Another Letter to the New York Times

Here is a letter I sent in response to letters to the editor about the FDA advisory and Andrew Solomon's column entitled "Bitter Pill."

As a parent who testified at the FDA hearing on February 2nd, I have been disappointed with your coverage of the new FDA advisory regarding antidepressants and suicide. I do appreciate what a shock it must be to the medical profession (Letters: March 28) and depression experts such as Andrew Solomon (Bitter Pill: March 29) to realize that their well entrenched and long held views about the value of antidepressants in treating depression may not be based on good science. The people who have been treating and writing about depression may be victims themselves of duplicitous cover-up by both pharmaceutical companies and regulatory agencies who, for well over a decade, have been suppressing and failing to publish “inconvenient” results of clinical trials. Untreated depression is dangerous and poses a risk of suicide, but it certainly has never been demonstrated that the best treatment for depression is an antidepressant. In fact, it is highly likely that the greatest risk of suicide comes with the mistreatment of depression. Not all victims are “untreated” as Mr. Solomon implies. Many victims of suicide either have been or are on psychiatric medications. For far too long doctors, coroners, and statisticians have failed to record the terribly serious consequences of improper dosing and the rebound effects created by the crippling chemical dependency these drugs incur. (Mr. Solomon issues some poor advice when he suggests that someone doing badly should stop taking the medication “at once.”) With the technological tools available today and the seriousness of this issue, this failure to collect data is egregious. If this data were properly collected, the misapplication of these drugs might well show not only a greatly increased risk of suicide in some, but also chronic problems with depression due to an inability to stop the drugs in others.

I am sick and tired of hearing the refrain we are “frightening” depressed patients from seeking treatment. I think people should be frightened of antidepressants and know that these are powerful drugs with known adverse effects, not the least of which is exacerbation or even triggering of mania and psychosis by their stimulant properties. My daughter would be alive today if she or I had been properly informed of the risk of akathisia and what it entailed. Even her doctor, a psychiatrist, who saw her on the last day of her life had no idea what she was witnessing. For far too long we have bought the drug company line that these drugs are benign and a panacea for all our pyschosocial ills. Experts need to open their mind to the possibility that these medications may actually worsen outcomes for many patients with mood disorders, either by making them suicidal, by triggering new symptoms, or by lengthening the course of depression. It is quite possible that the whole risk-benefit ratio has been misrepresented for years.

Letter in Response to Medscape Article

I wrote this letter to Dr. Thomas A. M. Kramer at the University of Chicago who wrote an article in Medscape entitled "Talking Points About Antidepressants and Suicide." He never acknowledged it but subsequently he wrote another somewhat more cautionary article entitled "All the Things They Taught Us That Were Wrong."

Dear Dr. Kramer,

Your recent article in Medscape has been brought to my attention. You are a doctor and a professor. I am just the mother of a wonderful young woman who died from a Paxil induced suicide. Yet from just two years of intensive study of the subject as well as communication with countless victims of SSRI induced suicide and harm, I feel I have a better understanding of some of the issues than you demonstrate in your article.

You do not cite any scientific evidence for your assertion that there have been “numerous satisfied patients and practitioners.” Like the evidence for suicide and harm, this is largely “anecdotal.” Professionals do attest to seeing benefit in their patients but clinical trials indicate that at least some, if not all, of this benefit could be attributed to the placebo effect. Beyond that antidepressants are known to be stimulants and undoubtedly do change mood as a result of this effect, but the long term impact of taking a stimulant has not been properly studied. The chemical dependency created by antidepressants is rarely explained to patients commencing treatment and when they stop the rebound from this dependency is often mistaken for a relapse of disease.

There are several reasons why questions about SSRIs are finally getting the attention they deserve. First of all the huge increase in their use has finally resulted in a critical mass of victims who previously thought that they were alone. The rise of the Internet has enabled them to find each other and the small group of dedicated professionals who are trying to understand what is going on. It has also opened up access to what little research there is on the issue.

