Who is going to tell us?

A very good friend of mine has recently undergone training to become a healthcare assistant. She was successful, and as a consequence has a job in a mental health unit.

Part of the training consisted of studying a number of modules, in the form of booklets like the one above.

My friend thought I’d be interested in what this particular booklet had to say about antidepressants. The text is concise, and omits important details such as the importance of maintaining a consistent dosage.

However, it gives trainee healthcare assistants two vital pieces of information that most of the public have been denied: that “SSRIs have been linked with suicidal thoughts” and that “they might only work for people who are severely depressed.”

This knowledge helps healthcare assistants keep their patients from self-harm, but also makes them aware of the possible dangers if antidepressants are prescribed to their own partners, children or parents.

While healthcare assistants and other staff protect those under their care in hospitals, others may need the help of the Police to save them from self-harm. What led to my briefing police officer colleagues, followed by production of training materials, was an incident that happened shortly after my son’s inquest.

I was asked to look at the log of a police incident which involved a man who had left his marital home and was living temporarily with his parents. The previous evening, two police officers responded to a call from a member of the public and found the man, who was very agitated and acting irrationally in a position of risk. The officers talked to the man, calmed him down, and returned him to his parents’ home. The following morning two officers from the next shift went to the house in response to a call from the parents: the man had hanged himself in his bedroom during the night. One of the attending officers recorded on the incident log the significant piece of information that the man had been prescribed Citalopram the previous week.

It was apparent that, if the officers on the evening shift had been aware of the potential for harm in the man’s medication, they would have able to offer positive support. The man could have been informed that his agitated condition potentially had its source in adverse reaction to his prescribed medicine, which could be addressed with proper medical attention.

Moreover, the man’s parents could also have been made aware so that they could have watched over him through the night. Tragedy could well have been averted. The outcome could have been so different for all concerned, including the police officers who attended.

Every frontline police officer, call-taker and custody officer needs to be made aware of the dangers of antidepressants. At present, this is not happening.

However, wouldn’t it be better if we could all be made aware of the dangers of antidepressants? We may be called upon to assume the role of unofficial healthcare assistant to a loved one at any time. As we can see from the booklet above, it’s not exactly a complicated message. 

But who is going to tell us?

Let’s start with the GPs. When the only advice given to the patient is “Read the leaflet,” that is plainly unprofessional. Patients need to be warned explicitly of the danger of suicidal thoughts, but, just as importantly, the person who is nearest to the patient needs to be warned. This is usually a partner, parent or other family member who will need to act as healthcare assistant to the patient during the crucial first weeks.

And there are still significant numbers of prescribers in the medical profession who continue to go against the NICE advice to consider other therapies before reaching for the prescription pad. It would help if these doctors would restrict their prescribing of antidepressants to those who are actually diagnosed with clinical depression. Not those suffering from situational anxiety, stress, bereavement, PTSD, PND, backache or PMT, for which antidepressants were not designed, and for which they are likely to do more harm than good.

The UK’s coroners have overseen literally thousands of inquests into antidepressant-related deaths in recent years. In 2008, one of their number decided to report the high number of self-inflicted deaths in his area that were linked to antidepressants. He was criticised for doing so and, in the 5 years since then, no other coroner appears to have followed his lead. As time has passed, coroners have appeared more reluctant than ever to even mention antidepressants during inquests. So we can’t rely on the coroners.

The pharmaceutical companies could of course make a difference, but that would require ethics. If you were to believe the pharmaceutical companies, all antidepressant-related suicides are the fault of the victim rather than the drug. At the inquest that followed the Citalopram-induced suicide of Yvonne Woodley (right), Lundbeck sent along a paid representative to attempt to defend the indefensible.

In the USA, the pharmaceutical giants fought unsuccessfully against the proposal of the FDA, the regulatory authority, to have a prominent “black box” suicide warning on the PIL.

On the other hand, despite repeated requests from bereaved families, the MHRA (UK regulator) won’t even consider asking the companies to make their clearly inadequate suicide warnings more noticeable. This “independent” body, incidentally, is funded entirely by the Pharmaceutical companies. Letters to NICE or the Department of Health usually receive a standardised reply to the effect that they are happy to go along with whatever the MHRA says.

And right at the top of the governmental tree, the present Prime Minister, David Cameron, has invited the recently-knighted Andrew Witty (right), CEO of GlaxoSmithKline, on to his influential Business Advisory Group.

Meanwhile the Welsh Assembly seems no more inclined to investigate the true extent of antidepressant involvement in the 79 Bridgend hangings than it did at the time they happened. A case of an opportunity lost.

So, if we can’t expect any help from doctors, coroners, drug companies or various government agencies, who is left to tell us?

As far as I can see, our best chance of help could come from the media. For example, the persistent Peter Hitchens continues to raise awareness of the dangers of antidepressants, while Will Self (left) has contributed to the discussion with a BBC radio programme The Prozac Economy, and a recent perceptive article entitled Psychiatrists: the Drug Pushers.

And every so often a powerful article may appear in the newspapers that provokes discussion:

Even so, there are times when the media falls short of revealing the whole story. In Huddersfield, a newspaper reporter got tied up in verbal knots while trying to avoid the “a-word”, while an otherwise excellent BBC TV documentary told us plenty about the British Army’s attitude to soldiers with PTSD, but avoided revealing how the mis-prescription of antidepressants contributed to avoidable suicides.

If we are to reduce the number of antidepressant-related deaths, it looks like we are going to need to rely on the media in all its various forms to provide our basic healthcare training. Just keep reminding us what the healthcare assistants have been told:

SSRIs have been linked with suicidal thoughts … they might only work for people who are severely depressed.

Footnote (May 2015)

Excerpt from an article written by Dr David Healy

“I believe the SSRI era will soon stand as one of the most shameful in the history of medicine. The shame does not stem from what drug companies have done, which is only what might have been expected, but from the failure of doctors to know as much as they should have done about drugs they dish out so liberally.”