactive and strangle the profession, taking away psychiatrists ability to practice new and ‘innovative’ techniques. (Boettcher, 1998)”
From Psychiatric Coma Treatment in Australia, 1959-1982 (review from Amazon page for the book: Deep Sleep: Harry Bailey and the Scandal of Chelmsford by B. Bromberger and J. Fife-Yeomans):
“Treatment involved people being nursed naked in mixed wards, subjected to tube feeding. Occasionally patients escaped and residents occasionally witnessed people running naked down the street, a tube dangling from the nose. Reportedly, the stench of urine on the ward was overpowering. Harry Bailey engaged in sexual relations with some of his patients and had a special room at the private hospital where he worked in order to have private time there with selected patients.”
“No referring doctors to his private hospital ever questioned anything. No nurses raised any issues with any investigative authority. A trainee nurse shocked by what she saw contacted the Health Dept in 1972, but got no response. It was only when the Church of Scientology got involved that a process was set in motion to get psychiatric coma treatment banned. However, the medical profession closed ranks and only Bailey got the blame.”
“Between 1963 and 1979 at least 24 patients died as a result of DST [deep sleep therapy]. Another 24 committed suicide after being discharged.
“In all, 183 deep sleep patients died either in hospital or within a year of returning to the outside world, while 977 were diagnosed as brain damaged.”
“The horrors of Chelmsford would never have been exposed had it not been for the courage of one person, nurse Rosa Nicholson.
“After a friend died following deep sleep treatment, she spent 18 months trying to get a job at Chelmsford. In mid-1977 an advertisement in a Sydney newspaper gave her chance.
“For the next two years she smuggled hospital and patient records out of Chelmsford, photocopied and returned them.
“She remained undercover for a decade, leaking damaging evidence against Bailey to those who would listen.
“Staff said Bailey had sex with his female patients, often ordering them sent by taxi to his office or home late at night.
“Commissioner Justice John Slattery said in his 12-volume report there were ‘strong suspicions’ that Bailey was involved in the suicide of his patient and lover, singer Sharon Hamilton.
“Bailey was the sole beneficiary of Hamilton’s will.
“‘No one questioned Bailey because he was the leader in his field,’ Whitty [former ‘patient’] said. ‘He had all the credentials of an eminent specialist – you couldn’t help but believe in him.'”
“Some [of the ‘patients’] underwent psychosurgery, of which Bailey was a leading proponent. He believed that one indication for cerebral surgery was homosexuality.
“The commissioner reported that Dr Bailey had falsified death certificates and had lied to coronial inquests going back as far as 1967.
“Private hospitals are supposedly now inspected much more closely and the state’s current minister for health has taken a strong position concerning controversial treatments in psychiatry—which, by the way, has created problems for the local College of Psychiatrists, which does not want to see psychosurgery totally banned, for instance.”
Observations and Comments
Perhaps the most noteworthy feature of this entire matter is the fact that the continuous narcosis procedure was known to entail a significant risk of death or disability as early as 1922—forty years before the very eminent Dr. Bailey’s “treatments” began. Remember Dr. Klaesi’s 12% fatality rate!
In addition, the 1963 edition of Taber’s Cyclopedic Medical Dictionary has this to say about using barbiturates to produce sedation or deep sleep for legitimate surgical purposes:
“After Care: While unconscious, place on side unless an air-way has been inserted, when patient may lie on back. Watch for quiet breathing and gray color of face which should be reported at once to surgeon. Have oxygen ready. Never leave patient while unconscious.” (p B-9)
It is clear from this quote that there was, as early as 1963, a recognition within general medicine of the risks entailed in the use of barbiturates to induce sleep, even for short periods. The reasons for the concern are first, that barbiturates suppress breathing, and, second, that the fatal dose is relatively close to the dose required to induce sleep. Despite this, and the high death rate, the use of continuous narcosis at Chelmsford Private Psychiatric Hospital ran from 1962 to 1979—a total of 17 years.
Then and Now
Of course, it could be argued that the 1960s and ’70s were a long time ago; that psychiatrists are much more careful now; and that such things would not happen today.
