Author Archive for Peter Wood

Greg’s Dilemma: Riding a Bike Backwards

bike-backwards

Editorial Note: Last week in Greg’s Dilemma, Greg outlined the difficulties he had with dependence on and withdrawal from serotonin reuptake inhibitors and benzodiazepines. The first comment was from a therapist who seemed to say “pull yourself together”. This eerily echoed the next part of Greg’s dilemma – that could have been posted last week but was held over till this week. Our response will come next week.

Jeffrey Junig

A comment that psychiatrist Jeffrey Junig made once haunts me. He had been writing a blog on psych central where he was dismissing the likelihood of prolonged protracted withdrawal symptoms from benzodiazepines. Several of us went on the comment site to rebut and share our experiences. To one person claiming problems of cognitive fog, etc, he wrote the following:

“You must recognize by now, after your frustration with the medical system, that whatever is going on with your health has no ‘plausible’ explanation. I suspect, though, that someone trained in neuroscience and medicine will have a better likelihood of coming up with a plausible theory, than someone without that training.

Millions (literally) of people have started and stopped benzodiazepines who have no complaints of ‘problems following lists or written instructions, reduced ability to think creatively and abstractly, poor focus and concentration.’ Your theory is that there is something special about YOUR brain, causing you to have a different experience than other humans. Yes– there are enough people with symptoms like yours to fill a web forum or two—- but among the 200 million people in this country alone, there are large groups of people complaining of pretty much any symptom you can imagine. That’s human nature.

The idea that you, and perhaps another 0.1% of the population (that’s generous), have something different about your brain that made it respond in the way you describe, is not plausible to me.

On the other hand, conditioning is a universal phenomenon– in almost all animal life. Conditioning is why you find your way home at the end of the day. I am confident I could ride a bike today, even though I haven’t been on one in 25 years; that’s the power of conditioning.

The first issue in your case is distinguishing whether you truly HAVE ‘trouble following lists or written instructions, reduced ability to think creatively and abstractly, poor focus and concentration’– or if instead you only THINK you do. If you want to know the answer to that question, see a neuropsychologist and go through the battery of tests that determine those things. But if you do that, be prepared to accept the likely answer– that you are normal in all of those things.

If you DO have those problems, then you have to consider a mechanism— and a reason why you are uniquely effected. You also have to rule out other reasons…. for example, something must have been a problem for you, for you to start benzos in the first place. Either you had anxiety, or you had an addictive nature that caused you to take them. How do you know that one of those things– things that were present BEFORE the benzos– didn’t progress to your current problems?

This is often what I fear is wrong with me, that I’ve conditioned myself to have these reactions. My mom was on Zoloft for several years and went off it with only a few days of brain zaps. Why is this so severe for me? I don’t have the self-confidence to be calmed by the thought that I’m an outlier or that maybe way more people do have problems but don’t recognize the problem as from their medication. There are millions of people who are taking or have taken SSRIs and benzos who, as Junig mentions, seem to have nowhere near the trouble getting off the meds that I have had.

And on the other side, I read from those critical of psychiatry that these drugs cause irreversible changes in brain functioning. Trust me, when you have exaggerated anxiety to negative thoughts, reading that only heightens the feelings of helplessness. Maybe there isn’t anything that can be done for me. I can’t go on like this indefinitely, I know this. So I ask you again:

What am I supposed to do?

The Wise List?

Beware of everything

Editorial: There is a wonderful listserve Essential Drugs on E-Drugs@healthnet.org. It’s an information service rather than a discussion forum.

Recent mail

E-DRUG: Swedish essential medicines list now in English

This is an interesting development having a Swedish document translated to English! The list “Kloka listan” is a list of essential medicines for common diseases. When it was first launched, in Stockholm area in 2001, it was decided to use different marketing tools make it known to people (posters and interviews with the public in public places, TV spots etc.). So much so that a patient would, when the doctor was to write a prescription, ask if he wrote a medicines that was on the wise list! Shows the value of putting resources into education and mimic industry tactics, not just making decisions that people don’t understand why they should follow.

http://www.janusinfo.se/In-English/The-Wise-List-2015-in-English/

Kirsten

Kirsten Myhr

Response

I clicked on this and went in to read it, thinking this was promising. The idea is very appealing – especially the activism component.

My comment on the psychotropic section of The Wise List in English if printed would be a sequence of profanities. It’s what you would expect when people make selections based on ghostwritten articles whose data is sequestered – a document almost completely captured by marketing departments.

It’s a list not of which drugs are best but which marketing departments have been best.

I would be interested to hear anyone else’s view for the cardiology, respiratory and other all other sections that have a heavy preponderance of on-patent drugs.

I realize E-Drug is not supposed to be a discussion forum – I will post the document on RxISK.org for anyone who wants to comment.

The activism component of this idea is wonderful but it’s disturbing to think it might be captured so readily by company marketing.

David Healy

The Wise List is above and here.

Study 329 Stories

Whose fault is it?

Kristina Gehrki

It is refreshing to see the BMJ publish an article highlighting the corruption, collusion and dangerously unethical behaviors among the pharmaceutical and psychiatric industries, university medical departments and government “regulators.” I’d like to tell my teen-aged daughter all about the “retraction.” Unfortunately, she died from SSRI-induced akathisia, Serotonin Toxicity and prescribed suicidality. When she was experiencing life-threatening SSRI-induced side effects, her doctor did what many misguided doctors incompetently do: increased the toxin. Sadly, her death-and the deaths of hundreds of thousands of other innocent children, is not retractable.

Perhaps lawmakers might some day pass universal Informed Consent laws so that parents can be accurately informed prior to prescribing. Doing so would help better protect children from the torture and deaths that occur when profits are valued more than people…

Tracy Eisen

I wanted to say thank you for publishing this article. I was once on Paxil myself, as a newly 20 year old, for panic disorder without agoraphobia. While taking just a quarter of the normal starting dose (5mg was my dose), I displayed flat affect and a “zombie” like appearance. This was within several weeks, about two. I then became suicidal.

For something that is supposed to be an ANTI-depressant, I’m amazed at how PRO mental disorder it truly was.

I’m a very happy woman, and was always a happy teenager. This was not normal. The small, sane part of my brain told me I needed to tell someone I was feeling this way, but I didn’t want to – they would try to stop me if I did tell someone. I will never forget what that feeling was like, and I truly wonder if I am a PTSD patient now because of it.

In the end, I did try to hurt myself. I was very lucky to have my mother and a very close friend stop me and take me to the doctor. They pulled me off Paxil completely and switched me to another SSRI and a benzodiazepine to ease the withdrawal side effects from the Paxil. I’ve been on this SSRI ever since, and it has now been about 10 years.

