One Story to Rule them all: From Prozac to Abilify

Paul John Scott’s review of :
Prescription for Sorrow: Antidepressants, Suicide and Violence
by Patrick D. Hahn
(Samizdat Health. Available in Print or Kindle )

Prozac, arguably the most famous drug of our lifetimes, was never approved for sale.

Rather, Prozac when combined with anti-anxiety medication was approved for sale. In an unpromising design that seems so very much at home with the rest of the strange deeds set forth in this clarifying, well-curated new book, for a third-to-half of the patients studied, the antidepressant fluoxetine was studied as part of a cocktail, even though the approval went to Prozac alone.

This was because, when taken by itself, Prozac made people too agitated.

It’s a remarkable detail – how the antidepressant that supposedly saved the world had to be studied with a benzo chaser in order not to make trial subjects jumpy – and yet it’s but a minor trespass among so many here. The news that early trials of Prozac were hobbled in this way is by now something of a fossil in the sand. An artifact of a siege that has already been cataloged by countless others.

So why put the checkered path to market of SSRI’s and their well studied harms under the glass once again? This book offers a fair answer to that question, or it did for me anyway, with its welcome skill in gathering such an unwieldy set of events in a coherent narrative. Our late-twentieth-century tale of SSRI capitalism and loss, it suddenly seems, needed a handbook that gets the science but more importantly the gall.

It comes along in an opening chapter on Prozac, within a section reserved for the testimony of Dr. Peter Breggin during the Wesbecker case, an early-90s lawsuit filed by the survivors of the deadliest murder-suicide in Kentucky history.

Our reminder that sedatives compromised the foundational Prozac data arrives in the narrative after the disturbing detail that the drug, when given to animal research subjects, made cats hiss and growl. Faced with the numbing morass of moral violation that greets all who set out to write about meds and harm, Hahn has an eye for the images that make you wince.

By this point in the narrative, Breggin had been attacked as an alarmist and loon in the New York Times and Time magazine. As a good hearted participant in the 1990s ever willing to embrace the popular consensus, I probably read those pieces and nodded along at the time.

Hahn’s excerpts of the psychotropic cheerleading found throughout magazines and other print media — the inexplicable drive-bys and water-carrying from journalists of the period — are some of the more effective elements of Prescription for Sorrow. You can’t really understand the tunnel vision shared by clinicians, regulatory bodies and pharmaceutical manufacturers without it.

The marginalization of Breggin comes along in a chapter on Prozac, which is followed by a chapter on Paxil, with later chapters covering the research of Irving Kirsch, the campaign to invalidate the Black Box Warning, the harrowing use of SSRI’s by some rampage shooters, and the problem of SSRI withdrawal.

The chapter headings are organized around simple questions that seem to cut to the goods: Do Antidepressants Help? Are Antidepressants Addictive? Did the FDA Black Box Warning Increase Suicides?

Here is where Prescription, with the double meaning in its title and a pop-art cover-design by Billiam James finds its place. We have plenty of worthy books by expert witnesses, clinicians and researchers, and while they are all on my shelves, for reasons I can’t seem to explain, none of them managed to so tidily corral the salient variables like this one.

My copy is marked up with a parade of low events that accompanied the high regard of these pills and the self-regard of their promoters. It notes how in the chapter on Paxil, the part where David Healy, seeking answers in a murder-suicide, is led into a room with a quarter million pages of manufacturer data, remembering how, “my heart literally sank.” He somehow found something. The jury returned “the first ever verdict for the behavioral effect of any drug.”

Five pages later, the story of Study 329 told so well as an academic exercise this year in Children of the Cure, by Healy and Wood and The Illusion of Evidence-Based Medicine, by Jureidini and McHenry, becomes briefly illuminated for something else: the vanity it exposed in the KOLs who authored the now-notorious paper purporting to prove the safety and effectiveness of Paxil in children and adolescents.

Those details are soon eclipsed by the reader’s growing realization that the FDA acted with palpable boosterism of the drugs. And yes, it’s all been said before — the FDA is not interested in biting the hand that feeds them — but it took Prescription for Sorrow for me to actually get it enough to write Why? in the margin.

I must have wrote that in the margin three more times.

I am here for the human beings behind these experiences, so at times when clinicians and even drugmakers express self-pity that their products are not subject to continuous praise, something finally clicks:  the emotional haplessness linking regulators with the regulated.

After a GSK executive says the firm has been bullied by the state of New York lawsuit, an FDA panelist tells the New York Times that “sitting up there and having the public yell at you that you’re killing their children is no fun. But I suppose that has become part of the process now.”

Their retreat into victimhood when faced with customers who have had to bury family is telling. It places a distance between the listener and the harmed, allowing the healing arts to continue ahead untroubled.

Paul John Scott  pauljohnscott.com