In 1983, an article titled “Suicide Associated with Akathisia and Depot Fluphenazine Treatment” appeared in the Journal of Clinical Psychopharmacology. The authors were Katherine Shear, MD, Allen Frances, MD, and Peter Weiden, MD. The article presents two case studies of individuals who had killed themselves while suffering the effects of depot fluphenazine-induced akathisia. Fluphenazine is a neuroleptic drug marketed in the US as Modecate and Prolixin, among other brand names. Here’s the conclusion of the piece:
“Although we cannot be sure that akathisia caused the deaths of our patients, akathitic symptoms seemed to be immediate precipitants of suicidal behavior. We urge clinicians to be alert to the discomfort of akathisia and to treat it aggressively.”
Note that although the authors acknowledge that they can’t be sure that fluphenazine-induced akathisia drove the individuals to suicide, the tone of the article and the presented facts leave the reader in little doubt that this was the case. I have written more extensively on this topic elsewhere.
The usual treatment recommended for neuroleptic-induced akathisia, incidentally, is to withdraw or reduce the drug.
Eleven years later (1994), DSM-IV was published, with Allen Frances as the editorial chairperson. This edition of the manual recognized the existence of neuroleptic-induced akathisia and categorized it as a diagnosis “requiring further study.” It was coded as 333.99. Two-and-a-half pages (744-746) were devoted to its description. Here’s a quote:
“The subjective distress resulting from akathisia is significant and can lead to noncompliance with neuroleptic treatment. Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts. Worsening of psychotic symptoms or behavioral dyscontrol may lead to an increase in neuroleptic medication dose, which may exacerbate the problem. Akathisia can develop very rapidly after initiating or increasing neuroleptic medication. The development of akathisia appears to be dose dependent and to be more frequently associated with particular neuroleptic medications. Acute akathisia tends to persist for as long as neuroleptic medications are continued, although the intensity may fluctuate over time. The reported prevalence of akathisia among individuals receiving neuroleptic medication has varied widely (20%-75%).” (p 745) [emphasis added]
Another quote from the same section of DSM-IV:
“Serotonin-specific reuptake inhibitor antidepressant medications may produce akathisia that appears to be identical in phenomenology and treatment response to Neuroleptic-Induced Acute Akathisia.” (p 745) [Bold face in original]
So akathisia can also be caused by SSRIs.
In DSM-IV-TR (Text Revision), 2000, the same two-and-a-half pages of text were included, with the addition “Although the atypical [i.e. newer] neuroleptic medications are less likely to cause akathisia than the typical [i.e. older] neuroleptics, nonetheless, these medications do cause akathisia in some individuals.” (p 801)
However, in DSM-5 (2013), the only comparable references are 333.99, “Medication-Induced Acute Akathisia” which runs to a total of four-and-a-half lines of text:
“Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.” (p 711)
and 333.99 Tardive Akathisia, which is combined with 333.72 Tardive Dystonia and which together run to another three-and-a-half lines of text:
“Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction.” (p 712) [emphasis added]
Note the admission that the akathisia can last for “months to years” even if the drugs are stopped. The notion of people suffering from akathisia for a period of “months to years” is unconscionable. Nevertheless, it took the APA sixty years of neuroleptic use and, inevitably, sixty years of tardive akathisia before they even acknowledged that this problem was caused by their drugs. And bear in mind that the phrase “months to years” could mean permanent.
Readers can view clips of victims of akathisia here.
Here’s a summary of the akathisia material in DSM-IV (1994) that did not make it to DSM-5:
- Akathisia may be associated with dysphoria, irritability, aggression or suicide attempts.
- Akathisia can develop very rapidly after initiating or increasing neuroleptic “medication.”
- The development of akathisia appears to be dose dependent. Reported prevalence is 20%-75%.
- Increasing the neuroleptic dose will often exacerbate akathisia.
- Selective serotonin reuptake inhibitor (SSRI) antidepressants may produce akathisia that appears to be identical to that which is induced by neuroleptics.
- Akathisia can co-occur with neuroleptic-induced tardive dyskinesia.