Everytime I see an article like this, my heart breaks. I truly hope that this research saves other adolescents from experiencing what I went through. I wouldn’t wish it on my worst enemy.

A.N.Other

I took part in a clinical trial of Prozac through the Mayo Clinic in the mid 1980s. I was super excited to try it. Not only was it hyped to help with depression, which I have a family history of, but it was touted as helping with weight loss as well. I was given a week’s supply at a time and was to be seen weekly and report for follow up. The first week I didn’t notice any change. The second I sometimes felt a bit disoriented, but nothing too far from the ordinary.

The third week was TERRIBLE! I could not sleep. I went out walking virtually all night long and the day was a flurry of activity. I virtually never slept. That was not so bad but I had other, much more disturbing things happen. I had fleeting thoughts of self destruction but much more worrisome was the fact that I had visions of myself causing others great bodily harm. Most of the details have faded over the years but I still vividly remember being at lunch with a friend and visualizing myself stabbing her in the forehead with my fork – I pictured the blood running down her face and dripping off her chin and it made me laugh out loud. When she asked what was so funny, of course I couldn’t tell her! I never took another pill but had more weird visions for a number of days.

When I went to my follow up, I had written everything down in detail. I talked very briefly with the doctor. He gave me kind of an odd look, I thought, and said, “Well, it looks to me as though you aren’t suited for this study, after all.” With that, he turned and dropped not only my detailed notes but my entire file folder in the wastebasket and told me I was free to go. I am much more assertive now and would have insisted on taking things with me but at the time I was still half “out of it” and simply went home.

I wonder how often something like that happened. I had not thought of it for a long time until reading your article. From time to time after the drug was approved there were cases of suicides, homicides and other extremely disturbing side effects but I have not heard anything for some time.

Thank you for an interesting and informative article!

See recent posts on Study 329 on this site.

All parts of this study are available on Study329.org, along with the reviews and review history of both the original Keller paper and the Restored Study 329, programs made about it, blog posts and of course the Data from the Study.

Study 329

RxISK’s last story featured a young woman who went on Paxil soon after the Keller et al version of Study 329 was published. We would love to hear more from anyone who was put on an SSRI during this period or who was recruited into an SSRI trial. What were you told about the risks and what happened to you?

Study 329 has just gone live. The Restoring Study 329 article with its appendices, data, history, accompanying feature by Peter Doshi and editorial by David Henry can be found on the Restoring Study 329 site Study329.org.

Here are the key findings at present.

Efficacy

Efficacy

Harms

Suicidal and self-injurious behavior

Background

Three amigos

A 329 Story

GSK - Science with a conscience

Editorial: This is an account from someone who went on paroxetine – Paxil – Seroxat – soon after Study 329 came out. She didn’t commit suicide. But it would be difficult to describe these effects of the drug as good. And it is also difficult to view the culture in which the drug was given as therapeutic. Most of us can probably remember the power of a sympathetic adult when we were teenagers.

This Thursday on Study329.org we will make Restoring Study 329 available along with a host of material linked to this one of most famous clinical trials in medicine. The paper brings out hazards of treatment such as suicidality and withdrawal but not the pernicious and pervasive effects of emotional numbing so well outlined here.

At age 12, as a seventh grader in middle school, I began experiencing extreme distress every morning on the way to school. I would feel a sense of terror in my chest and cry in the car, afraid to enter the classroom. Instead, I felt the need to have my mother or father by my side. I could not articulate a reason for this churning of awful feelings, and felt I had no control to suppress my tears. This was accompanied by an intense need to perform perfectly in all my academics – to earn straight As in each class. Anything less was cause for more tears and hurt.

This emotional downfall seemed to come out of nowhere. The school therapist tried to find out the root of this issue: were my parents pressuring me to excel? No, they told me that perfection in school was not necessary. I am only child, from a white, upper middle class family. The “rules” that I had to get perfect grades, were all self imposed. This terror and anxiety lasted months.

Since my emotions were impeding my ability to go to school, a severe weight was placed on my issues. I was taken to Kaiser, where a series of psychological tests were done to me. I remember IQ tests, ink blots, and even X-rays being done to me (I do not recall what for). I believe I was diagnosed with Anxiety. During this time, I felt sad, helpless, miserable, and hopeless. Despite having a best friend for support, I did not feel listened to, understood, supported, or given examples from a strong and compassionate adult.

Shortly after, I was prescribed Paxil. I was not in any sort of talk therapy at this time. The psychiatrist that prescribed me the Paxil, I viewed as cold and uninterested, and I did not have a good rapport with her at all. Every time that I saw her, often with the accompaniment of my mom and dad, I felt alienated and judged. I was very opposed to receiving any kind of therapy or being medicated at that time because I associated mental illness and treatment with a huge ugly stigma. It made me feel embarrassed and ashamed. Finally, one night my mom sat with me in my room while I was in bed and asked me again to take the Paxil, as I had initially refused many times. She said “Are you with me?” I took my first pill.

I do not remember a distinct time when my perception shifted after taking the medication and I was able to go to school without incident. My anxiety diminished, however my demeanor took an opposite approach. After taking Paxil regularly, I became lethargic, moody, lackadaisical, blank, rebellious, anti-authoritarian, silent, disinterested, and numb. I felt blank inside, like nothing mattered to me or was of any consequence. My performance in school no longer held any weight to me. Not only did I quit my perfectionistic behavior in school, I stopped caring altogether.

I took Paxil from ages 13-17. During these years, I received my first Cs, Ds, and failing grades in classes. I began self-medicating with marijuana at age 14 and began consuming marijuana daily over the course of a year. I even attended classes stoned while taking Paxil. I also experimented with other hard drugs. I felt not invested in my health, wellness, or reputation as a student. Screaming fights with my parents began, that were so loud and scary, the police were called to the house multiple times by neighbors. I could not relate to or feel connected with them at all. I expressed my anger and frustration through yelling and crying. There was a sense of powerlessness.

Over the course of the four years that I was prescribed Paxil, I never received talk therapy, which was not required by Kaiser in order to continue my prescription of Paxil. I only met with the psychiatrist that originally prescribed me Paxil at Kaiser once every six months, who did not probe in depth into my experience with Paxil nor into my emotional state of being. Her only concern was to maintain or increase my dosages. I did not have the support of a psychologist or any adult authority figure to speak with about my emotions or behavior. I felt out of control of my own body and like important decisions were being made about and imposed on me and that no progress was being made towards exploring the reasons being my anxiety and learning coping mechanisms in order to live successfully. Instead, my feelings were being suppressed, and were coming out in dangerous ways.

In my junior year of high school, age 16, I decided to embark on a life-altering trip abroad in Latin America for six weeks over the summer to volunteer and live with a host family. During my trip, for the first time I felt deep emotions again after so many years of feeling blanketed by Paxil. I felt as though my shell had cracked open and the light came pouring back in. At one point over the course of this trip, I made the decision to come off of my medication upon my return to the US.

