From 2002 onwards, the BBC presented four documentaries about SSRIs in its Panorama series, the first one called ‘Secrets of Seroxat’. I recommend everyone with an interest in drugs to see them. I started one evening and couldn’t stop until I had seen them all. The journalist, Shelley Joffre, cleverly exposed that the Glaxo spokesperson, Alastair Benbow, who is a doctor, lied in front of a running camera. For example, he denied that paroxetine could cause suicidality or self-harm, while he sent data to the drug regulator 1 month later that showed exactly this, and which immediately led to a ban on using the drug in children. The drug regulator also lied when it said that this information was completely new to Glaxo (which had known about it for about 10 years). In addition, the head of the drug agency echoed the drug companies’ false assertion that it was the disease, not the drug, that caused the terrible events.
US senator Charles Grassley asked Glaxo for how long the company had known that paroxetine carried a suicide risk.93 Glaxo wrote back that they ‘detected no signal of any possible association between Paxil and suicidality in adult patients until late February 2006’. However, government investigators found that the company had the data back in 1998 and David Healy found evidence in internal company documents that 25% of healthy volunteers experienced agitation and other symptoms of akathisia while taking Paxil.80 Other studies have found similarly high rates, both in children and adults.94
After the first Panorama programme, the public was asked to submit emails to the BBC about their experiences with the drug, and 1374 emails were read by clinical pharmacologist Andrew Herxheimer and researcher Charles Medawar, cofounder of Social Audit. A clear pattern emerged. Though Glaxo had fiercely denied that SSRIs cause dependence and can lead to suicide, it was clear that both claims were wrong. It was also clear that the drugs can lead to hostility and murder, e.g. ‘After 3 days on paroxetine, he sat up all night forcing himself to keep still because he wanted to kill everyone in the house.’62 The richness of the patients’ own reports was impressive. For example, many described electric shock sensations in the head and visual problems when they tried to stop; such reactions had been coded by the authorities as dizziness or paraesthesia.
The UK drug regulator’s passivity throughout many years made Peter Medawar so frustrated that he suggested that drug agencies be closed down because they were always the last ones to know about the harms of drugs. Because of the revelations from the patients, the UK drug agency now accepts adverse event reports submitted directly by patients to the agency, without having to pass the doctors’ obstacles first.
After I started to do research on SSRIs, I have regularly appeared in the media about these drugs and have heard many frightening stories. They are remarkably similar and here is an extract sent to me by a patient who escaped the tyranny of life-long treatment and incompetent psychiatrists:
After a traumatic event (shock, crisis and depression), I was prescribed happy pills without adequate information about possible side effects. A year later, I asked the psychiatrist to help me stopping the drug, as I didn’t feel it was helpful … When I left the psychiatrist, she had convinced me … that I was undertreated and should have a higher dose … She warned me against stopping the drug, as it could lead to chronic depression.
During a time when the psychiatrist had long-term sick leave, I had the courage, supported by a psychologist, to taper off the drug. I had been on the drug for 3.5 years and had become more and more lethargic and indifferent to everything. It was like escaping from a cheese-dish cover. Tapering off is not unproblematic, it gives you a lot of abstinence symptoms …
When the psychiatrist returned after her illness, she was ‘insulted’ about my decision to stop the drug. However, I was much better, and in reply to my question that I was no longer depressed, she said, ‘I don’t know.’ ‘But if I don’t want happy pills?’ ‘Well, then I cannot help you!’ was the answer. I have not mentioned the name of the drug, but this psychiatrist had a close relationship to a manufacturer of happy pills.’
People tell me about medical students who are put on happy pills when they have difficulty with their studies, almost always with the fake myth about correcting a chemical imbalance and also comparing this with insulin for diabetes. When the students get abstinence symptoms when they try to stop, they are told that it’s not abstinence but the disease that has come back and that they likely need the pills for the rest of their life.
I must admit that this makes me both angry and terribly sad, particularly because we don’t seem to learn anything from history. In the 1880s, the UK government didn’t think opium use in India resulted in ‘any injurious consequences’. In the 1930s, four out of 10 prescriptions contained bromides and the problem of chronic intoxication wasn’t recognised, just as – at the same time – addiction to barbiturates wasn’t recognised and doctors pointing this out were ignored.62 It took 40 years – 40 years – before the addiction problem was finally accepted by the UK Department of Health and it was realised that the reason people continued with barbiturates indefinitely wasn’t that they were ill but because they couldn’t stop without great suffering.62 In 1955, the United States produced so many barbiturate pills that 7% of the population could eat a pill every day.95
In the 1960s, the doctors believed that benzodiazepines were harmless and prescribed them for almost anything. At the peak of their use, the sales corresponded to a usage in about 10% of the Danish population,96 which is extraordinary since the effect disappears after a few weeks because of development of tolerance and because the drugs are highly addictive and have many harms. The trials are biased, but when used as sleeping pills – before tolerance sets in and they still work – the increase in sleeping time is 15 minutes in older people with insomnia, whereas adverse cognitive events are five times more common, adverse psychomotor events three times more common and daytime fatigue four times more common.97 Patients who take such drugs also have a higher risk of falls and motor vehicle crashes, and a study found that the use of benzodiazepines increased the risk of dementia by about 50%.98 Why would an old person take such a dangerous drug rather than read a book until falling asleep naturally?