- “In its most severe form, the individual may be unable to maintain any position for more than a few seconds.” (p 744)
The critical questions are these: Why did the APA shorten the entry in question from two-and-a-half pages to a total of eight lines? Why did they suppress the critical safety information in DSM-IV, particularly the danger of suicide and aggression? And why was the specific and clearly-stated causal link to neuroleptics and antidepressants in DSM-IV diluted in DSM-5?
In my post of November 8, 2016, I provided numerous accounts of individuals who became actively suicidal or violent when in the throes of acute akathisia.
The Australian scandal is particularly noteworthy in this context, in that the procedure—and the deaths—continued for a period of seventeen years and involved 24 deaths in the “hospital” and multiple suicides and emergent brain damage after discharge.
Why didn’t the psychiatrists stop the procedure sooner—after one death, say, or, better still, not start it at all, since the dangers were already well known? It also needs to be asked why didn’t the other psychiatrists at the facility confront the eminent Dr. Bailey and/or report his actions to the proper authorities. Why did it have to fall to a nurse—Rosa Nicholson—to obtain the necessary information surreptitiously and blow the whistle? How much longer would the carnage have continued had she not taken those brave initiatives? Are today’s psychiatrists any more courageous than their Australian colleagues in New South Wales in the ’60s and ’70s? Are there psychiatrists working in today’s shock shops who realize the damage that’s being done, but daren’t speak out against the “eminent” psychiatrists in charge?
Although deep-sleep “therapy” is hopefully a thing of the past, psychiatry in my view has always been more willing than real doctors to jeopardize the lives and safety of their “patients” and to dispense with the tiresome formalities of informed consent. From about 1907 to 1930, Henry Cotton was the medical director of New Jersey State Hospital. Dr. Cotton believed, without a shred of evidence, that infections were the source of “mental illnesses,” and launched a program of removing teeth, tonsils, uteri, spleens, etc., in the guise of “treatment” (here). Other dangerous, and unevidenced, “treatments” used by psychiatrists have included: malaria therapy, insulin coma therapy, lobotomy, and ice baths. The administration of high-voltage electric shocks to the brain continues to be used despite abundant evidence of harm.
There is growing prima facie evidence of a link between the use of psychiatric drugs, especially SSRIs, and the apparently unmotivated mass-murders/suicides that have been a fairly constant facet of American life for the past 30 years.
1. On April 20, 1999, Eric Harris and Dylan Klebold opened fire on classmates at Columbine High School in Columbine, Colorado, killing 12 students and one teacher. The pair subsequently took their own lives. On autopsy, Eric Harris had Luvox (fluvoxamine, an SSRI) in his bloodstream.
2. On July 20, 2012, James Holmes entered the Century 16 movie theater in Aurora, Colorado. He shot and killed 12 people and injured 70. He had been on an increasing dose of sertraline (Zoloft, an SSRI) from mid-March until the 26th of June. It has been suggested that he might have been experiencing withdrawal or “discontinuation” symptoms at the time of the shootings.
3. On December 14, 2012, Adam Lanza killed his mother, Nancy Lanza, and later shot and killed 20 children and 6 adult staff members at Sandy Hook Elementary school. He then took his own life. Although no information has been made public about any psychiatric drugs Lanza may have been taking, in an August 22, 2013 freedom of information hearing on this matter, Connecticut Assistant Attorney General Patrick B. Kwanashie stated that he would not release this information on Adam Lanza, because such an action could:
“…cause a lot of people to stop taking their medications, stop cooperating with their treating physicians…” (excerpt beginning at 1:04 into the video)
which, I suggest, leaves us in little doubt that Adam Lanza was taking psychiatric drugs at the time.
4. On September 16, 2013, Aaron Alexis shot and killed 12 people at the Washington Navy Yard in DC, and was himself later killed by police. Alexis was on trazadone (an antidepressant SSRI).