When I came back, with the help of an amazing therapist, I tapered off of my medication. It was challenging, but the benefits of coming off of the Paxil outweighed any of the negative symptoms I had on the medication. I recall feeling depressed & lethargic as I tapered off of the Paxil over several weeks, but I also increasingly felt like I inhabited my body again. I felt like myself. I cared about school, my community, and friendships again. I stopped the drug abuse. My grades came back up. I did not beat myself up as badly as I used to at age 12 before I started taking the Paxil. I started volunteering at various community empowerment organizations. I developed a core group of friends. Talk therapy helped me heal from years of feeling numb and suppressed on Paxil. I finally felt my emotions again, happiness, sadness, joy, etc. I began applying for colleges and received acceptance from a prestigious state school.

I am now 26 years old. I still feel in a sense that the four years that was on the medication Paxil, were sort of lost years. Many times from that period feel like blank spaces in my life. I am so thankful that I was able to get off of the medication and make steps in the positive direction for my future. I now am able to feel a range of emotions from joy, elation, and happiness, to sadness, anger, and frustration but using the techniques that I have learned in therapy and in life experience, I am able to cope with them and ride any waves that come up. Although Paxil suppressed my self for years, I continue to learn to improve myself everyday without medication.

8.24.2015

Benzodiazepine and Antidepressant Dependence

Ativan

Sally MacGregor has written about the horrors of dependence on olanzapine – see Olanzapine Withdrawal and Back In Olanzapine Waters. Here she picks up a conundrum – Primary Care Doctors react to the idea of Benzodiazepines as though they have been the greatest threat to the stability of society since World War II, while at the same time it seems still dishing out these drugs in large amounts and at the same time close to forcing people onto SSRIs and related antidepressants, despite abundant evidence that these drugs cause very similar problems with dependence and withdrawal. This is not a rational world.

Luke Montagu wrote about his own experience of addiction and withdrawal in the Times magazine recently. His story is grim, and got wide publicity. Many people felt optimistic that the message about drug dependency and withdrawal was finally beginning to be heard. I didn’t feel so upbeat, because whilst the Times article was headed ‘Antidepressants and Benzodiazepine Withdrawal’, most of the comments following the story concerned benzo withdrawal. I wondered if that muddied the waters in terms of how the different classes of psychotropics are regarded….

Benzodiazepine dependent…

I’ve been mulling over the benzodiazepine dilemma for ages. Benzos are a problem – I know, because I became addicted and had the worst cold turkey experience imaginable when I just stopped taking them. Hallucinations, vomiting, loss of balance – the lot. Possibly even a small stroke. I still take them because I am indeed dependent, and too scared to embark on the desperately long, slow process of getting off. I was prescribed clonazepam when one neurologist thought my acute withdrawal reaction from an antipsychotic – olanzapine – could be a form of epilepsy, and clonazepam is used as an anti-epileptic. I was fairly sure, even then, that I wasn’t having ‘complex partial seizures’ but taking clonazepam neatly postponed the prospect of de-toxing from benzos.

I am hideously aware of what it might be doing to me, and hate the ‘Benzodiazepine Dependent!!!’ message that pops up on my GP’s computer when he brings up my notes. Especially as the exclamation marks are big and red and scary and make me feel like a junkie, every time.

Temazepam and lorazepam

Benzos, specifically temazepam, were the only psychotropic drug that ever worked for me. They did what they said on the packet – within 10 minutes of taking a couple of temazepam I could feel my muscles relax and, more importantly, my mind too. As the side effects from the various antidepressants and antipsychotics banjaxed me – a few tamazzies were the only things that gave me a couple of hours relief from the tormented restlessness. They were indeed addictive in the sense that I quickly became psychologically and physically dependent on my daily fix. Interestingly, it was only temazepam that had that lusciously warm effect – diazepam just made me feel low.

Lorazepam works very quickly and effectively at reducing extreme anxiety. I know this because my friend Maggie found that half a 1 mg lorazepam tablet helped her unwind and sleep. She was in the grip of terrible panic and anxiety, despite over a decade of venlafaxine, sulpiride and zopiclone. Like me, Maggie was told that she would need to take her drugs for the rest of her life to prevent a recurrence of a brief psychotic depression back in 2000. Then her Dad died and the insomnia and anxiety came back in spades. Her GP would only prescribe 8 lorazepam pills at a time, so she eked them out and got frantic when time came that she needed some more. She knew that she might not be given any – because of the extreme danger of dependency – and if she was given them, the 8 pills would come with a lecture.

Lyrica

When her psychiatrist suggested she take Lyrica (pregabalin) instead, because it was safer, she followed the advice: despite the dizziness, slurry speech and chills. And three car accidents – so unlike Maggie, who has her advanced driver’s certificate and was probably the safest driver I’ve known. She will have no problem getting her prescription renewed because the psychiatrist has said that she can take Lyrica quite safely for the rest of her life. Along with the zopiclone, sulpiride and venlafaxine.

When I first went to my GP with insomnia, way back when in 1996, he warned me about the benzodiazepines. They were deeply addictive, extremely harmful in the long term and caused worse withdrawal symptoms than heroin. That was almost 20 years ago. And the desperate dangers of benzodiazepines is a message I’ve heard regularly since. GPs, psychiatrists and nurses are extremely aware of the dangers posed by mother’s little helpers, and generally very reluctant to prescribe them.

Z drugs

So, what do they give us instead, to help with sleeplessness, despair and panic? First line usually an antidepressant; always an SSRI or variant thereof. Or a ‘Z’ drug for straight insomnia: zopiclone here in the UK.

My neighbor, on the verge of hallucinating through acute insomnia, phoned the local surgery and explained her problem to the receptionist. Where I live, patients are obliged to tell the receptionist why they want to see a doctor (unless you are bolshie, like me, and just snap ‘personal’) before waiting for the triage nurse to phone back, and then explain the problem all over again…but, as it happens, Elaine was spared that stage because the receptionist phoned back after a couple of hours and said that a prescription for 10 zopiclone was waiting for her to collect. The zopiclone made her feel rough, a phone call with a doctor resulted in a prescription for citalopram, then an additional one for mirtazapine.

Elaine has been taking the drugs for over two years – and has yet to see a doctor face-to-face. The three consultations she’s had have taken place over the phone. Boy, these drugs must be safe if you don’t even need to see the person you’re prescribing them for. But, as Maggie and Elaine have been told – there is no danger of becoming dependent. Elaine feels ready to drop one of the anti-depressants and the GP just said ‘don’t do it too quickly: halve the dose for a week, then stop’.

