In 2023 a new set of Canadian Guidelines for the Management of Alcohol Use Disorders put a serious problem on the radar for doctors that few of them likely expected. See Antidepressants, Alcohol and Anne-Marie.
The antidepressants doctors commonly prescribed, often telling people these medicines would help them manage their alcohol issues, were likely causing the problem – increasing the alcohol use the doctors fondly imagined they might be treating,
The idea that antidepressants might trigger alcohol use disorders will come as no surprise to readers of RxISK and DH Blogs Anne-Marie put this problem on the RxISK radar over a decade ago – Driven to Drink. She has since drawn attention to a significant public health toll linked to women in particular drink driving and having serious accidents that impact not only on their lives but also the lives of others.
The cause that Anne-Marie brought to the consciousness of some of us has more recently been picked up and championed by Evan Wood in Vancouver all the way into Canadian Guidelines on alcohol use disorders – Antidepressants and Alcohol.
There is an extraordinary contrast here. Faced with a wink and a nod to something that sounded vaguely sensible – that antidepressants might help because people use alcohol to soothe their nerves or moodiness – doctors jumped on board and dished these drugs out by the bucket-load. Doctors, in contrast, have been much slower to follow the compelling evidence Evan has faced them with – that what might appear to be common sense does not apply in this case.
It’s not just doctors, who have jumped onto this bandwagon without looking for a shred of evidence beyond common sense. In 2024, the NHS in Britain set about reviewing the detection and management of alcohol use disorders in the UK. The draft proposals did not mention antidepressant induced problems. The focus was on whether there might be some trauma in this or a prior life that needed tackling in order to put things right. This is a recipe for counsellors and therapists referring people to doctors to get scripts for antidepressants in order to facilitate a therapy that isn’t making much difference.
The Airlie Bird gets the Worm
Given this example, it seems easy to make a case that faced with problems, just like the famous bird, medical birds often bury their heads in the sand. Except this is unkind to ostriches. Unlike doctors, ostriches are not hiding from predators or problems. They are digging nests and turning eggs.
This image, designed to illustrate male medical ignorance about women’s medical issues, comes from the Airlie Family Medicine clinic website, in Victoria Australia.
Having made the point about ostriches and doctors, the efforts of two extraordinary people, Evan and Anne-Marie, one of them a doctor and a man, likely supplemented by the efforts of others in the background, have created a platform for saving lives and preventing a lot of misery, perhaps especially among women.
SSRI induced alcoholism is not just a women’s issue but it may be more important for women, as increasingly younger women are more likely to start taking SSRIs than men. These SSRIs may be leading not just to alcohol services having to deal with an increasing number of women but also medical services across the board dealing with women for liver disease serious enough to require liver transplants, and other alcohol linked medical problems.
BBC’s Hazel Martin produced an extraordinary Panorama programme on the growing problem of liver disease among young women in Britain- See I had no idea social drinking would damage my liver. As Hazel makes clear, her interest in the issue stemmed from an alcohol consumption that didn’t seem more than social. But it did lead to liver problems and her discovery that these are more likely to be triggered by much lower levels of alcohol intake in women than men.
The figures for alcohol related medical problems in other countries, along with Hazel’s efforts beyond the UK to draw attention to the problem, are leading to a growing awareness that this is not just a British problem. Other countries are also affected. The problem, however, is not universal – it’s primarily a white woman’s problem. At present other communities are less likely to take alcohol – or SSRIs.
A Hair of the Doc that Bit You?
One of the ways we can all contribute is by getting SNOMED and MedDRA codes for antidepressant induced alcohol use disorders. SNOMED codes are useful for filing reports in our medical records, and with our doctors. MedDRA codes help with filing reports to regulators – FDA, EMA, MHRA, TGA etc. See SNOMED – Having an Impact.
We need to hAir the problem.
Using the RxISK Drug Search Tool, it is difficult to find any evidence of antidepressant induced alcohol use disorders. Rather than search by drug, you have to put in alcohol use disorder as a side effect and see what drugs come up linked to it.
There are 471 reports at the moment, which suggests FDA have only recently been getting reports of this problem. Their first reports date from 2017. Since 2017, reporting has increased from 3 to over 20 per year, but this can only be a fraction of the tip of the iceberg.
Roughly 1 in 10 reports are linked to an SSRI. Roughly 1 in 5 link to SSRIs and analgesics like tramadol and acetaminophen/paracetamol (Tylenol/Lemsip/Panadol etc). Tramadol is easily explained – it’s an SSRI.
Searching under alcoholism produces 6400 reports for the top 100 drugs. We can eliminate over 2,200 of these as the refer to treatments for alcoholism, like Naltrexone, Acamprosate, and Antabuse, which may cause it but not clearly so, along with Alcohol which clearly does cause alcoholism. Of the remaining 4,200 reports, SSRI and related drugs were reported over 1000 times which was 24 % of the total rising to 33 % is we include other serotonergic drugs like acetaminophen (Tylenol) paracetamol (Panadol/Lemsip) and Mirtazapine as well as Buspirone.
