Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Les Ruthven’s book, Much of U.S. Healthcare is Broken: How to Fix It. In this blog, he addresses the research showing that psychiatric hospitalization increases suicidality as well as further dangers of psychiatric drugs, including tardive dyskinesia. Each Monday, a new section of the book is published, and all chapters are archived here.
Does psychiatric hospitalization and medicine save the lives of suicidal patients?
Inpatient psychiatric treatment requires that the patient must be both in an acute stage and be dangerous to self or others.
In a previous chapter I reported data from the Centers for Disease Control and Prevention11c that suicides for the years 2007 to 2017 increased by 30% while the teen rate (ages 10 to 24) increased by 56%! The main thrust to curb this major mental health problem has been to identify those at risk and through suicide hotlines to offer and arrange treatment, depending on the severity of risk either outpatient or inpatient psychiatric treatment and need for medication. Many of those at risk for suicide were found to have a diagnosis of clinical depression but many by history could not be so diagnosed.
This might be seen by some as a silly question, but in these cases do we treat the “depression” in order to save the patient’s life? Or do we focus on and treat the patient’s suicidality and look to the patient’s personality and current life stresses related to the thoughts of self-harm? Since the 1950s, and probably before, the uniform answer by psychiatry to this question has been to treat the depression in outpatient or inpatient treatment and if successfully treated the patient’s suicide risk will subside! At least that’s the “theory” but let’s look at the facts.
In one study involving suicide risk in relation to psychiatric hospitalization, the investigators11d found there are two sharp peaks of risk for suicide for hospitalized patients—one in the first week after admission and one in the first week after discharge. In another study from England and Wales11e involving a four-year sample (1996-2000) there were 754 (16%) suicides of current psychiatric inpatients and a further 1,100 (23%) suicide deaths within three months following discharge!
Nearly one-fourth of these suicides occurred in the first week following admission, 236 (31%) suicides occurred on the ward, the majority by hanging. Post-discharge suicides were most frequent in the first two weeks after discharge, the highest number on the first day! My behavioral health management firm managed inpatient psychiatric and substance abuse admissions over two decades for over 20,000 inpatient admissions, and all psychiatric inpatients were medicated as a part of their treatment!
The above study results are bad news for psychiatry and the belief that inpatient psychiatric treatment and medication are effective treatment for those at risk for suicide. Moreover, psychiatry has accepted the research that antidepressants (ADMs) have an added risk for suicide11b and psychiatrists again caution careful monitoring of antidepressant drug-treated patients. The drugs themselves may well contribute some to the inpatient suicide figures but I suspect the greater cause is not addressing the distressing life situations giving rise to the patient’s suicidality. However, for psychiatry this would mean taking psychiatry back to the late 19th and the early 20th century, which psychiatry is obviously reluctant to do.
If one reads the ADM literature, it is quite apparent that the pharmaceutical industry—with the help of psychiatry—since day one has been involved in a cover up of the dangerousness of these drugs. In my book on antidepressants1 (pp. 133-136), I told the story of Dr. David Healy, a researcher in psychopharmacology at the University of Wales, College of Medicine in the Department of Psychological Medicine. Dr. Healy gave a popular SSRI antidepressant and a non-serotonin ADM to normal, non-depressed nurses and other hospital staff in what the industry calls a Phase 1 study. This is the first step in evaluating any new drug, trying out the drug on normal people without the health problem under consideration.
Dr. Healy found that the SSRI seemed to make some of these emotionally normal employees “better than ever” but, as mentioned above, two volunteers became acutely suicidal. Dr. Healey was an expert witness on several legal actions against drug companies in which people had committed homicide or suicide while taking SSRI ADMs. Under the rules of evidence Dr. Healy was able to obtain the Phase 1 data on GSK’s drug Paxil (see above).
Dr. Healy’s lengthy correspondence to the UK Medicines Control Agency (MCA), the equivalent to the US FDA, was an attempt to alert the MCA about the dangers of SSRI ADMs found in his research and the research of others. Needless to say, the MCA did not want to hear this bad news, much as the FDA would not want to hear any bad news about the drugs the FDA has approved. The MCA, a defender of itself and the drug industry, did not want to hear that these drugs should never have been approved because they are unsafe (and I might add ineffective).
The fact that these drugs are not efficacious is one thing—at least they can fall back on the “better than a placebo” argument—but the BAD news is that these drugs are dangerous. Dr. Healy’s research seems to have been critical in the MCA’s later ultimate warning against the use of Paxil in treating depressed children (also in FDA’s subsequent black box antidepressant suicide warning). This warning was the first chink in the armor of the ADM drug industry, but the industry’s response seems to have been very effective since ADM use has continued to grow since then, including drugs for the youth depression market.
Healy found (and reported to MCA) that in GSK’s Phase 1 study there were few reports of “emotional lability”; however, these reactions the investigators said were not found to be related to suicidal thoughts or behavior. What Healy found, however, was that in 34 submitted Phase 1 studies 25% reported a significant agitation, nervousness/akathisia rate! These most dangerous side effects occurred in emotionally normal people. Some of the multiple dose studies in healthy volunteers lasting 2-3 weeks yielded an up to 85% withdrawal rate in the volunteers! I do not think one has to be a trained pharmacologist to advise not to take such a drug but despite this, most of these drugs were approved and reached the market.