I took myself off temazepam because I knew I couldn’t control the urge to take 10 or more at a time. I needed more to achieve the friendly, mellow effects, one of the criteria for addiction, and that worried me so I swapped to zopiclone. I believed that life without a sleeping tablet wasn’t possible – mainly because the memory of acute sleeplessness was too powerful and frightening. I had no desire to take more than 7.5 mg a night because it didn’t leave me feeling too good in the morning: a foul taste in my mouth, hung over and jangled up. On the one occasion I took three because I felt so bad, I was sick as a dog. So, on the basis that I’ve never indulged in ‘drug seeking behavior’ around zopiclone, it could be said that it isn’t addictive. It has always felt more like an enemy than my old friend, temazepam but hey – it’s much safer. So everyone says.

I’ve now taken zopiclone for 10 years, knowing that after all this time they do nothing to help me sleep, and that they work on the same receptors to temazepam. And that they are extremely difficult to taper. Tell that to a GP: he or she may accept that zopiclone acts similarly to the dreaded temazepam, and will certainly tell you that you shouldn’t take them for longer than a couple of weeks, but will probably be reluctant to concede that they are difficult to stop.

I’ve been trying to stop for nearly two years now; I managed without too much difficulty to reduce the dose by half to 3.25 mg. Then I needed to start chopping a tiny, slippery tablet, about 2 mm in diameter, which was very difficult. I asked my GP if he could prescribe a liquid formulation so that I could carry on tapering. He squirmed a bit and said – no. It is theoretically possible but would have to be made up specially – and the local Clinical Commissioning Group who control his budget wouldn’t wear the cost.

Try crushing it, he suggested and take half the powder in a teaspoon of yoghurt. That what they did with old people in nursing homes. Heck – poor things. The crushed pill is the bitterest substance I’ve ever tasted and no amount of yoghurt, honey – even marmite – makes it palatable. We tried though. But, yet again, problems began when I was down to almost nothing. A week or so later the familiar nightmares, irritability and aches began – so I walloped back up to 3.25 and have stayed there. I’m not sure why my GP thinks that zopiclone is less addictive than a benzo – except that he sees my difficulty as a psychological fear of stopping, not a physical problem.

Selling SSRIs by dissing benzos

Once the addictive nature of the benzos became widely accepted, fueled by litigation and large compensation awards, the pharmaceutical companies seized this as a golden-egg marketing opportunity. If you can sell a new drug on the basis that it is completely different to those satanic benzos – you are onto a winner. Particularly once diazepam, lorazepam et al, were out of patent and cheap as chips. No big bucks to be made out of human distress with the benzos – but look! We have alternatives: completely safe, no risk of dependency, utterly and unquestioningly non-addictive. Expensive, yes, but just look at the benefits.

This message has been drumming away in the background for over 30 years, stoked by the drug companies. Keep pushing the dangers of benzodiazepines. Addictive. Long-term use leads to dementia. Withdrawal is worse than heroin – we’ve all seen pictures of heroin addicts: hollow-eyed wrecks with no teeth, writhing and vomiting in the throes of withdrawal. Benzos lead to disinhibition and recklessness too, and we can’t have that. It is very much in Big Pharma’s interests to keep that image alive.

Pharmaceutical companies are corporations and corporations exist to make money for shareholders. They have a legal duty to maximize the bottom line. The more vigorously they sustain the ‘evil benzos’ message the more willingly (and, apparently, unquestioningly) the world of medicine is going to welcome new, alternative psychotropics.

Why doctors fail to spot the inconsistency in maintaining that benzos are pure evil, but all other psychotropics are safe isn’t so obvious. So safe that you should take quetiapine, venlafaxine or Lyrica for the rest of your days. But as they all affect receptor mechanisms in the brain – the ‘deranged brain-chemical’ theory of mental illness depends on this message – I simply cannot fathom why the medical profession hasn’t worked out that so called safe alternatives are anything but.

All psychotropics hook

The deep reluctance, embedded in medicine, to concede that all psychotropics cause physiological dependence, and have the potential to trigger a living hell when someone tries to stop taking them, is really hard to understand. Maybe it means acknowledging that harm has been caused on an unimaginably large scale? If you have spent much of your working life prescribing antidepressants and the like – to say that they can cause appalling damage could be just too difficult? Not only are you opening up the hideous prospect of having harmed your patients, it also means admitting that you’ve been duped by skilled marketing, and no one likes feeling they’ve been stupid.

In the meantime, a useful class of medication is going down the pan. Benzos work quickly. They can relieve the torment of acute insomnia and calm severe panic in minutes. They can be taken when needed, and for just as long as needed. They are relatively safe if you take too many, particularly if you don’t wash them down with a bottle of gin. A big olanzapine or venlafaxine OD is much more risky. Think seizures and heart failure.

It should be possible to make the benzodiazepines a useful and effective short-term treatment for mental anguish? To think about why they work so quickly, in comparison to antidepressants. Establish the best possible way of using them to ameliorate intense distress without causing severe addiction. But benzos have become the ‘untouchables’ of psychotropics. They have a potentially useful role in withdrawal from antidepressants and antipsychotics – but try telling your GP or psychiatrist that you’d like to stop taking the citalopram, mirtazapine or quetiapine, and could you please have some diazepam, lorazepam or temazepam to help you during the taper.

In the meantime: beware. Concessions by medics and drug companies that dependency and withdrawal do indeed exist will be heavily, and deliberately, skewed to the benzos. A recent online survey by the Royal College of Psychiatrists, asking patients about their withdrawal experiences was limited to – benzos. What we so desperately lack is data on withdrawal syndromes for all the other classes of drug. The focus on benzodiazepine dependency is a smokescreen. It diverts attention away from any acknowledgement that antipsychotic and antidepressant dependence is a big, big problem. Just as big as being a benzo junkie.

Kicking Lyrica

Editorial Note: This post was put together by Johanna Ryan from reports to RxISK on Lyrica – Pregabalin. Lyrica is closely related to Neurontin. Many anticonvulsants such as carbamazepine have been used for forty years for pain syndromes such as trigeminal neuralgia. Neurontin but especially Lyrica have been promoted heavily for this. Both cause dependence and withdrawal and because pain and burning sensations are such a feature of withdrawal, they can both become the problem they are used to treat.

 Burning feet

Please describe the side effect, and its impact, in as much detail as you can

Memory prob:

I developed really bad constipation. My skin started peeling on my hands. I packed on about 20 pounds in two months with no change in my diet or exercise. I’m a high school teacher and had trouble remembering the names of my students. I had significant problems learning new material that I needed to teach. I felt like my emotions were completely shut off. Looking back on it, I turned into a brain dead zombie.

Did you continue taking the drug? Why or why not?