Tylenol
Tylenol is intriguing. It comes with prominent liver damage warnings. For decades, as a result of being consumed with alcohol or in overdose, it has been among the commonest triggers to a liver transplant.
What’s intriguing about this?
Despite it being among the best-selling and most consumed drugs in the world for several decades, neither Johnson and Johnson who make Tylenol, nor any of the many other companies in any of the countries where it is among the most consumed drugs – especially in pregnancy – can tell any of us how it works.
This has to be a crazy statement doesn’t it?
Nope. Go to the Johnson and Johnson’s website (or Kenvue, a JnJ offspring) and search for the company view on how Tylenol works. They used to waffle about Aspirin like actions on Cox 1 and Cox 2 systems and about prostaglandins and then began talking about central, maybe opioid-lite mechanisms, but lately the websites officially concede that no-one knows how Tylenol works.
Acetaminophen/Paracetamol is not an SSRI but it does bind to serotonergic receptors and reuptake sites and it produces a similar numbing of emotions to the numbing we get with SSRIs along with sexual difficulties and loss of libido.
In addition, of course, SSRI and related drugs are used in the management of pain. SSRIs are not particularly analgesic but like Tylenol they seem to make us less bothered about or emotionally numb to the pains we have.
SNOMED and MedDRA
We are applying for SNOMED and MedDRA codes for SSRI triggered alcohol use disorders and will post them here but there are lots of other codes to apply – such as aripiprazole induced amphetamine use, alcohol abuse, gambling, for instance.
The SNOMED code for alcohol use disorder is SCTID: 1336085007. For alcoholism the code is SCTID: 7200002. The problem with these is they don’t tell anyone that your Antidepressant has caused the problem
Let’s see how the ‘authorities’ respond to asks for codes for SSRI – induced problems. Strictly speaking everything reported to FDA’s MedWatch (on RxISK) is drug-induced or potentially drug-induced. Akathisia is a MedDRA event – SSRI-induced akathisia isn’t.
The MedDRA code for alcohol use disorder is 10080021 and for alcoholism is 10001639. If you report either of these to FDA or any other regulator along with the name of your drug – it will feature in regulators lists under the name of the drug you think caused it.
When your antipsychotic causes you to take methamphetamine, the MedDRA code for substance use disorder is 10079384.
The SNOMED code for “substance use disorder” is SCTID: 1306691007. The code for “Physiological dependence on substance in therapeutic use (disorder)” SCTID: 1345157004.
The problem with these two as they stand is you may be landing yourself in trouble getting them into your medical record without something to indicate your use of methamphetamine has been trigged by prescriptions of aripiprazole or some other antipsychotic.
The SNOMED code for antidepressant dependence and protracted withdrawal oesn’t have the same problems as it indicates it’s the drug your doctor gave you that is causing the problem – SCTID: (SCTID: 1285639002). For more on SNOMED and what you might be able to do with it – see SNOMED and You.
Alcohol Mysteries
Weeks after Anne-Marie reported her SSRI driving her to drink, another report – Every Drink Spiked – added to the story.
Petra was stopped by the police – her blood alcohol level was right on the legal driving limit. She was mystified – she had had almost nothing to drink. Her father was also mystified and set about investigating and established that the duloxetine she was taking had caused her blood alcohol level to double compared with the levels she had when not on duloxetine.
In several cases since then, the same changes have been observed under police supervision and have contributed to people not being sentenced as they might otherwise have been.
No-one knows how this increased blood alcohol levels while on an SSRI happens at least to some of us but likely not all of us. Chat GPT, Grok etc have been interrogated and come up with nothing except referring you to Every Drink Spiked on DH.org.
We can speculate about common liver effects or interactions. A failure of SSRIs to break down normally can lead to damaging radicals that can cause liver damage. But no-one is looking at any of these things.
The extraordinary thing about this is that here is an event that definitely happens in some of us sitting in broad daylight, which could be used to prevent some of us going to jail, or losing our jobs, or injuring others but everyone just walks by.
For the last decade, I’ve been expecting a reaction among researchers like the reaction among gardeners below. Scientists are not supposed to be able to tolerate an unexplained something sitting there right in front of them. Science and gorgeous gardens wouldn’t exist if science and gardening enthusiasts ignored things like this.
Anonymous says
Dr. Healy I have some slightly positive news to share although I don’t consider this great progress it’s something either way. Anyway a couple of years ago I told you that I contacted HPRA Ireland and I didn’t get any results back then I was reporting I got PSSD from Vortioxetine I don’t think the person who I was talking to understood what I was talking about when I my tried to tell them about pssd. They contracted me via email after I filled out the form where you fill in the side effects. But I felt like I was going around in circles because explaining what PSSD is was difficult. Anyway a few weeks ago I found out that there is a MeDRA code for PSSD so I filled out the HPRA again and included the MeDRA code. I got an email reply the next day asking for more details about PSSD caused by Vortioxetine so I decided to give the HPRA a phone call and I had a good discussion about my symptoms. After about a week I got another email from the HPRA saying that they will update my report with my information on their database. And share my report with other pharmacovigilance bodies, in line with GDPR.