5. On March 24, 2015, Germanwings co-pilot Andreas Lubitz locked the pilot out of the cockpit, and deliberately flew the plane into the French Alps, killing all 144 passengers and 6 crew members. Autopsy report showed that Lubitz had citalopram (an SSRI) and mirtazapine (an atypical antidepressant (NaSSA) in his bloodstream at the time of his death.
And remember, this is just a short list of the murder/suicides that have made the news. The vast majority of these incidents occur within families or small groups, and frequently aren’t even reported outside the local area.
There have been some tentative research explorations of this issue. For instance, in 2010 Moore et al. published Prescription Drugs Associated with Reports of Violence Towards Others on PLOS One. They concluded:
“Acts of violence towards others are a genuine and serious adverse drug event associated with a relatively small group of drugs. Varenicline [a smoking cessation aid], which increases the availability of dopamine, and antidepressants with serotonergic effects [SSRIs] were the most strongly and consistently implicated drugs. Prospective studies to evaluate systematically this side effect are needed to establish the incidence, confirm differences among drugs and identify additional common features.”
In 2015, Tiihonen et al published a letter in World Psychiatry, 14:2, June 2015, showing a homicide risk ratio of 1.31 (95% CI: 1.04-1.65) for current vs. no current use of antidepressants. In other words, current users of antidepressants were about 31% more likely to commit homicides than people who were not using these drugs.
The following year, Flynn et al published a paper on 60 cases of homicide and suicide in Social Psychiatry and Psychiatric Epidemiology (2016) 51: 877-884 showing:
“Thirty-three (62%) had previously been diagnosed with a mental disorder. The most common diagnosis was depression, psychosis was rare, and none of the offenders had been diagnosed with personality disorder. Nearly a third had been prescribed psychotropic medication at the time of the homicide–suicide, mostly antidepressants.” [emphasis added]
As we have seen earlier, there have been many reports of a link between acute akathisia and suicide/violence. But it is likely that other mediation mechanisms are also at work. Here’s what Joanna Moncrieff, a British psychiatrist, wrote in The Myth of the Chemical Cure (2008):
“Acts of violence and hostility have also been linked to use of SSRIs. Again, quantitative evidence is difficult to find because, like suicide, extreme violence is rare. However, evidence from case reports of violent incidents, including legal reports and data from drug-monitoring agencies, suggest that a link between SSRIs and violence is at least a possibility. The association, if it exists, may again be attributable to activation or agitation; or it may be due to emotional blunting effects, whether these be specific to SSRIs or generic to all psychoactive drugs.” (p 170)
Other authors have written convincingly on this issue, notably Peter Breggin, MD (Talking Back to Prozac, 1995) and Joseph Glenmullen, MD (Prozac Backlash, 2001), but to the best of my knowledge, there has never been a large-scale systematic attempt to explore the possibility that murders, suicides, and the mass murders/suicides are causally linked to the use of akathisia-inducing SSRIs and neuroleptics. Why has the APA or other psychiatric body, or indeed any group of concerned psychiatrists, not undertaken a definitive research project to explore this possibility? Don’t they care what happens to the people who take their drugs? And why, in such a context, has the APA truncated the critical safety information in the DSM from two-and-a-half pages to eight lines?
The fact is that neuroleptics and SSRIs are two of psychiatry’s mainstay drugs. The prescribing of drugs and the administration of electric shocks is pretty much the totality of psychiatric activity at the present time. Is the APA concerned that exposing the relationship in question to close scrutiny would suppress the sales of these products, and would negatively impact their members’ earning power and prestige? Are they systematically subordinating public safety to the guild interests of their members? They latch onto FDA approval as the green light to prescribe the drug in question even though it is common knowledge that there are loopholes and conflicts of interest in the approval process. (For example, here and here.)
The late Australian psychiatrist, Henry Bailey, peddled his dangerous and misguided treatment philosophy for 17 years, a process that directly entailed the deaths of 24 people. Acute and tardive neuroleptic-induced akathisia has been with us since the 1950s. Acute and tardive SSRI-induced akathisia has been with us since about 1990. The cumulative death tolls from these reactions are unknown and probably inestimable. Isn’t it time to address the basic question: Are these drugs turning otherwise law-abiding people into suicidal killers? And were the recipients of these drugs informed of these risks?