  • NO: “The side effects while taking Lyrica were intolerable. I was a brain dead zombie but didn’t realize how bad things were until I was completely off the stuff and was able to reflect back on how I was when taking the stuff.The withdrawal was absolute hell. I tapered in 20 mg doses (the smallest available dose) over the course of about 4 months. I experienced agitation, skin crawling, major depression (I spent most of the summer in bed), panic attacks, and became severely suicidal. About a month after my last dose, in the space of maybe a day, I felt like I had walked out from under a dark cloud that I had lived under for two years (I took gabapentin before switching to Lyrica). I could feel emotions again, the depression lifted, the suicidal thoughts disappeared, and, I could think again! My neuropathy flared up badly as I decreased my dosage but it settled down after a few months (with the help of Lidoderm patches and a B-vitamin/ alpha lipoic acid supplement) and I found that the pain I was left with was way better than the side effects from Lyrica.”

What advice would you give to someone who was considering taking this drug?

  • “Lyrica does work for neuropathic pain but, in my experience, there are far better solutions for neuropathy. The side effects while taking it are terrible, you won’t know how badly the stuff affects you until after you get off of it, and the withdrawal is absolute hell. If you need to take a prescription neuropathy drug, take gabapentin at the lowest dose you can manage since the side effects aren’t as severe nor is the withdrawal as bad.Here is what I wish I would have known when I first started dealing with severe neuropathy:
    If you are experiencing localized neuropathic pain, stabbing or burning in spots that you can point to, use prescription Lidoderm patches on those spots every day for several days. It may take a couple of days but it’ll work wonders. My localized neuropathy was horrifying, 100 (no, I’m not exaggerating!) on the 1-10 pain scale, and when I finally tried it, Lidoderm patches made it completely disappear within about 6 weeks.

For the more diffuse pins and needles type of neuropathy that spreads over an entire limb, try a B vitamin and alpha lipoic acid supplement. There are several published medical studies that show that this works. I take a supplement that I order online called Neuropathic Support Formula. I really didn’t have much hope for it but I was desperate and finally decided to try it. About an hour after my first dose, I was surprised to notice that the constant pins and needles had diminished. I take it twice a day, I experience no side effects, and after a few months, I barely notice the pins and needles anymore. If I forget to take it for more than a day, I notice an increase in pain.

If the Lidoderm and B vitamin/ alpha lipoic acid isn’t enough then try gabapentin (not Lyrica). If you’re thinking about increasing your dose, test out if you will experience withdrawal when you want to get off the stuff. On one of your doses, take one capsule less than you usually do. You’ll know in about 5-6 hours how bad the withdrawal is for you. Some people have no problems with decreasing the dose while others, like myself, experience significant withdrawal (racing heart, skin crawling, agitation, etc.). It’s good to know what you’re facing so you can weigh the advantage of less pain if you increase your dosage vs a longer withdrawal period when it’s time to get off the stuff.

I had neuropathic pain from a broken pelvis I got from a major bike accident and from Cauda Equina Syndrome as a result of a failed back surgery. I took gabapentin for a long time and kept increasing the dose and then switched to Lyrica on the advice of a pain management doctor. I’ve since discovered that all my doctors except one have no idea about the potential severe side effects and withdrawal problems with both gabapentin and Lyrica. None of them had me try Lidoderm patches for severe localized neuropathy (my physical therapist told me about it) and none of them know about B vitamins and alpha lipoic acid.

So, my doctors had things completely backwards. Instead of starting me on treatments with no side effects or withdrawal risk (Lidoderm patches and B vitamins/ alpha lipoic acid) and then adding gabapentin as needed, they started me on gabapentin, kept increasing the dosage until I was at the maximum and then switched me to the even worse Lyrica. I figured out the much better solution on my own and of course, went through the hell of Lyrica withdrawal on my own with no support from any of them. I’m not sure if they really believed me when I told them how bad the side effects of Lyrica and Lyrica withdrawal was.

If you are already taking Lyrica and want to taper off, ask your doctor for a dose equivalent prescription for gabapentin since it’s significantly easier to taper off of then Lyrica. I figured this out towards the very end of my Lyrica taper and it made my last couple of tapers much easier.”

There is a Lyrica Survivors group that is very active on Facebook. It is a closed group so you will have to ask to join the group. There are currently over 1300 members from all over the world. It’s a great place to ask questions and find support if you are struggling with the side effects and/or withdrawal from Lyrica.

Antidepressants and Violence: The Numbers

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How on earth could an antidepressant drug drive someone to murder? In the past two columns RxISK has heard from two people who know they can. In The Man Who Thought He Was A Monster, Steindor Erlingsson shared his own story of being tormented with urges to stab his wife and young children while on antidepressants. These were utterly alien thoughts, which horrified him – he loved his family dearly, and had never assaulted anyone.

In last week’s column we “heard from” James Holmes, recently convicted of the inexplicable slaughter of twelve complete strangers in a Colorado movie theater. Through Holmes’ personal diary and the testimony of his doctors, we traced how a shy, troubled young man who had never given anyone cause to fear him went from vague thoughts of doing away with the whole screwed-up human race, to actively plotting and carrying out a mass killing.

After reading these two columns RxISK volunteer Johanna Ryan had a question: If Steindor is right, and those who have murderous thoughts on antidepressants are often too afraid or ashamed to report them, is there any other complaint that might give us clues?

Here’s what she found among the FDA and Health Canada reports on RxISK:

 Zoloft NumberZoloft PRREffexor NumberEffexor PRRCymbalta NumberCymbalta PRR
Homicide8015.6509.5296.0
Homicidal Ideation1348.31529.5985.4
Morbid Thoughts195.4246.94212.2
Negative Thoughts15230.110620.2315.5
Obsessive Thoughts427.9499.3285.2
Violence Related Symptom255.0316.3275.4
Physical Assault526.9719.6364.7
Aggression6104.56234.63422.5
Nightmare2763.84426.15016.9
Feeling Abnormal11683.116104.217764.6

Each of these drugs has logged about 30,000 complaints, so it seemed valid to compare them. Steindor had been on Effexor, James Holmes had been on Zoloft, and Cymbalta had been implicated in another RxISK article in 2012: gory, disturbing dreams that resembled Hollywood horror movies, even among those who had always avoided such films.

It also impressed her that a few non-SSRI drugs, like Zyban/Wellbutrin and the anticonvulsant Neurontin which is widely used as a “mood stabilizer,” had been blamed for more suicides than the SSRI antidepressants. The FDA lists 2,168 suicides for Wellbutrin and 2,205 for Neurontin compared to “only” 1,130 for Zoloft. Yet those drugs had far fewer complaints for violence-related symptoms.