Dr. David Healy says
Thanks for this note showing how effective these codes can be.
D
Harriet Vogt says
Today, along with a very smart woman PSSD sufferer, I joined a meeting of the EU Women’s Health Interest Group, ‘to discuss current and persistent gaps in women’s health research’. We were hoping to raise awareness of PSSD amongst the Eurocrats. Didn’t happen. External participants couldn’t speak – just mutter amongst ourselves in the chat. Particularly frustrating when Corinna de Vries from the EMA was talking about representing pregnant women in drug trials, claiming to be responding to questions in the chat – but studiously ignoring them/us.
The event was really just a political alignment of good intentions – heralding the development of a strategy to end gender inequity in health research.. One of the few men in the group did say something that resonated – he talked about the way medicine overall was ‘masculinised’, and this overrode the gender of practitioners as well as patients.
We’re all broadly aware of gender inequities in medicine – especially the propensity for women’s serious health issues to be misdiagnosed as emotional , ‘in our heads’ – leading to delayed treatment for endometriosis, vaginal mesh injuries, chronic pain, cardiac issues etc. etc.
This built-in misogyny or ‘masculinisation’ in medicine, that bothers Johanna, Lucy and me, and likely Anne-Marie and many others, really isn’t cheap ‘ole. When you look into the detail, it’s pervasive. I’ve heard you talk about the problems this creates for appropriate SSRI dosage.
https://www.sciencedirect.com/science/article/pii/S2059775424000774?dgcid=rss_sd_all#bib12
Just one example – painkillers were traditionally only tested on male rodents (poor little things) – even though, by all accounts, women feel pain differently for various bio-reasons/theories to do with hormones and neural circuitry that are beyond my ken. But psychosocial demands that cause us to underestimate or put up with pain – that make sense.
One of the more interesting things I came across in the research ferret was how our menstrual cycle can affect how we respond to antidepressants (and I guess other drugs as well). Who knew? You – and who else?
“Some antidepressants have been found to affect women differently at different times of their cycle, meaning that dosage may be too high at some points and too low at others. Women are also more likely to experience drug-induced heart-rhythm abnormalities’ and the risk is highest during the first half of a woman’s cycle. This can, of course, be fatal.”
There is no clearer example of misogyny than medical reactions to women with PSSD. Rosie Tilli being the most extreme one – can’t feel her vagina, must be crazy, section her. And , as Johanna and I have been discussing recently, this grim state of women’s sexual deletion , seems to be taken less seriously than men’s because it is less physically obvious. It’s all in your head, love, and who needs orgasms! Exactly, this point is brought out by a female respondent from a new qualitative study with PSSD sufferers:
‘And the therapist …. I went to also told me [pauses] don’t you think that you’re putting too much value onto this? Like …. you’re too freaked out about it …. don’t you think that you’re putting too much value on this. [Pauses], um, [pauses] and that’s what everybody was telling me. They were like, “so you can’t orgasm anymore, so what?”
https://www.tandfonline.com/doi/full/10.1080/0092623X.2025.2495959?scroll=top&needAccess=true
So, it’s not really surprising that Anne-Marie’s SSRI induced heavy drinking was dismissed initially as female drunkenness. It’s a testament to her determination and insight that, with Rxisk’s support, she over-turned that misogynistic assumption to help put awareness of a destructive adverse reaction on the map. I would still bet that loads of women on SSRIs who have traffic accidents are written off as – drunk ‘women drivers’.
The Hazel Martin piece was interesting – particularly the association between liver damage amongst social drinkers from the alcopop generations. Alcopops were sort of the drinks’ business’s’ SSRIs – blockbusters , supposedly ‘safe and effective’, just a soft drink with a bit of a kick. But deadly. A great way of boosting margins and developing an alcohabit in future generations.
Dr. David Healy says
When I was young, they were written off as women drivers. At least this is no longer possible as women are clearly better drivers than men
D
Anne-Marie says
This built-in misogyny or ‘masculinisation’ in medicine, that bothers Johanna, Lucy and me, and likely Anne-Marie and many others, really isn’t cheap ‘ole. When you look into the detail, it’s pervasive. I’ve heard you talk about the problems this creates for appropriate SSRI dosage.
https://www.sciencedirect.com/science/article/pii/S2059775424000774?dgcid=rss_sd_all#bib12
I think you may be right especially in the psychiatric profession. I waited months to see a legal aid psychiatrist through criminal justice system and was really desperate to tell them what had been happening to me. I had to see him at the solicitors office, the days waiting for this day seemed like an eternity. Eventually I get to the solicitors office and waited anxiously in the waiting room.
Then in came the psychiatrist looking very important and the Receptionist took him into the solicitors office. I thought to myself finally someone is going to help me. I felt a relief I was there. I was then called into the office to see the psychiatrist, he went through my arrest and history and asked me several questions. I told him about the tablets and cravings to drink and that I couldn’t stop myself. He didn’t say anything and told me I needed to go to rehab. The female solicitor then came in and asked him if upping my dose would help me. He replied no it could make me manic and rehab is what I needed. He then said he would write my report and my solicitor would give me a copy.