The fact that Prozac was exonerated after the first hearing on the subject in 1991 greatly slowed the process of uncovering the truth. A research study was proposed at the time of that hearing but was never undertaken. Lawsuits were filed against Eli Lilly and documents had to be handed over revealing the company’s awareness of the issue even before approval and their effort to control it. In Germany, Lilly was required by the regulatory agency to include in their package insert a warning for the possible need for a concomitant sedative in the initial weeks of treatment. This was not on the label in the U.S.

Many other antidepressants came on the market in the next ten years and sales skyrocketed. Paxil, as I’m sure you are aware, causes more problems in withdrawal or with missed doses. It became the number one selling antidepressant in Britain and awareness of problems with withdrawal became widespread prompting an investigation by BBC reporters. After a documentary was aired on national television the BBC received an unprecedented response from over 65,000 people. Included in the many responses were stories of at least two dozen suicides linked to Paxil. This led to another documentary on the suicide issue. Pressure mounted on the regulatory authority in Britain to do further investigation and when they did, they found a number of clinical trials which had never been published showing “inconvenient” results about both the risk and benefit of the drug. Last year the MHRA (the British equivalent of the FDA) issued a ban on all antidepressants except Prozac for use in children. Shortly afterward Eli Lilly changed their doctor’s fact sheet in the U.K. to state that Prozac was not recommended for use in children. They have not made this change in the U.S. A pdf file of the U.K. doctor’s fact sheet is available on ahrp.org.

This is some of the background to the February hearing and recent advisory. Two major articles were published this month, one in the British Medical Journal and one in Lancet, attesting to a lower benefit and higher risk demonstrated in several unpublished trials. Only trials that help with approval are usually published. This does not make for a very objective process. The FDA simply does not have the means at its disposal to keep rigorous control especially in the field of psychiatry where symptom diagnosis and improvement are subjective. Most antidepressant trials only run for 8-10 weeks and no follow-up on long-term use has ever been done. Yet patients are being put on these drugs and left on them for years. Furthermore no study of suicidal effects has been undertaken. In general every effort is made to rule out suicidal patients in clinical trials. No objective way of measuring degrees of suicidality has ever been defined. Despite this, suicidal acts have still been shown to increase in patients taking antidepressants over those on placebo when they are compared in clinical trials.

The FDA has not issued the advisory lightly on the basis of a cursory reading of misrepresented data or on claims of bereaved and, some would say, misguided families. To say this is dangerous and naïve. While it is true that no child has committed suicide out of the 1700 in the few trials that are under immediate review of the Columbia project now, in a much wider review by Dr. Arif Khan that covered over 71,000 adult trial participants the number of suicides on antidepressants was substantial and higher than in untreated patients. Over 60 families testified at the hearing on February 2nd and the stories were chilling as well as highly repetitive. The people who are dying are not ones, in most cases, who were given the drug for major depression or people who had ever expressed suicidal thoughts. This was a refrain heard over and over again. These were not people anyone was expecting to commit suicide, not people who needed to be watched for suicidality. This is a very important point. These suicides are not ones committed out of a sense of hopelessness and despair as we so often assume suicides are. They are impulsive, violent, and out of character. People who have survived suicide attempts on the drugs describe an out of body, intensely dissociative state. No one should underestimate the ability of these drugs to do this. Even if there is only one in a thousand chance that the drug would do this to any one individual, it is such a catastrophic effect that everyone needs to be aware of the possibility, especially when benefits have been exaggerated.

An epidemiological decrease in suicides has been noted in the last ten to fifteen years since antidepressants have been on the market. In fact this has been extremely slight overall and not consistent across age groups most affected by antidepressant usage. An article published last year in World Biological Psychiatry (4: 184-190) is entitled “A Stubborn Behavior: the Failure of Antidepressants to Reduce Suicide Rates.” There was a dramatic increase in the suicide rate between the 1950’s and 1980’s from a much lower rate that had preceded it for decades. The very slight decrease which has occurred in the last years of the ‘90’s could be attributed to other causes and still has not brought us back to where we were before the great increase of the past two generations (which -- perhaps randomly -- happens to coincide with the introduction of older classes of psychotropic drugs). To use epidemiological evidence as proof of benefit is poor science and poor logic.

