The ssri scandal ...

The following is an excerpt from a new UK book called "Medicines out of Control?" by C. Medawar and A. Hardon. It is subtitled "Antidepressants and the Conspiracy of Goodwill".

Interestingly, the book is a 2004 limited edition and the authors have asked for responses, before publishing a revised edition next year.

Here's the excerpt:



"The case history

The story that unfolds in the first three chapters spans the last 150 years. Throughout this time, doctors have prescribed an uninterrupted succession of drugs for mental distress, each time believing they were not addictive and that patients had only themselves to blame if addiction set in. A pattern emerged - it continues to this day - in which one drug after another, officially proclaimed as not addictive, has later proved to be just that.

Between the 1860s and 1960s, doctors treated mental distress by prescribing alcohol and opium, then morphine, heroin and cocaine. Later came chloral, bromides, barbiturates and many similar drugs. Chapter 2 explains how each of these drugs, bar alcohol, was also used to treat addiction - and later found to cause it too.

The story in Chapter 3 begins around 1960, as the reality began to sink in - that ‘iatrogenic’ dependence (caused by medical intervention) had become widespread and damaging. This realisation spurred a wholesale switch to a new class of drugs - ‘tranquillisers’, like Valium, Librium, Ativan, Xanax and Halcion. It took over 20 years to establish that they too were addictive and another decade to address the problem. Until the 1980s, the risk of becoming addicted to a tranquilliser was officially described as remote, but the opposite again proved true.

Present day remedies for anxiety, depression and mental distress date from the 1990s. By this time, tranquillisers had been internationally ‘scheduled’ as drugs of dependence and prescribing was restricted to the short-term; their use slowly declined. Chapter 4 tells how doctors then began to prescribe a new class of ‘antidepressants’ instead - for longer and in larger doses than before. Prozac started this trend; it spawned other ‘blockbusters’ - Paxil/Seroxat, Zoloft/Lustral, Celexa/ Cipramil and Efexor/Effexor - all still with us today.

This time round, the risk of addiction was denied, in effect by burying the goalposts. The drugs themselves were promoted as if they were essential supplements, badly needed to help to restore levels of a key, mood-regulating, brain chemical: serotonin. At the same time, the authorities formally redefined the concept of dependence to ensure that drug prescribing couldn’t possibly cause it. This meant that most doctors recognised ‘dependence’ only in the context of uncontrolled drug use, something close to abuse. That explains why, today, dependence on antidepressants seems painfully obvious to many users, though the problem doesn’t officially exist.

Crisis unfolding

Officially there is still no antidepressant ‘dependence’ problem, but a crisis is now clearly looming. The turning point can be quite precisely dated - it came with a heavy flurry of revelations between October 2002 and the summer of 2003. If there was a pivotal moment, it was probably 25 June - when GlaxoSmithKline quietly published a small-print amendment to the prescribing instructions for Seroxat. The company had upwardly revised its 2002 estimate of the risk of withdrawal reactions - from 0.2% to 25%. The official risk of Seroxat/Paxil withdrawal problems had increased overnight from 1 in 500 to one in four.

This 125-fold increase signalled that ‘science’ was catching up with common sense - and that sets the scene for the later chapters in this book. The case history gives way to a critical analysis of how and why the crisis arose, and its wider implications. Two related questions become central:

What does it reveal about the quality and direction of medical science, and the reliability of the medicines control system that - in spite of all the fuss and the precedents - it took over a decade to identify a prominent and potentially hazardous adverse drug reaction that affects one user in every four?
When the Internet was groaning with evidence of the problem in store, why were users’ comments and complaints ignored? This is a good moment in history to be asking that question: the more this antidepressant crisis unfolds, the more it seems that narrative evidence from users can never credibly be ignored again.


The story that started to unfold as a crisis in late 2002 began in earnest in the mid-1990s: the growth of the Internet had begun to change history, as antidepressant users began to compare notes and exchange ideas. Vivid and revealing accounts of serious withdrawal and other problems began to surface, then dedicated websites began to appear, all discussing the same thing. Users were hooked once again.

Of science and common sense

During the five-year window, 1998 to 2002, the powers-that-be did all they could to deny the miserable realities that antidepressant users increasingly described. During this period, the authorities entrenched their position; they went on digging and made the hole deeper still.

Secrecy played a key part in maintaining the official denial: Chapter 5 outlines the extent and effect of it. Towards the end of this five-year window, the element of cover-up became more obvious as the weight of scientific evidence got stronger and as public protest grew. Legal actions increased the pressure, and then the media weighed in. Finally, two BBC-TV Panorama programmes (2002, 2003) tipped the balance, and the endgame began.

The events that unfolded thereafter - and led to consideration of a third Panorama programme scheduled for early 2004 - underline the value and power of user drug intelligence. These developments also challenge the relationship between ‘narrative evidence’ and science - the orthodox view that ‘science’ might be debased and compromised by patients’ views."



This is the link to read a bit more of the book on line:

http://www.socialaudit.org.uk/60403162.htm


Juno