When I got the report there was no mention of me telling him i thought the medication was causing the alcohol cravings. I was so upset I changed my solicitor.
This happened again at the next solicitors I tried to tell him about the alcohol cravings and again he totally ignored me.
These psychiatrists are deliberately ignoring what you are telling them.
It has left me feeling the system is completely corrupt. I have no trust in anyone anymore.
Dr. David Healy says
Harriet is well on the way to making the case that SSRIs are a feminist issue
D
Harriet Vogt says
(Expletives deleted), Anne-Marie, I nearly choked on my supper reading what happened to you.
I agree – there is something uniquely unforgivable about psychiatrists and the disconnected, oppressive way in which they interpret our/patients’ reactions to ‘psychiatric’ drugs. Sure, women’s physical health issues tend to be dismissed far too often as ‘emotional ‘– but there’s something sinister and inhuman about assuming a superior understanding of another person’s inner being.
Nobody can crawl inside our minds. Nobody knows our mental landscape better than we do ourselves. Nobody can sense how psychotropic drugs are affecting our state of being better than we can. You KNEW the drugs were driving you to drink. I’ve quite often wondered how shrinks can imagine they know better than the person whose mind and body it is?
Of course, there’s the fundamental – do not pass go – problem of having been diagnosed with a ‘mental health disorder’ in the first place. A word I can never spell – anosognosia – a lack of awareness of our psychiatric condition is kind of assumed. Your treatment was an outrageous example – and Rosie Tilli’s just hideous. What would they know, poor poppets aren’t in their right minds? Just hysterical women.
And then there’s all that DSM diagnostic baloney – the conceptual reduction of the human beings we know ourselves to be to categories of symptom clusters with funny labels.
My all-time favourite critique of the DSM is this brilliant piece – reviewing the DSM as if it were, well I suppose it is, a dystopian novel. “The Book of Lamentations’. It’s an oldie but a greatie:
‘The scene this prologue sets is one of a profoundly bleak view of human beings; one in which we hobble across an empty field, crippled by blind and mechanical forces whose workings are entirely beyond any understanding. This vision of humanity’s predicament has echoes of Samuel Beckett at some of his more nihilistic moments—except that Beckett allows his tramps to speak for themselves, and when they do they’re often quite cheerful. The sufferers of DSM-5, meanwhile, have no voice; they’re only interrogated by a pitiless system of categorizations with no ability to speak back. As you read, you slowly grow aware that the book’s real object of fascination isn’t the various sicknesses described in its pages, but the sickness inherent in their arrangement.
https://thenewinquiry.com/book-of-lamentations/
But there’s something more. By and large – unlike the plumbers and carpenters of the medical world who know and can see what they’re doing – psychiatrists seem to have almost no idea of how the tools of their trade affect their patients. I’ve listened to David talk about the therapeutic principles behind various chemical compounds and that kind of makes sense. There needs to be some bridging concepts to enable the jump from chemicals to feelings.
But when I listen to other psychiatrists – they mostly talk of effects on patients in terms of the benefit lists they’ve learned from ‘RCTs’ – and then they go into biobabble , aka total gobbledigook like ‘neurogenesis’ and chemical imbalances and other garbage. And I think what’s happened is that biopsychiatry has had the legs cut off it – and left them high and dry. So they’re still kind of gibbering on with these bio marketing theories – but with no substance or connection. They’re lost and clinging to the wreckage. When all they really need to do is listen to you, Rosie and every other individual patient describing how they feel on a particular drug – and they might learn something. Patients would also be a lot safer.
I wonder if you ever sent the Rxisk blogs and clinical guidance that your case enabled to the legal aid psychiatrists who dismissed you so casually. I really hope so.
Dr. David Healy says
H
Had the legs cut off it and left high, dry and gibbering is a great description.
D
Anne-Marie says
I wonder if you ever sent the Rxisk blogs and clinical guidance that your case enabled to the legal aid psychiatrists who dismissed you so casually. I really hope so.
No this all happened between 2006-2010 long before the rxisk post and clinical guidelines. There was no awareness of it then. It was pretty bad trying to get anyone to listen.
I was once in the cells in the courtroom waiting for my turn to appear before the court and I heard a solicitor talking to a woman in the cell next to me who it turned out was being charged with exactly the same thing as me. When the solicitor had gone I called out to the woman and asked her if she was on antidepressants and she replied she was on prozac. I asked if she had been drinking and she said she had and couldn’t remember the night before. I told her the same thing had happened to me and about the alcohol cravings. She said the same thing was happening to her. I told her to go to the gp and get off the prozac and tell her solicitor too. I wanted to tell her solicitor as well but she had gone and I was stuck locked in the cell so couldn’t do anything. It’s happening more than people are aware.
Dr. David Healy says
AM
This is an important addition to the scientific literature. Your point about women in jail needs to be raised with the government who are at the moment very concerned with prison over-crowding.
This is like Peter Sullivan’s case – a man detained for decades for something he didn’t do. In this case we have a lot and a growing number of people detained for events for which they are not responsible
D
Anne-Marie says
I’ve written to my mo in the past and he wrote to the depth of health and all we got back was a standard letter that they send to everyone. Was not helpful at all.