According to Kay Redfield Jamison, at least 40% of the people who commit suicide have in fact been treated with psychiatric drugs or perhaps “mistreated” is more accurate. The failure of government authorities to collect data on suicides and suicide attempts is hindering a resolution of this issue. Coroners and emergency rooms should be investigating every suicide and suicide attempt for a link to psychiatric drugs. There should be a thorough documentation of the treatment history and analysis of the blood levels of prescription medications should be as routine as it is for illegal drugs and alcohol. This information should be in the public domain. It could be preserved anonymously to protect privacy but it should be collected. Public health and safety are at stake.

Suicide has never been taken seriously as an adverse effect and, even though de novo suicidal behavior was first described in the early 90’s, the pharmaceutical industry with the unfortunate complicity of the medical profession has shown great determination in suppressing this as an issue. The general public has great faith in our drug approval and safety procedures that is gravely misplaced. Many victims have no idea, in fact, that a drug reaction is the source of their misfortune. I don’t think you can appreciate the strength and courage it takes to face something as horrific as the fact one’s child or loved one has died because of the very treatment that was supposed to help, unless it happened to you. Doctors too are naturally very reluctant to face the truth. No wonder it has taken so long. It is easier to believe it’s the disease even when it makes no apparent sense that it could have been. Many medical professionals, including yourself, tout the great safety of these drugs in overdose, but, in fact, dosing is critical to a safe reaction and many people who die were given doses too large for their metabolic abilities. See medicationsense.com. The risk of suicide from these drugs does not come from the risk of overdose but from something far more sinister and mysterious -- the ways in which they affect brain chemistry.

You mention only two biologically plausible mechanisms for inducing suicide but in fact as long ago as 1993, Martin Teicher and Jonathan Cole in Drug Safety (8:13 pp. 186-212) describe nine different mechanism, including akathisia, switching patients into manic or mixed states, interfering with sleep architecture, and inducing an organic obsessional state. The so called rollback phenomenon which you describe at length is in fact very rare in the case of antidepressant induced suicide. Many victims of antidepressant induced suicide have no history whatsoever of suicidal ideation and were not even given the drugs for a major depressive disorder but rather for such things as anxiety, insomnia, migraine headaches, minor psychosocial ills. Very few of the victims were actually getting better; most of them were getting dramatically worse from the moment they started the medications but were told by their doctors to stop whining and be patient for the several weeks they take to work.

Furthermore what I consider egregious in your article is your failure to mention the grave danger of giving these drugs to someone who may be manic or potentially manic. Dr. Dimitri Papolos refers to this danger several times in his book The Bipolar Child. He says that “the introduction of antidepressants may cause an earlier onset and possibly more virulent course of the illness.” He mentions this as a problem for both children and adults.

Are you aware that many school shooters in the past decade were on antidepressant medication? Eric Harris, the Columbine shooter, was one. He had been on Luvox, now withdrawn from the market, for a year. Three months before the shooting his dose was doubled. Before Luvox, he was on Zoloft and he told his doctor he was having trouble with it. He was unable to concentrate and felt restless. This information about Eric would have been lost from public view forever if a Harris neighbor had not been aware that Eric’s application to the military was rejected because of his treatment with an antidepressant. It took a special request to get the coroner to test his blood level for the presence of the drug. No one should blithely assume that his behavior was not influenced by an adverse reaction to his medication.

Dr. Kramer, I think it is irresponsible of you to say that supposedly mysterious deaths like my daughter’s should be kept quiet so as not to scare other depressed people. People need to take medication with a complete and full understanding of what it can do; they also need to realize that treating depression is more complicated than simply taking a pill. I urge you to do a lot more reading on this subject and educate yourself fully about what antidepressants can really do.

Yours sincerely,

Letter to Boarding School Head

I wrote the following letter to the headmaster of an elite private boarding school in New England who expressed an interest in hearing my views on the subject of psychotropic drugs.

Dear Sir,

Thanks for your kind note. I have been on quite a journey since my daughter’s death and would be glad to share some of my thoughts with you. I know as a school administrator you are in a difficult position since it’s probably not up to you most of the time, if ever, whether a student (or staff member for that matter) is taking an antidepressant or some other psychotropic drug. Nevertheless maybe I can help by describing some symptoms of adverse reactions that might be mistaken for underlying disease, a few thoughts on what to do if confronted with an emergency, and finally ideas for raising awareness about both depression and its treatment.