The companies denied for decades that benzodiazepines cause dependency and got away with it. Although serious dependency was documented already in 1961, it wasn’t generally accepted until more than 20 years later.27 In 1980, the UK drug regulator concluded, based on submitted reports of adverse events to the agency, that only 28 people became dependent on benzodiazepines from 1960 to 1977.62 We now know the true number is more likely to have been around 500 000, or 20 000 times as many!
As doctors and regulators refuse to learn from history, I was happy to fund a PhD student who wanted to carry out the research: Why is history repeating itself? A study on benzodiazepines and antidepressants (SSRIs).99 We found that the definition of substance dependence changed from DSM-III to the DSM-IIIR revision that came out in 1987 where the criteria for dependence were narrowed so that they must include also behavioural, physiological and cognitive manifestations.51 This substantive change came about after the recognition of benzodiazepine dependence and – very conveniently – just before the SSRIs were marketed in 1988. It was a smokescreen that served to deflect attention from the fact that SSRIs also cause dependence. We found that discontinuation symptoms were described with similar terms for benzodiazepines and SSRIs and were very similar for 37 of 42 identified symptoms described as withdrawal reactions for SSRIs. To call similar problems dependence for benzodiazepines and withdrawal reactions for SSRIs is totally irrational. And for the patients, it’s just the same. It’s very hard for them to stop either type of drug.
Another similarity to the benzodiazepines is that it took the drug agencies many years after they had the information before they warned about the drugs.99 The UK regulator misrepresented the data when it described withdrawal reaction after SSRIs as generally rare and mild. An analysis of the reported adverse events by independent researchers showed that the reac
tions had been classified as moderate in 60% of the cases and as severe in 20% by the same UK regulator that announced to the public that they were mild!52 What they also found was that suicide attempts had often been coded by the companies as non-accidental overdose.
Just like in the 1960s with the benzodiazepines, the companies – assisted by their hired psychiatrist opinion leaders and drug regulators suffering from self-inflicted blindness – have hooked many millions of patients on drugs most of them didn’t need. And when people became abstinent, whether on benzodiazepines or on SSRIs, company tactics were just the same: Blame the disease, not the pills.21,24,62 The companies fiercely denied that their SSRIs could lead to dependency even though they had shown in their own unpublished studies early on that also healthy volunteers become dependent after only a few weeks on the drug.24
It’s truly amazing that the companies have succeeded to such an extent with their deceptions and shocking that the psychiatrists believe them. SSRIs reduce the number of serotonin receptors in the brain,21 so when a drug is abruptly removed, the patients will feel badly about it, just like an alcoholic or a smoker will feel terrible if there is no more alcohol or cigarettes around. Therefore, whatever the symptoms are, they cannot be interpreted as meaning that the patient is still depressed and in need of the drug. The worst argument I have heard is that the patients are not dependent because they don’t crave higher doses. If that were true, smokers are not dependent on nicotine because they don’t increase their consumption of cigarettes! It’s unbelievable what nonsense professors of psychiatry have told me in order to maintain the level of self-deception in their specialty.
The true risk of relapse of depression for a patient who is no longer depressed is small. We cannot measure how small it is in patients who are in treatment with SSRIs, as they have perturbed the normal equilibrium in the brain. However, it’s clear that most of the symptoms that occur after abrupt withdrawal of an SSRI aren’t depression symptoms but symptoms of abstinence.51 Even when slow tapering of SSRIs was attempted after successful behavioural treatment for panic disorder and agoraphobia, which have nothing to do with depression, about half of the patients had withdrawal symptoms.100 Unfortunately, willing doctors with numerous financial ties to makers of the drugs assist in propagating the delusions in their research, above all Stuart Montgomery from the UK, who seems to interpret all withdrawal symptoms as relapse.62,101,102 In 2003, a systematic review in the Lancet reported that 41% relapsed when they continued with placebo compared to 18% that continued on active drug,103 but it’s plainly wrong to interpret the symptoms that occur after abrupt drug withdrawal as relapse.
Our citizens are drugged to about the same extent today as they were 50 years ago. The decline in the use of benzodiazepines of more than 50% has been compensated by a similar increase in the use of SSRIs (see Figure 17.1).27 SSRIs are used for many of the same conditions as benzodiazepines, and it seems a bit too convenient to me that psychiatrists now say that much of what they previously called anxiety – when it was still okay to use benzodiazepines – in reality was depression, so that they can now use SSRIs for the same patients. The change in treatment of anxiety disorders, from benzodiazepines to SSRIs, has happened despite a lack of evidence in support of this change.27
We have seen a similar explosion in dubious indications for SSRIs as we previously saw for benzodiazepines, and before that for barbiturates, although all these drugs are addictive.51,99,104 Until 2003, the UK drug regulator propagated the falsehood that SSRIs are not addictive, but the same year, the World Health Organization published a report that noted that three SSRIs (fluoxetine, paroxetine and sertraline) were among the top 30 highest-ranking drugs for which drug dependence had ever been reported.62
Figure 17.1 Total sales of specific neurotransmitter reuptake inhibitors and of benzodiazepines and benzodiazepine-like drugs 1970–2007, as defined daily doses per 1000 inhabitants per day
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