Harriet Vogt says
Expect Rxisk and Anne-Marie explored ‘every avenue’.
In the unlikely event this was one you didn’t explore – I came across a report (2020) from The Parliamentary Advisory Council for Transport Safety – seemingly a long established charitable org. The work was funded by a Department of Transport grant. And that was my thought – the Department of Health paid no attention – but what about more directly relevant, DoT?
There was quite an interesting, if elderly, Swedish study referenced that found:
‘20% of drink drivers had problems with controlling violent behaviour, 25% had suicidal thoughts, 12% had attempted suicide and 27% had been prescribed medication for emotional problems. Moreover, 61% of female drink drivers and 42% of male drink drivers reported earlier depression, the corresponding percentage for anxiety was 61% and 42% and for emotional abuse earlier in life 55% and 29%.’
https://dacemirror.sci-hub.box/journal-article/163c64a3c8e18200e5f8e5278247ea49/karjalainen2013.pdf
As usual, the focus was on the drivers’ ‘mental disorders’, with no attention paid to the possible, not inevitable, iatrogenic effects of the drugs they were prescribed.
But then the food we eat seems to have only come onto the medical radar quite recently. Bizarre that states of mind and body have become so medicalised and disconnected from what we ingest and how we live our lives. My Australian granny knew we are what we put into our bodies. ‘Evidence based medicine’ replaced common sense – and look what happened.
Dr. David Healy says
H
These are great details to get. Someone else mentioned Henri Paul to me – Diana’s chauffeur in 1997 the night she died. A man who had broken up with his girlfriend, got put on Prozac, not known to drink but began to drink heavily. Other drugs were thrown into the mix but the Prozac was left in place. When it happened I was already wary of Prozac and thought about Prozac and suicide but have a much clearer idea now.
One of the saddest cases I’ve ever been involved in was Sara Carlin’s. Bob Fiddaman had lots about her death on his site. Sara was Neil Carlin’s teenage daughter. Her inquest was in 2010. She had been on paroxetine for a year at that point and back then it was difficult to argue for an SSRI causing a suicide after being on it for a year. It was easy to argue for suicides shortly after starting or stopping but on it for a year was stretching things – especially as she was also doing other risky things like drinking more than she had ever done before. Soon after Anne-Marie turned up and for 12 or more years I’ve known exactly the case that could have been made for Sara. It still haunts me.
In the meantime between 2012 and 2022, deaths from traffic accidents in the US with a high blood alcohol level have increased by 10% for men and 40% for women.
We need to get a message out to everyone who has a close brush with death linked to an SSRI-alcohol interaction to report things to regulators, doctors, their political representative, the media – whoever they can think of who might be able to make a difference. Worth knowing also of the death of any celebrity for factors like these.
D
Ann-Marie says
Omg ! I woke up this am and snomed dawn on me how this will save lives.
It will be the difference between life and death, prison or freedom, liver disease or health.
Thank you Dr Healy and Harriet and Evan and anyone else helping to do this.
Cant believe this song also came on the radio this morning and made me cry. Its so relevant to our problem.
https://youtu.be/ClU3fctbGls?si=AvE4dLvIn30vv20A
mary H. says
This is incredibly interesting. Seems to be another case of “everybody” aware except the GPs!
Shane (Cooke)’s case is another in the same vein of course, although, thankfully, he survived. I well remember his solicitor saying soon after the incident that he knew ” when I interviewed him in the middle of that night that this was not an ‘alcohol incident'”. Who believed him though? Not the GP, nor the psychiatrist chosen by the courts; his barrister simply called it “a moment of madness” and the judge wanted his case to be a warning to others who got tanked up on alcohol and attacked the NHS!
All of that was in 2002 – how much has changed since? Maybe the prescribing of Seroxat has lessened but only to be replaced with other SSRIs that cause the same kind of problems.
Anne-Marie says
I was thinking if you attend a&e or see a medical in the cells they will put in what medication your on along with alcohol intoxication and all the codes will come up i.e.: SSRI induced alcoholism?
Would it not alert to a possible problem? If so it could be life saving!
Dr. David Healy says
Nope it won’t work that way. For an SSRI-induced alcohol use disorder code to turn up in your record you will have had to recognize the link and ensure it gets into your record and if you’d done this you wouldn’t still be on the SSRI and drinking.
If we’re talking about the code turning up somewhere other than you’re record, and alerting a doctor, its not going to just turn up. The doctor or whoever will need have registered that fact that there is a link between treatment and the problem – and at the moment doctors do not register this
Getting it SNOMEDED into records, registered in Databases like MedWatch and getting recognised in legal cases increases the chances that a doctor or someone will recognise what is going on when a patient or someone they know starts spinning out of control.
D
Ann-Marie says
This is so frustrating because a simple alert could make a huge difference to someone’s life.