The first thing to appreciate is that antidepressants are stimulants. This is not well acknowledged. Many people experience increased agitation when they commence treatment or have their dose increased. For some this can take the form of a serious form of agitation called akathisia. It is quite rare but nevertheless exists and is a strong precursor of violent behavior. It is a clear indication that someone is not reacting well and is probably on too big a dose for their metabolic capability. One becomes jumpy, frightened, unable to sit still, unable to sleep – very, very disturbed. This can be treated by tapering the antidepressant and administering a concomitant sedative, probably a benzodiazepine. It is essential not to leave the patient alone for a minute until the extreme agitation subsides.

Antidepressants can also trigger or exacerbate manic symptoms and even psychosis. In the Journal of Clinical Psychiatry (62:1, January, 2001) doctors found that over 8% of psychiatric admissions to hospital were caused by antidepressant associated mania and psychosis. Again this will be reflected in an inability to sleep and strange thinking. I personally believe that highly creative and intelligent individuals, such as you have at your school, are more vulnerable to this reaction. Often when this happens the individuals are diagnosed as bipolar when really it is a drug reaction; nevertheless the damage can be long lasting, if not permanent. Until recently antidepressants were often administered to young people with bipolar diagnoses but now finally there is a strong contraindication for this condition. In The Bipolar Child, authors Demetri (M.D.) and Janice Papolos state (in italics), “antidepressants and in many cases stimulants given without the benefit of a mood stabilizer (possibly even with the protection of a mood stabilizer) can cause havoc in a child suffering from a bipolar condition, increasing anxiety states, potentially inducing mania, more frequent cycling, and increases in aggressive outbursts and temper tantrums.” Over 80% of the children in his study became “agitated, or more aggressive, paranoid, or psychotic. Many were hospitalized.” (p. 75)

Other possible effects include de novo suicidal ideation, that is, the onset of new suicidal thinking that did not exist before treatment commenced. This again is not well acknowledged by the pharmaceutical industry or the medical profession but it has been demonstrated over and over again in healthy volunteer studies and so called RCT trials (where the drug is started, withdrawn and then restarted to test for a linkage between the drug and side effects). Unfortunately the suicides which occur on antidepressants are impulsive, violent and out of character. They are not suicides done from a sense of hopelessness and despair. Notes are almost never left. Victims are in an intensely dissociative state. Survivors of attempts describe an eerie, out of body experience. These suicides leave families (and communities) reeling because they are so unexpected. There can be almost no time between the impulse to die and the act itself. This is why anyone experiencing intense agitation or severe sleep disturbances on the drugs must be watched very closely. Even they do not know what they might do until moments before they do it. These suicides most often occur in the middle of the night or early morning hours because they are linked to a severe disruption of sleep architecture. Antidepressants suppress REM sleep and people on antidepressants have been observed to have rapid eye movements while they are awake and this is associated with strange behaviors, including hallucinations.

The last adverse effect I want to mention is the onset of intense obsession. This one is harder to detect. If anyone is on the drug and experiencing thoughts that they simply cannot let go of, they should seek help and probably taper the drug and go on a tranquilizer.

Attention Deficit Disorder drugs can also precipitate mania and bipolar disorder. Strattera, given for ADD, is really an antidepressant under another guise.

These effects can also occur in withdrawal from the drug. These drugs create a chemical dependency and if stopped too abruptly can lead to terrible problems. This is something that really concerns me in a school setting. It really needs to be impressed upon the students that, if they are in treatment, they must be consistent about taking their medication and, if they want to come off, it must be done with the proper supervision and at a very gradual pace. Even just a few missed doses can wreak havoc on a young mind. And it can take months to recover from being on a course of antidepressants. Few people realize this. Rebound symptoms from withdrawal are often mistaken for a relapse of depression and thus people get sucked into a vicious cycle of medication and distress. These drugs don’t just treat mental symptoms – they create them too.

I have learned about these effects the hard way and there are many medical professionals who don’t recognize them. Even worse they often take these symptoms as a sign that dosages need to be increased which is exactly the wrong thing to do.