Reports of both suicide and violence on paroxetine (Paxil or Seroxat) rival those for Zoloft, although the larger number of complaints for paroxetine make comparisons a bit tricky. All the other SSRI drugs can cause these symptoms, although Paxil/Seroxat and Zoloft seem to lead the pack. So can SNRI’s like Effexor and Cymbalta.

But Johanna also spotted one odd symptom for which Zoloft beat any other drug used for depression, hands down: “Feeling guilty.” What did that mean, she asked?

Drug NameNumber of ReportsPRR
Neurontin (gabapentin)61.4
Prozac (fluoxetine)62.4
Wellbutrin (bupropion)102.5
Celexa (citalopram)124.2
Cymbalta (duloxetine)205.0
Paxil (paroxetine)335.3
Effexor (venlafaxine)13037.5
Zoloft (sertraline)18858.5

Only Effexor comes anywhere close to Zoloft in this respect.

These drugs seem to have distinctive signatures. Cymbalta triggers gory dreams but not guilt, although a robust 1,776 say they “feel abnormal.” Effexor also comes close to Zoloft and Paxil in the rates of homicide and homicidal ideation. And Effexor beats Paxil hands-down at making people feel guilty.

Who knows what is going on but it does seem that minor differences between these drugs can produce major differences in us and in our experiences. We need any of you who have had several different drugs and had different experiences on them to write in and tell us about what was different.

As Johanna found both anticonvulsants and antidepressants can cause suicide but the antidepressants seem more likely to cause violence. We can only understand what might be going on here if some of you can give an account of your inner experience of these drugs that sheds light on what is going on.

The RxISK stories

Johanna also took a look at Zoloft’s RxISK page, which includes excerpts from the reports we’ve received in the past three years. She found plenty of relevant reports, some quite disturbing.

Physical violence

There were at least five reports of actual physical assaults, two extremely serious:

I hit my husband in the head with a baseball bat while he slept. No history of any domestic problems or violence. We were together for 27 years, happily married for 25, until this one-time incident happened, and destroyed our marriage. After the incident I never saw my husband again. I found myself in the ER, then locked in.

I had an “abnormality of mental functioning” caused by triple dosing of the drug combined with alcohol and emotional state. Am currently serving a minimum of 17 years in prison on a murder charge for killing a loved one. Seriously considered suicide following the event. No longer taking the drug. Will appeal against the outcome and create awareness of such risks to the wider public.

Murderous thoughts

Two people reported specific thoughts of murder, such as this one:

I started having thoughts/visions of hurting or killing my children. These were accompanied by feelings of lack of control, extreme fear and anxiety and a physical sensation of warm tingles moving up my spine and out my extremities.

Mania

Four reported something like classic mania, including this woman:

Most people said that I was not behaving like myself at all, that my behavior was bizarre and often frightening. I was consequently hospitalized against my will. Switched rapidly from friendly and expansive to extremely angry at the slightest perceived provocation. I was driving too fast and aggressively, screaming obscenities at my estranged husband and making perceived threats. Grandiose ideas, talking to everyone I met; very impulsive and apt to make poor decisions.

Uncontrollable anger

There were many reports of repeated angry outbursts that went way beyond mere irritability, and were quite out of character for the person:

I would scream at everyone, especially my children. The hyper-stimulation of their just being around—talking, playing, moving—was too much to handle. Eventually, I had to have a sitter care for them at all times until I was well. Thankfully, I had enough support that I did not physically abuse the children, but I was very close to it on many occasions. It was an awful experience.

Alcoholic drinking

Several who had been either nondrinkers or very moderate drinkers reported drinking heavily and craving alcohol on Zoloft. Two noticed a sudden ability to drink without any hangover the next day. They all reported their behavior while drinking as aggressive and out-of-control.

Emotional numbing

There were LOTS of reports of sexual dysfunction of course, from both men and women,” Johanna noted. “Some were strictly physical, but many reported an inability to feel emotions or to care about other people as well. For some this emotional numbing was the only problem, or was clearly much worse than any sexual dysfunction they had.

“One man’s story really seemed to echo James Holmes’ descriptions of losing normal fear. Holmes wrote that the “fear of failure” had led him to do well in life far more than the “fear of consequences.” His fear of failure – dropping out of college, becoming a weird loser socially, disappointing himself and his family – seemed very much tied to caring about certain people and certain goals. Zoloft put an end to both types of fear, he said, which made him both “fearless” and uncaring. That gave the hostility room to grow and take over.

The story on RxISK was much more prosaic, but pretty alarming in its own way. The man said he stopped paying his bills, and was forced to retire early from his job, because he lost all “normal” anxiety. He then spent his whole retirement account in a few years and neglected to pay the real estate taxes on his house as well, so he’s pretty much flat broke. Now that he’s off the meds he feels acutely what a fool he was – but he realizes he knew what he was doing all along. He was just unable to care.

To one extent or another, this happens to everyone on SSRI’s, and explains why people who are “much too sensitive” emotionally often find them helpful. It may also explain why doctors so often can’t spot the problem: Letting your bills pile up and your kitchen sink overflow with dirty dishes are typical symptoms of “depression.” If this man’s doctor did not listen carefully he could miss the fact that his patient did not feel sad or exhausted – he may even have been out having fun while neglecting his chores. He just didn’t care anymore.

Antidepressants and homicide

Antidepressants have been an issue in some of the horrific mass shootings of the past twenty years, and in many less publicized murders as well. Most news accounts have nonetheless seen the problem as a lack of professional help or a failure to seek it because of stigma—ignoring the “professional help”, largely pharmaceutical, the person was receiving. It has been very rare that defendants or their lawyers have raised the medication issue themselves – they have shied away.

It’s not hard to see why. In America in particular, three decades of “tough on crime” rhetoric have taught the public to see most defenses based on mental illness as excuses for bad behavior, and view them with suspicion. The idea of temporary insanity in a defendant who appeared to be functioning normally until shortly before the crime strikes many as outright fabrication.

Then there’s the drugs themselves. In both Europe and North America the vast bulk of the psychiatric profession has declared SSRI’s and other antidepressants to be innocent of any harm, and in fact to be life-savers that have prevented thousands of suicides. While the FDA found enough compelling evidence of suicidal impulses among children and teens to warn against using antidepressants in youth up to age 24, this Black Box warning has been so regularly disparaged and denounced by leading psychiatrists that it’s seldom brought into the courtroom.

These are also well-known drugs. The average jury will contain at least one or two people who take them or have done so in the past, and everyone knows someone who has tried them. Some people will feel they’ve been a godsend; some will feel they have helped somewhat, and others not at all. Yet very few will link someone who has turned suicidal or violent, or completely changed character to the drug they might be on.

As one man recalled of his Zoloft drinking binges:

I thought I was drinking to get past the pain of my divorce, and I think that’s what family and friends thought too. None of us thought anything about Zoloft. We just thought I was an out-of-control alcoholic, even though I never was a drinker before.