If you are on medication and are arrested you have to see a medic and I was thinking this could be an ideal time and place for a medic to spot the problem but they just see you as drunk. I was refered to as mental health a few times but noone ever spotted the reason why. The same for A&E. The problem could be resolved very quickly if someone just spotted the link.
So much damage can be done just by this one side effect.
mary H. says
Anne-Marie, you know the way Antidepaware used to work – possibly still does – by looking at inquest reports for links to antidepressants etc? Maybe someone could start collecting reports of “alcohol crimes” and see how many are linked to SSRIs? It could become an interesting collection and maybe could be used to warn the unsuspecting public – for sure, no doctor is going to warn them!
Ann-Marie says
Mary you are right, I was also thinking about SSRI Stories ( I think thats what it was called) it had hundreds and thousands of SSRI and alcohol related newspaper articles. It has since disappeared. All that important information just gone that could have helped to bring awareness to the problem.
I also saw someone post on X asking people to respond to a petition to fda and post their experiences or research on the link provided to the fda.
I will try and look for it again and post it here.
You hear of many things happening but never hear how things turned out. I never heard anymore on the MHRA review and what came of it.
Ann-Marie says
Here’s the link Mary for people to post their side effects to fda via this petition to fda.
https://x.com/ACE_CoalitionEd/status/1924553504355479962
Harriet Vogt says
I’ve just been reading your 2014 paper – ’93 cases of alcohol dependence following SSRI treatment’ – and the HUNDREDS of comments on Anne-Marie’s original 2012 piece – still bubbling in 2024:
Val says
November 30, 2024 at 6:46 pm
‘My husband was recently put on Sertraline to help with alcohol binging. Ever since he has not been able to stop drinking for more than 2 or 3 days per month, which is much worse than I can ever remember. I’ve never seen him this bad in the 16 years we’ve been together. Early on I mentioned that it seemed to be making his drinking worse. I tried finding information out there and nothing came up except for your article. I will try to address this with him when he’s able to listen. Thank you for the information!!!’
And thinking, hang on, after only 69 yellow card reports over a 14 year period, the MHRA took action to issue a warning on the aripiprazole risk of ‘gambling disorder’ ,aka medication induced compulsive gambling:
https://www.gov.uk/government/news/aripiprazole-abilify-reminder-on-known-risk-of-gambling-disorder
It seemed like a lot of the comments on Anne-Marie’s piece may be from US based folks – but presumably Rxisk still has all the email contacts – might it be worth sending out a request for anyone UK based to send in a Yellow Card to the MHRA – and a Rxisk report to their GP – as well as US citizens alerting the FDA?
Looking for a ‘celebrity’ legal opportunity to raise the profile of what seems like yet another common but ignored/denied adverse effect makes sense. I found a lot of ‘slebs had been done for DUI (driving under the influence), not much mention of medication except, Tiger Woods, and the particular medication wasn’t identified.
Tiger Woods
The 14-time major champ was arrested on suspicion of DUI in Jupiter, FL, in May 2017. Police records say officers found Tiger sleeping inside his running car on the side of the road with his brake lights and right turn indicator on. The tires on the driver’s side were flat and the rims had minor damage, according to officials, as well as other scuffs on the vehicle. The police report said once Tiger was awakened, his speech was slurred. He confessed to taking medications and later said he had “an unexpected reaction to prescribed medications.” He also tweeted the following month that he was receiving “professional help.”
https://www.delish.com/food/g23709144/celebrity-duis-mugshots/
However, whilst hanging around the ‘sleb gossip sites, the other person who may be of interest is Ben Affleck. He is open about his use of antidepressants and ‘alcohol addiction’. Logically- you might think a guy living his life on antidepressants in the belief that they help him , wouldn’t be driven to drink too , unless…
https://people.com/health/ben-affleck-has-taken-antidepressants-since-he-was-26-gma-interview/
https://www.nytimes.com/2020/02/18/movies/ben-affleck.html
Dr. David Healy says
Can we get email addresses for either of these guys?
D
Ann-Marie says
I just came across this article regarding Linda Robson from loose women. Antidepressants made her drinking and ocd behaviour worse. It was from 2022 I never seen it before.
https://www.dailymail.co.uk/tvshowbiz/article-11134725/Linda-Robson-details-battle-overcoming-alcoholism-depression-OCD.html
Dr. David Healy says
Can we get her or her agent’s email address
D
Anne-Marie says
AI Overview
+1
To book Linda Robson for an event, you can contact the Champions Speakers Agency at 0207 1010 553 or email agent@championsukplc.com. For general inquiries, you can also reach out to Robert-A-PR-Management on Instagram at robertaprmanagement@outlook.com.
Anne-Marie says
Tiger woods reaction was medication not alcohol.
Harriet Vogt says
Linda Robson’s experience is a great find, Anne-Marie. The ‘Allergic reaction’ explanation is already accepted. She’s a sort of heartland British national TV treasure – whom I expect has particular appeal to the middle aged women who are the peak of antidepressant prescribing.
‘Linda has previously explained that alcohol wasn’t the core problem, finding out she was ill during one of her rehab stints – following an allergic reaction to the antidepressant she was taking, which was responsible for a large part of her erratic behaviour’.