As for how to head off a tragedy this is tricky. Many, many people are wedded to their assumptions about the safety and benefits of antidepressants. It wouldn’t be a bad idea to raise the community’s awareness of just how drugs are approved and monitored. The process is very flawed.

In addition, a lot can be taught about more benign and healthy ways to treat depression. At Stanford there is a renowned professor, William Dement, who has been waging a crusade about healthy sleep for decades on campus. His slogan is “Drowsiness is red alert!” There is no doubt that sleep deprivation contributes to depression and mental illness. Teens must be educated about the importance of good sleep habits and it’s relationship to mental health. Nutrition also is important. Food and mood are related. Yoga, meditation, cognitive therapy, spiritual direction – all of these things can and do help; they produce longer lasting benefits than medication. If you are conducting screenings for depression, guard against using these as an excuse to hand out pills. Use them as an opportunity to raise awareness about the other factors influencing mood.

Lastly it is very important to warn students about two other dangers. Taking any illegal drugs, particularly ecstasy, while on prescription psychiatric drugs is a recipe for disaster. Also it is claimed that antidepressants can induce a craving for alcohol.

There are excellent books on the subject if you want to read more. One is by a doctor based in Cambridge and maybe he would be willing to speak at your school; he testified at the FDA hearing (as did I). His name is Joseph Glenmullen. His book is Prozac Backlash. Another is Let Them Eat Prozac by David Healy. This book is currently available from lorimer.ca (in Canada), but is soon to be published by New York University Press.

I hope you find this helpful. Let me know if you have more questions.

The FDA Advisory

On March 23rd the following article was published in response to the FDA Advisory on antidepressants and suicide. My reply is below.

Medicine to console the sullen
Antidepressants can calm, uplift troubled teenagers
Joan Ryan
Tuesday, March 23, 2004
©2004 San Francisco Chronicle



A boy came into psychiatrist Edward Oklan's San Anselmo office recently to explain why, morning after morning, he tried to keep his parents from opening their front door. He feared that global warming had melted the ice caps overnight and had flooded the world. He knew it didn't make sense. But he worried about it every single night and morning.

An antidepressant eased his anxiety.

UCSF psychiatry Professor Lynn Ponton has seen teenagers who starved themselves, cut themselves, attacked classmates, talked about jumping off the Golden Gate Bridge. Under antidepressants, the dark scratchy clouds inside their heads slowly disintegrated.

As executive director of San Francisco Suicide Prevention, Eve Meyer talks of the people who might be alive today if they could have been persuaded to take antidepressants.

"Some people have a very hard time believing they have a disease that is physical and chemical and needs to be treated with medicine,'' Meyer said Monday. "This move by the FDA will make that negotiation process a little more difficult.''

Meyer was referring to advisory issued by the Food and Drug Administration Monday that calls for the makers of 10 antidepressants to warn patients and doctors that the drugs might increase the risk of suicide among both children and adults. The advisory is a follow-up to the FDA's public hearing in Washington last month in which parents told of children who harmed or killed themselves shortly after starting antidepressants.

The FDA's advisory is not a bad thing in itself. Doctors and patients should be vigilant in monitoring the side effects of any new medication, especially ones that treat mental illness.

But the criticism and fear of antidepressants seems to be veering toward hysteria. Last spring, British health authorities warned that all selective serotonin reuptake inhibitors (SSRIs) except Prozac were unsuitable for children. I recently read about a high school student in rural Washington who claims the antidepressant Paxil drove him to hold his English class at gunpoint for 45 minutes. And the relatives of a man who killed his wife, daughter, granddaughter and himself were awarded $6.4 million by the company that manufactures Paxil. The Wyoming jury decided Paxil played a role in the murder-suicide.

But the research simply does not support the growing public impression that taking SSRI antidepressants is tantamount to picking up a loaded gun.

On the contrary, the rate of youth suicide in 15 countries declined by about 33 percent over the past 15 years, which coincides with increases in SSRI prescriptions, according to a recent review of epidemiological studies by the American College of Neuropsychopharmacology.

In a 2003 U.S. study, epidemiologists at Columbia University randomly selected 588 ZIP code regions around the country. They found that a 1 percent increase in the rate of antidepressant prescriptions correlated with a .23 percent decrease in suicides per 100,000 adolescents.