Faced with an acknowledged killer who blames his brutal actions on Zoloft, most in the jury box will say, wait a minute. I know all about those drugs. My mother’s on them, and my nephew, and a few coworkers too. None of them have done anything crazy, so why would Zoloft drive this man out of his mind?

If they were that dangerous, the government or someone would have to warn us. Wouldn’t they?

Gun

Editorial Note: See The Man who thought he was a Monster

Sunday’s child is full of grace

He was born on a Sunday. He had an average background with few health, physical or mental problems. His main difficulty was a certain social anxiety.

He went to University to study Neuroscience – probably to try and understand people.

His first attempt to seek help was from the Student Mental Health Clinic on March 16, 2012. The intake worker noted that he seemed extremely anxious, and she mentioned a certain misanthropy.

Seeking help

The first medical contact was on March 21, 2012. The doctor viewed him as having a schizoid personality (socially isolated – loner) with marked anxiety and some homicidal ideation. She prescribed Klonopin (a benzodiazepine), and sertraline (Zoloft).

A week later, he complained of memory problems in class, and the Klonopin was swapped for Propranolol 10mg BD (a beta-blocker). His memory problems continued and the propranolol dose was reduced to 5mg BD.

Klonopin and Propranolol can cause memory problems. Both can also act as antidotes to the anxiety and agitation Zoloft can cause. SSRIs can also cause memory problems.

Meanwhile his dose of Zoloft was being increased in steps from 50mg to 100mg to 150mg per day.

He stopped Zoloft somewhere around June 30, 2012, unaware of the risks of a withdrawal syndrome.

On Zoloft

On Zoloft, he had disinhibition, affective instability, altered sexual functioning, and thoughts of violence, and he became delusional.

Disinhibition

  • He began flirting in a way that was out of character for him.
  • He began spending much more, where he had been frugal.
  • He began visiting dating sites, where he had never done so before.
  • He signed up for motorcycle classes without no reason to do so.
  • He terminated a friendship in a way he would never have done before.
  • He began talking for the first time of violence.

One friend said: “He began to “loosen up a bit” on medication and “became more talkative to random people.”

In the notebook that has been made public, he clearly outlines that he lost his sense of fear while taking Zoloft.

Affective instability

In the notebook he refers to his having developed a “dysphoric mania.” This is an accurate description of the affective instability that SSRIs can cause. It generally refers to a state in which the person, in very quick succession, can feel energized, reckless and invincible, and then depressed and suicidal.

He linked this dysphoric mania to his impulses to spend excessively which were out of character for him.

Sexual dysfunction

In line with a majority of people taking an SSRI, he reported a degree of sexual dysfunction while on Zoloft. By his account, the higher the dose of treatment, the more marked these symptoms became.

Emotional numbing

He reported a degree of emotional numbing. This happened from early in treatment and became more marked as the dose of treatment with Zoloft increased. He reports that his anxiety “turned off.”

As per the notebook, he reported that his anxiety levels remained turned off even after he discontinued Zoloft.

Homicidal ideation

Prior to going on Zoloft, he had rather non-specific global thoughts of harming others. He appears to have had a low opinion of the human race, expressed for instance, in thoughts that it might be no harm to “nuke” them. These thoughts seem consistent with his acknowledged social phobia. (Think Scrooge in the Christmas Carol – the Victorians once saw misanthropy as close to a virtue).

He expressed such thoughts to his doctors, and it is clear that they were concerned, and struggled to work out if he was exhibiting signs of psychosis.

But on Zoloft, he developed new thoughts centering on the possibility of specific homicidal acts. These were not the same as his former vague ideas of killing people. They were focused and specific, and “realistic.” They were entirely different to any ideas he had had before.

(In the case of people who have been regularly suicidal in the past, and who become suicidal on SSRIs, it is common to find them saying that the new ideas are quite unlike their usual suicidal ideas and indeed some can hold both sets of thoughts in their mind at the same time).

Delusional thinking

SSRIs like Zoloft can disrupt motivational hierarchies (our values and priorities) leading to alcoholism, violence and a range of other behaviors not usual for the person taking them.

He had a change in his motivational hierarchies. He did not just have thoughts that differed from those he had before, he had a different motivational link to his thoughts. The possibility of acting on these thoughts had emerged in a way that had not been present before.

He attempted to communicate this new state of affairs to his doctors and their failure to grasp it made the looming action even more real. The ideas became something that required action.

Zoloft withdrawal

When he stopped Zoloft, he did so abruptly from a dose of 150mg. There is no indication he was told to taper (although the medication packaging comes with some warning). He was unaware Zoloft could produce dependence and a withdrawal syndrome.

He became confused on withdrawal – being both more and less depressed. He became emotionally labile – dysphoric mania as he described it.

The reduction in fear he experienced while on Zoloft continued after he had stopped. Lots of people have continued emotional blunting or depersonalization – detachment from your thoughts or feelings – for months after stopping treatment with SSRIs.

Effort to communicate

The trial records show that on several occasions, he referred to the changes in his thinking, saying that if he told anyone what he was thinking they would then have to lock him up.

The medical response was that he was responsible for his own thoughts and actions.

I and my colleagues react to people threatening to kill themselves and others in exactly this way every week of the year – and for the most part this is the correct reaction and reduces the risk of violence to others. It is not the correct reaction to a new SSRI induced situation.

He appears to have attempted to communicate the changes he was experiencing in messages to friends, and classmates

There are difficulties in conveying alien thoughts of the kind that can be triggered by an SSRI.

  • The person rarely if ever links what is happening to the drug. Few people think a drug could do something like this.
  • The thoughts are ego-alien and foreign and when they happen first you have not learnt how to handle them, or how to conduct yourself responsibly vis-à-vis these thoughts or feelings.
  • It is difficult to convey material that has problematic content. People in these situations communicate obliquely. They frequently think that they have conveyed enough for others to understand what is going on, only to find that the other person has missed the message.
  • There are difficulties in communicating the adverse effects of a drug to a doctor who has put you on the drug hoping to help you. When things go wrong, the doctor can seem like the only way out of the problem and no-one wants to antagonize their doctor for this reason.

On Friday July 20th 2012, 8986 days after he was born, he entered the movie theater.

Afterwards

He was arrested and hospitalized. Four months later, he became disturbed in hospital and was prescribed a variety of tranquilizers.

At the end of December, he was put on another SSRI for the first time since the end of June and 5 days afterwards attempted to kill himself. He was put on suicide watch.

The agitated reaction subsided sometime later. No-one thought to stop the SSRI. Every expert who interviewed him, interviewed a man who was on a cocktail of meds. He spoke reasonably but was blunted. Its not clear there were any delusions.