In 1998, Donald Schell, who had been taking Paxil (an SSRI) for two days, shot and killed his wife, Rita, his daughter, Deborah, and his nine-month-old granddaughter, Alyssa, and then killed himself. In 2001, a Wyoming jury in Tobin vs. SmithKline Beecham found:
“…SmithKline 80% liable for Schell’s actions…holding that ‘Paxil can cause some individuals to commit homicide and/or suicide.'” (here)
Motor Vehicle Crashes
In 2012. Chia-Ming Chang et al. published “Psychotropic drugs and risk of motor vehicle accidents: a population-based case-control study“ in the British Journal of Clinical Pharmacology. The research, which was conducted in Taiwan, found a significant increased risk of motor vehicle crashes in drivers taking antidepressants in various time frames before the crashes occurred. The time frames, adjusted odds ratios, and 95% confidence intervals are given below:
within 1 month (AOR 1.73, 95% CI 1.34-2.22)
within 1 week (AOR 1.71, 95% CI 1.29-2.26)
and within 1 day (AOR 1.70, 95% CI 1.26-2.29) before the crashes occurred.
So, drivers who had taken antidepressants even for just one day were about one-and-three-quarters times more likely to be involved in a motor vehicle crash than matched controls who had not taken the drugs.
It is of particular interest that antidepressants, both tricyclics and SSRIs, increased the risk of a crash more than benzodiazepines, which are traditionally recognized as driver-impairing. In 2018, there were 36,560 motor vehicle fatalities in the US (here). How many of these are attributable to driving under the influence of SSRIs, or other psychiatric drugs? Do psychiatrists care about this? Do they feel any sense of responsibility, or is it simply viewed as collateral damage in their ongoing and heroic struggle against “mental illness”?
Over the years, I have occasionally heard of individuals who acknowledge that while driving under the influence of SSRIs, they would feel invincible. They would tailgate aggressively, speed, pass on double yellow lines, etc. Are psychiatrists hearing these stories? Are they asking about these matters? Do they care?
To this day, the vast majority of the general public sees akathisia and related drug-induced movement disorders as integral to the individual’s “mental illnesses.” Which leads us to another question:
Why don’t the APA and similar bodies in other countries initiate comprehensive P.R. campaigns to set the record straight: to inform the general public that these stigmatizing movement disorders are adverse effects of psychiatric drugs?
Here again, are they subordinating the public welfare to their guild interests?
“On September 28, US Senator John McCain (R-AZ) introduced a bill in the Senate titled Veteran Overmedication Prevention Act (S. 3410). This is a companion bill to HR 4640, Veteran Suicide Prevention Act introduced in the House by Congressman David Jolly (R-FL) earlier this year. The objective of both bills is to combat suicide deaths by ensuring that accurate information is available on the relationship between suicides and prescription ‘medication.’ At the present time, 20 US veterans a day are dying by suicide.”
As far as I can ascertain, these bills got no support from organized psychiatry and died in committee.
There are now two more bills:
HR 100, Veteran Overmedication and Suicide Prevention Act of 2019, requires the Department of Veteran Affairs (VA) to gather various information on veterans who died by suicide in the past five years, including: a comprehensive list of prescribed meds…including toxicology reports…specifically listing any meds that carried a black box warning, were prescribed for off-label use, were psychotropic, or carried warnings that included suicidal ideation.
S 2991: Same title; same wording.
It is inevitable that there will be enormous resistance to both of these measures from Democrats and Republicans alike, and pharma largesse will probably flow like confetti. If you live in the U.S., please call your House and Senate representatives, and strongly encourage them to support these bills. The House sponsor is Vern Buchanan (Florida). The Senate sponsor is Dan Sullivan (Alaska). Co-sponsors from both parties are already on board in both chambers. If you don’t know how to contact your representatives, go here.
I also challenge psychiatrists, both individually and collectively, to support these bills. If the drugs are shown to be harmless in this regard, what do they have to fear? But if not, isn’t it better to know the risks rather than continue to prescribe in the dark?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.