Yet Oklan said a woman who came to his office Monday was reluctant to try Lexapro because, after all the news stories, she was afraid she would become suicidal. Oklan now hands out photocopied articles from medical journals in attempt to counterbalance the alarmist headlines.

"This is an illness, not a moral failing or a lack of willpower,'' said Oklan. "There are people out there suffering greatly. Their lives are saved by these medications. We can't let the hysteria throw the baby out with the bathwater.''

Indeed, the overheated warnings could, in the long run, be more harmful than the side effects from which they're trying to save us.

"The (FDA) advisory points up the fact you can't take these drugs lightly, but I worry that it might scare people off who really need them,'' Ponton said. "So many teenagers benefit greatly from these medications. Sometimes the depression is so profound that it could take years to turn it around by talk therapy alone. We can let them suffer, but when we have the opportunity to change their lives, why wouldn't we take it?''

Prescribing antidepressants is both an art and a science. It entails finding the right medication, or combination of medications, and tinkering with doses. It means exploring family history, taking into account home, work and school environments. When doctors evaluate patients thoroughly and monitor them carefully, antidepressants save those afflicted with depression and other mental illnesses just as surely as insulin saves those afflicted with diabetes.

"There's that moment after you've been on antidepressants for a time when you wake up one morning and say, 'Oh! This is what everybody else feels like!' '' said Meyer from Suicide Prevention.

I know. I have felt it myself.

Dear Ms. Ryan,

I do not believe the criticism and fear of antidepressants is veering towards hysteria. I can well understand the discomfort those who believe they have received immeasurable benefit from these drugs must be feeling, but, as someone who lost a beloved daughter two and a half weeks after she started Paxil, I think it is long overdue that at least the possibility these drugs cause irreversible harm in some patients is acknowledged and that doctors and consumers alike become educated about what to look for to detect an adverse reaction.

I am sorry but you are simply mistaken that the research does not support a link between SSRI antidepressants and suicidal and homicidal behavior. To try to base conclusions about the safety of antidepressants on epidemiological studies of suicide rates is not really good science. There may be a correlation between antidepressant usage and suicide rates, but this does not mean there is causation. Myriad factors influence suicide rates and, even if antidepressant usage overall does contribute to a decline in suicide, does this mean that, if a small group is actually getting worse and dying, that they should be ignored especially when it is becoming larger in absolute terms every day? Furthermore when data from these epidemiological studies is examined very closely, it often shows that in the age groups in which there has been the biggest increases in the use of antidepressants the rate of suicide has actually increased. In Australia between 1991 and 2000 rates of suicide in elderly patients did decline dramatically, while antidepressant usage went up between 50 and 100%, but in young adults, where antidepressant usage increased by a factor of 6, suicide also went up by nearly 20%. David Shaffer’s study, which is being widely quoted in the aftermath of this advisory, appears to go through a number of machinations to achieve his desired conclusion. His study shows antidepressant usage increasing by well over a factor of 6 in both males and females and even in 10-14 year olds. Suicide in 10-14 year olds actually increased by 18%; in 15-19 year olds antidepressant usage increased by a factor of 6.6 and suicide decreased by 10%. Whether this kind of reduction is even significant statistically in this size of study is not clear. Furthermore it is well known that suicide is underreported and a 10% variation could be further negated by variations in underreporting.

Far more telling than the vague conclusions which can be drawn from these kind of epidemiological studies in which the evidence is far from dramatic are the analyses of antidepressant clinical trials. In these trials it has been shown repeatedly that suicidal acts increase in antidepressant treated patients over those on placebo, while symptom improvement is only marginally better than placebo. Furthermore there have been challenge, dechallenge, rechallenge trials run in which suicidal symptoms (even in healthy volunteers) exhibit with the onset of treatment, disappear with cessation, and recur with re-initiation of treatment.