You’re also absolutely right about Tiger Woods. He appeared to be drunk, but had no alcohol in his system , just rx drugs.
https://abcnews.go.com/Sports/dashcam-footage-released-tiger-woods-dui-arrest/story?id=47742515
Ben Affleck’s case is pure speculation. He seems to perceive himself as an ‘alcoholic’ – his father struggled with alcoholism apparently so that must fuel the belief (I don’t understand how/why it could be genetic, but psychological makes sense). He’s done regular stints in rehab. He started taking antidepressants in his 20s, as fame and heavy drinking hit – but no connection has been made by anyone.
Very difficult to get hold of these ‘mega-stars’ directly. Agents are the best bet, in theory, reputational management of the asset. But his agent, Patrick Whitesall is something of a Hollywood mega-star in his own right. He’s just left the agency he helped to build, to run— ‘an NFL sports management company that and a sports, media, entertainment investment “platform” backed by a $250 million investment from Silver Lake private equity. ‘
https://www.hollywoodreporter.com/business/business-news/patrick-whitesell-ari-emanuel-wme-1236172966/
Very likely he will continue to manage his good friends Ben Affleck – and Matt Damon. I expect there will be layers of assistants intercepting emails, but there’s always an outside chance that an outrageous subject line might breach the wall.
inquiries@wmeagency.com.
Ann-Marie says
This is so interesting, they are now saying that ad04 also works for opiod use and gambling as well as alcohol abuse. They have now patented the genetic markers for the use of ad04. Mind blowing no-one in medicine mentions ssris effects on 5ht3.
https://www.psychiatrictimes.com/view/fda-has-granted-request-for-end-of-phase-2-meeting-to-discuss-alcohol-use-disorder-treatment-ad04
FDA Has Granted Request for End of Phase 2 Meeting to Discuss Alcohol Use Disorder Treatment, AD04
May 8, 2025 By Leah Kuntz
Adial Pharmaceuticals today announced that the US Food and Drug Administration (FDA) has granted Adial’s request for an end of phase 2 meeting to discuss a proposed clinical development plan and FDA guidance on the phase 3 adaptive with enrichment design of the upcoming clinical trial for AD04. The meeting will take place on July 25, 2025. AD04 is Adial’s lead investigational treatment, a genetically targeted selective serotonin-3 receptor (5-HT3) antagonist and therapeutic agent for the treatment of alcohol use disorder (AUD) in patients who engage in heavy drinking (defined as < 8 drinks/drinking day).1
“We recently announced the successful results of our Type D Meeting with FDA confirming Adial’s 505(b)(2) regulatory bridging strategy. Concurrently, we have made strong progress in developing the design of our phase 3 trial and look forward to aligning with the FDA on key requirements to move AD04 forward. Our recent analyses have reinforced the selection of our target patient population and continue to support AD04’s potential to effectively treat AUD and related conditions. We remain confident in the path ahead and look forward to sharing a comprehensive update following our FDA meeting in July,” said Cary Claiborne, President and Chief Executive Officer of Adial.
In honor of this news, let’s take a look at the other recent devolpments on AD04.
In February 2025, the FDA confirmed Adial’s proposed in vitro bridging strategy for the phase 3 formulation of AD04.2
Additionally, on February 11, 2025, the United States Patent and Trademark Office issued patent number 12,221,654 for Adial Pharmaceuticals’ identification of patients with specific genetic markers linked to substance use disorders and treatment with AD04.3
Post-hoc analyses of Adial’s prior clinical studies have indicated that patients with mutations in the 5HT3 receptor experience substantial and clinically meaningful reductions in alcohol consumption. The specific mutations that appear to respond to AD04 are single nucleotide polymorphisms (SNPs) on rs1150226-AG or rs1176713-GG genotypes in the gene that encodes the 5-HT3A receptor subunit. These genes are thought to affect the binding of AD04 to the 5HT3 receptor and its function. The AD04 treatment involves first detecting the TT genotype of rs1042173 in the serotonin transporter gene (SLC6A4) and then administering AD04 for individuals with opioid use disorder, alcohol use disorder, and other related conditions.
AD04 was recently investigated in the pivotal phase 3 ONWARD clinical trial for the potential treatment of AUD in subjects with certain target genotypes identified using Adial’s companion diagnostic genetic test. The test will be used in future clinical studies and is expected to be commercially available at the time of AD04’s launch. AD04 had similar adverse events to placebo, which further supports that it is likely to be extremely safe and tolerable. AD04 is also believed to have the potential to treat other addictive disorders such as opioid use disorder, gambling, and obesity.
Substance use severely harms individual health, increasing the risk of chronic diseases, mental health conditions, and tragically resulting in millions of preventable deaths every year. It places a heavy burden on families and communities, increasing exposure to accidents, injuries, and violence said Tedros Adhanom Ghebreyesus, PhD, WHO Director-General. To build a healthier, more equitable society, we must urgently commit to bold actions that reduce the negative health and social consequences of alcohol consumption and make treatment for substance use disorders accessible and affordable.