I understand some of the ADM believers put in the spin that these drugs react this way in normal but not depressed brains; how’s that for self-serving logic, which again deserves some type of an award for creative spin? Dr. Healy was an uninvited whistleblower to the conventional wisdom that antidepressant drugs are effective and safe in the treatment of depression and other disorders.
Psychiatry and the drug industry were threatened by the outspoken critics such as Dr. Healy and they did retaliate several years later when Dr. Healy accepted a full-time position at a prestigious Canadian university. He gave an invited lecture at the university prior to assuming his position, and following this—for some reason—the university declined to go through with hiring him for the position! Do you think this had anything to do with the fact that the university depended on the pharmaceutical industry and their grant money for conducting research?
The drug prescribing pattern that I had found in my study of psychiatric drugs in a 5,000-member benefit plan is very similar to the drug prescribing patterns found in the school and mass shooters. I have no data to support this, but I suspect from their multiple psychoactive drugs that most of the drugs were prescribed by the shooter’s physician rather than a psychiatrist. If this is true, this suggests that the adolescent shooter’s emotional/maladaptive difficulties were treated by a non-behavioral health professional with very unfortunate and tragic results for the victims and families of these school shooting victims.
Thomas J. Moore, Joseph Glenmullen and Curt D. Furberg12 studied under the Freedom of Information Act the question of prescription drugs and violent behavior by reviewing the FDA’s Adverse Event Reporting System (AERS) from the years 2004 to 2009. The researchers tracked drug case reports that included homicide, homicidal ideation, physical assault, physical abuse or other violence related behaviors. These were reported cases of violent events and there may have been other such violent events that were not reported by the drug companies to the FDA. If a prescription drug had 200 or more reports of violence during that period, then the drug was included in the data analysis.
The researchers identified 1,527 cases of violence disproportionally reported by 31 drugs. Suspect drugs included Chantix (a smoking cessation drug), 11 antidepressants, six sedative/hypnotics, and three drugs for attention deficit disorder. The evidence was weaker and mixed for antipsychotic drugs and absent for all but one anticonvulsant/mood stabilizer. 84.7% of the drugs reviewed had two or fewer cases of violence, which is reassuring for most pharmaceuticals.
Chantix, which increases the availability of dopamine, and the antidepressants with serotonergic effects (i.e., the SSRIs) were the most strongly and consistently implicated drugs in violent behavior. All ADMs, except for two tricyclic drugs (these were the older, first-generation ADMs), were associated with violence (i.e., the current ADMs). You may remember I reported that the new generation ADMs when they appeared in the market were said to be more effective and safer than the early generation drugs, which encouraged non-psychiatric physicians to use them to treat their patients with depression and anxiety. This occurred partly because the second-generation ADMs have fewer overdose deaths than the first-generation drugs.
Susan P. Baker et al.12a studied changes in suicide rates between the years 2000 to 2010, which showed a 16% increase. More importantly, the majority of the increase was suicide by hanging/suffocation, which accounted for 52% of the increase! During those years suicide by hanging/suffocation was close to the incidence of suicide by firearms. In these figures something “new” seems to be going on and it is likely to be associated with psychiatric medications and perhaps the side effect of agitation/akathesia. In light of the above, why does the FDA continue to say we need more data on any connection between ADMs and suicide?
A further look at drug induced tardive dyskinesia (TD). This adverse side effect of antidepressants and antipsychotic drugs causes uncontrollable involuntary movements in many motor systems, including the mouth, tongue and jaw. Is TD just a minor problem and does the benefit/risk ratio favor drug-induced TD?
Elysa M. Cornett et al.13 reviewed the literature on TD and came up with findings I am sure patients are not apprised of when offered psychiatric and other drugs to treat their psychosis, depression, anxiety, and other mental disorders. From the review the researchers reported a TD drug-induced incident rate of 2 to 5% annually and that there are an estimated 500,000 and growing TD cases in the U.S., which to me does not seem to be a minor problem.
TD is usually associated with long-term drug therapy (however, it can occur with short-term use as well), has a higher incident rate with first-generation antipsychotics (32.4%) as opposed to current-generation atypical drugs (13.1%); TD also occurs with benzodiazepines for the treatment of various anxiety disorders, affects more women than men, occurs more frequently in the elderly (also children and adolescents), and in sedating drugs (e.g., meprobamate) as well. With such frequent and severe adverse TD-inducing side effects, how can one justify the use of these medications?
As I edited and added to this section in February 2020, I noticed a number of TV commercials about the management of TD. If I had TD, I don’t think I would be satisfied with just managing my TD. While I am here, I have noticed that TV ads extolling the virtues about antidepressant and other drugs never report remissions, only reduction and management of the symptoms!
To see the list of all references cited, click here.
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.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.