I wish there was a simple answer to those who believe they benefit but to avoid the truth just to keep people from becoming frightened is not the way to proceed. It is imperative that the medical profession and consumers become aware of the very real danger of akathisia and intense agitation which can occur in the initial stages of treatment or during dosage changes and which indicate, in many cases, that a dose is too large for that particular individual and may require tapering down and administration of a concomitant sedative. My daughter would be alive today if her doctor or I had been aware that what she was experiencing was akathisia, not a worsening of depressive symptoms. (She didn’t even have depression; she was given the drug for “racing thoughts.”) She was told ativan was optional – it wasn’t. She would be alive today if she had taken it.

Furthermore our society needs to get over the mindset that the best treatment for depression is taking an antidepressant. Yes, untreated depression may be dangerous, but the best treatment for it is not necessarily an antidepressant. Taking an antdepressant may offer short term relief for many, but the risks of staying on such a course indefinitely have not been studied. The myth of “chemical imbalance” has been created by the pharmaceutical companies as a marketing ploy and is far too simplistic to explain the complexity of the brain. The articles which Dr. Oklan hands out so readily to his patients have in many cases been ghostwritten by pharmaceutical companies who bend over backwards to avoid publishing any “inconvenient” results; they are hardly hard evidence of the drugs’ safety or benefits. The whole scientific process has been corrupted by the great power and influence of the pharmaceutical companies. Even doctors are not getting objective information. On the other hand, the chemical dependency which this class of drugs create has not been well studied or explained to the average patient and is a real phenomenon. The stories of intensely difficult withdrawal and relapse into a state often far worse than the initial depression have been widespread.

Your article, in my opinion, does a disservice to the seriousness of this issue and fails to respect the horrific suffering of those who have lost loved ones on these drugs. I hope you will read the testimonies as they were delivered at the FDA hearing in full (there is a link at the advisory statement at fda.gov) and see if you still feel this issue is out of control. I don’t think you realize what pressure (and evidence of harm) there had to be to get very reluctant agencies both here and in England to take the steps they have.

My First Effort

Due to "popular demand" I am back to updating my blog. I am going to post a history of some of my efforts. This was my first letter to the Sunday New York Times Magazine in response to their story on Elizabeth Shin, a young woman who set herself on fire in her M.I.T. dormitory room two and a half weeks after starting Celexa.

To the Editor:
Re: A Suicide at MIT

It was with great difficulty, but also great interest, that I read the story of Ms. Elizabeth Shin (April 28th). It bears a remarkable resemblance to the story of my own beloved daughter's death this past January, another talented, accomplished, bright young woman, a graduate of Stanford in engineering. Like Elizabeth Shin my daughter had been troubled with some symptoms of mental illness and, like her, she was put on an antidepressant just a few short weeks before her death. Not much was made of this in Ms. Sontag's article but, personally, I think it is intimately connected. I read with dismay this past Sunday that scores of readers have written in and blame in equal measure the school, the therapists, the parents, and even the victim. Has no one written in to blame the medication itself and the failure of both the drug companies and the FDA to control the class of antidepressants known as SSRIs with proper warnings about their use?

I have been researching this issue since the day my own dear daughter died. There is no question in my mind that the medication (Paxil, in her case) pushed her over the edge. I am sure it was the same for Ms. Shin as it has been for so many others, including Andrea Yates, who was prescribed high doses of the SSRIs Effexor and Remeron shortly before her misdeed, and for Eric Harris, whose victims' survivors are now in the process of suing the manufacturers of Luvox, the SSRI he was on when he led the rampage at Columbine High School. Ever since the trial of the rampage murderer Joseph Wesbecker in 1994, who was on Prozac, doubts and evidence have been growing about the relationship between a misapplication of these drugs and murder and suicide. Because of the blockbuster nature of these drugs there seems to be a lot of resistance to researching whether there is a scientific basis to the claims made by SSRI survivors. Statistics are not even being kept in any kind of systematic way on the number of suicides and murders being committed while the perpetrators are under the influence of these drugs. My own fervent wish is that a major newspaper or magazine will publish an article on this subject. Frankly it breaks my heart to see a story like Ms. Shin's published with not even a passing reference to the issue. Even her family doesn't seem to be aware of what may have contributed to their daughter's death. The public assumes these drugs are benign because they have passed a flawed approval system and so many people take them, but the short term effects they have on some people, as well as the long term effects that will eventually come to light, are misunderstood and underestimated. The cost to our society could be enormous if this is not addressed.