Dr. David Healy says
For years, Anne Marie has been pointing to the role of S-3 receptor antagonists as a way to manage alcohol abuse – she has collected many studies dating back a decade or more.
This AD04 news flash may be just a fly-by-night company releasing a message to entice hedge funds to invest before they close up shop and make off with the money.
Or it may be a sign that companies want to get rid of SSRIs
D
Anne-Marie says
Gsk got rid of Seroxat.
Is it common then to get fly by company’s doing this? They seem genuine. They have passed several trials e.t.c am I just being nieve to belive them? Why would they be wrong when it’s the same as my research and I know from my own research it looks correct.
Dr. David Healy says
Innocent is a better word. There has to be some good evidence to make it worthwhile to submit a dossier to FDA and they are probably depending on the same papers as you. But a weight gaining drug is not a big market and if you can make money by fooling a few hedge funds – well there are plenty of folk out there who have been playing this game for a while.
D
Anne-Marie says
Well fda agree with their research so why are they ignoring us?
I know the answer because they can’t make any money out of our research but they could save tax payers thousands if not millions in having had to deal with us and our side effects through the system.
Dr. David Healy says
FDA are bureaucrats. It is not their job to keep us safe or save taxpayers a single cent
D
Harriet Vogt says
Just running to catch up with Anne- Marie. Not that easy knowing nothing about S-3 receptor antagonists – nor any others for that matter.
But, coincidentally, I have come across AD04 or odansetron in a recent unconnected discussion of the mostly useless drugs that obstetricians use to try and control the dangerous end of nausea in pregnancy – or hyperemesis gravidarum, as I learned it was called. They were all risky, even vitamin B6, the only one licensed. And a crapshoot to find one that was effective.
I can’t understand the logic of how a low dose antiemetic could have a positive effect on AUD. I could understand how a drug that made you feel slightly nauseous might. No doubt my ignorance, because I’m not sure logic is relevant to biochemistry. The claims seem to be based on assumed/perceived genetic differences. Ideologically I don’t feel comfortable with the inherited AUD position either but, who knows? Not me.
More constructively, I have been spending time again with Mary and Shane’s group. And listening to their stories about compulsive drinking – and eating – stories multiplied on reddit. Stories of a compulsion to down neat vodka until crazed. Gobble food to the point of putting on 10 stone which then couldn’t be shifted. And more on the Linda Robson background – that Anne-Marie discovered – apparently the poor woman was so driven to drink, she used to shout to passers-by from her window for supplies.
What I keep wondering – logically, thinking of feelings I understand, not receptors I don’t -mightn’t it make sense to at least consider these compulsions to drink and eat as part of an SSRI induced compulsion syndrome? Are there other compulsions?
I understand the likely role of the disinhibition associated with the drugs. I have the vaguest grasp of Ozempic/semaglutide/GLP-1 receptors – but gather they are satiety signalling hormones and thus decrease desire. Could SSRIs somehow dysregulate them? Is it relevant that SSRIs apparently reduce the effects of Ozempic?
I remember David talking about SSRIs being small molecules – that I envisage as scattershot, blasting through the system – and hormones are clearly in the firing line.- along with everything else. Another member of Shane and Mary’s group was talking about dysregulated periods and newly developed PMDD.
I know – I’d better stick to what I understand – whole human beings. Over to you scientists. But I do think there might be something in a concept of SSRI induced compulsion that extends beyond alcohol.
Anne-Marie says
Harriet I’m not saying it’s genetic but something is happening at 5ht3 receptor especially in alcoholics and they may be right when they say certain genetics but that’s not to say non alcoholics are also being affected by taking SSRI’s that’s also having an effect on 5ht3 receptors causing intense cravings for alcohol in some people. Mirtazapine does stop cravings also I know because I experienced it along with other people. Mirtazapine is an antagonist of 5ht3 just like ad04.
The point I was trying to make is if fda is agreeing that ad04 an antagonist at 5ht3 stops alcohol cravings then surely, they also have to agree it also works the other way round and that SSRI’s that work as agonists on 5ht3 can also cause some people to crave intense alcohol cravings.
It’s irrelevant if you were a non-alcoholic or alcoholic before even people who were or are alcoholic should not be prescribed a drug that worsens their own condition. It should be contra indicated in that population of people.
Anne-Marie says
A simpler explanation.
In pharmacology, an agonist is a substance that binds to a receptor and activates it, triggering a cellular response. An antagonist, on the other hand, binds to the same receptor but does not activate it; instead, it blocks or interferes with the action of an agonist.
Harriet Vogt says
Thanks Anne-Marie – that’s the sort of clarity I need.
I expect this is amongst your collection of papers – but, trying to understand how odansetron could have an effect beyond antiemetic – I dug out this small study from 1996. It kind of made sense of how this drug could affect a person’s reactions to alcohol- basically by intensifying how its effects are perceived. Makes sense to me at least.
‘These data suggest that the reductions in alcohol consumption observed in animals and humans treated with ondansetron may be mediated by increases in subjective intoxication, and/or increases in the aversive effects of alcohol.’
https://pubmed.ncbi.nlm.nih.gov/8879472/