We now know he wasn’t give the death penalty. He may have preferred it.

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If you see something, say something

This post by Steindór Erlingsson asks awkward questions in the week when the jury is likely to deliver a verdict in the sentencing part of James Holmes’ trial for the shooting dead of twelve people in Aurora Colorado at the premiere of the Batman movie, Dark Knight Rises, Holmes had no intentions of harming anyone before being put on Zoloft. His dose was increased twice and after each increase his thoughts became more malignant.

I have been haunted by serious emotional distress and suicidal thoughts for almost thirty years. This nightmarish existence has its genesis in traumatic experiences I had as a young man while working for several months as a volunteer for the Icelandic Red Cross in Ethiopia. (The worst was witnessing a passenger jet crash outside my town, working on the rescue and having to photograph the dead bodies while relatives were trying to identify their loved ones.) I arrived in Ethiopia a somewhat emotionally fragile individual, which might explain why on returning to my native Iceland I was suddenly living in a universe “divested of illusions and lights”, to quote Albert Camus, and felt like an “alien, a stranger”.

A two-year subsequent battle with diseases I contracted in Ethiopia (I had to leave the country seriously ill) and their consequences only increased my alienation. During this period I gradually sank into the realm of suicidal thoughts and entered the problematic world of psychiatry. Instead of asking me about the Ethiopian experience and what followed in its wake, I was given psychotropic drugs and electroconvulsive therapy (ECT).

And now the real traumas began…

Seven years after my return, I had an experience which made the Ethiopian traumas pale in comparison. At that time my emotional life had stabilized. I was living with my wife and new-born son and about to graduate from the University of Iceland. But a dark echo from the previous years sometimes reared its head in the form of spontaneous dizziness, rapid heartbeat and rapid breath. My psychiatrist at that time had the perfect solution: Cipramil, an SSRI antidepressant. (Note: This is citalopram, also sold as Celexa.) He told me this drug would make these symptoms disappear, while emphasizing that it had “no side effects.”

A few days after I started taking Cipramil, terrible thoughts came into my mind. I wanted to harm my wife and new-born son. Every time I saw a knife or thought about one an incredibly strong urge to injure them erupted. As a non-violent individual by nature, I had never experienced anything like this before. Even the death and destruction I’d witnessed in Ethiopia had never put such thoughts in my head. This went on for some time and I obviously did not dare to tell anyone, neither my psychiatrist nor family. I continued taking the drug and suffered in isolation. The feeling gradually disappeared.

One summer of terror… and years of “crushing guilt”

I had the same experience eight years later. At that time my emotional life was extremely chaotic and I was in and out of hospital. The doctors who were treating me had no idea of how to relieve my suffering. Instead of trying extensive psychotherapy, among other things, I literally became a guinea pig. I was given numerous drugs. New drugs were regularly tried or the dosages changed. These included Effexor and Zyban (bupropion, also sold as Wellbutrin). My wife, who is a scientist, was very worried about all the drugs I was ingesting. By looking at the scientific literature she realized that some of them were being prescribed way above the recommended dosage. I did not listen to her.

The violent thoughts struck me during the summer. As before, seeing or thinking about knives created an almost irresistible urge to harm my wife and two children. I was terrified. My wife sensed that something was seriously wrong when I asked her to hide all the knives in the apartment. I was able to tell her in a roundabout way what was going on in my mind. I also alerted some of my friends. I was finally hospitalized at the end of the summer. And the solution to stopping my thoughts was … yes, you guessed correctly: bilateral ECT. As a result big sections of my memory from this year were permanently erased. I was able to piece it together by talking to my wife and reading emails I sent.

These two harrowing episodes, that brought me almost into a devilish domain, have in many ways trivialised the Ethiopian traumas. The crushing guilt that the violent thoughts created, which is indescribable, extended the suffering way beyond the episodes themselves.

Information leads to liberation

That guilt haunted me until June 2009, when I read a book that has gradually enabled me to escape it. I cried when I read these lines in Peter R. Breggin’s book Medication Madness (2008):

Within a week of starting Prozac, Emily began to become obsessed with killing her mother. Never before had thoughts like these entered her mind. She imagined taking the eight-inch chef’s knife from the kitchen. She saw herself sneaking up on her mother at an unsuspecting moment … and plunging it into her back. The drive to kill wasn’t wrapped in any reason, excuses, or rationalization. Emily didn’t feel upset with her mother. In her words: ‘It came out of nowhere’ (p. 58).

This is exactly what I experienced during the Cipramil incident. Now I felt absolved. But Emily’s story did not fully explain what happened to me during the latter incident. I had to read further into Breggin’s book to find a convincing explanation:

Consistent with most of the cases in this book, severe adverse psychiatric reactions often take place within a day or two of starting or changing a dose of SSRI antidepressant, or adding other drugs (p. 135).

This is exactly what I experienced. I felt absolved again.

Two years prior to making this enlightening discovery I had stopped taking psychotropic drugs. I have had my share of difficult withdrawal symptoms. My newfound knowledge only increased my resolve to continue my journey through life without resorting to The Emperor’s New Drugs.

As I dug deeper, I came across a paper by Yolande Lucire and Christopher Crotty that lists diverse drugs that “all induce suicidal and homicidal thinking as an occasional side effect.” More specifically, Thomas J. Moore, Joseph Glenmullen, and Curt D. Furberg list 11 antidepressants that have consistently been tied to an elevated risk of violence, “even when compared with antipsychotics and mood stabilizers, which are used in psychiatric patient populations in which violent acts may occur.” Cipramil, Effexor and Zyban are all on this list.

Why didn’t anyone tell me about this possibility?

I feel violated by psychiatry. I have longed for justice after I realized that Cipramil, Effexor and Zyban were most likely responsible for the violent thoughts that I had towards the people I love most dearly. Why didn’t anyone tell me about this possibility? Even though reading Breggin’s book relieved me of most of the guilt, it did not make me very optimistic that difficult subjects like these would eventually be discussed openly.

Shortly after reading Medication Madness I became conscious that difficult subjects would ever be discussed openly. It was David Healy’s book Let Them Eat Prozac (2004) that made me realize this:

No matter how many physicians or others reported to SmithKline suicides or homicides they thought related to [Paxil/Seroxat], SmithKline would deny any evidence for causation while there was no randomized controlled trial evidence. The fact that they had never undertaken any trials and had no plans to do so smacked of washing their hands in the face of crucifixion (p. 222).

We all remember accounts in the news of individuals who committed unspeakable acts of violence against their loved ones. As an individual who has never so much as hit another human being, I am now, at the invitation of Big Pharma, in the horrible position of understanding what was going on in the mind of some of these individuals. I assume that there are many more of us who did not give in to this terrible urge. I hope my story will relieve the crushing guilt of some of these individuals.