When the idea that selective serotonin re-uptake inhibitors (SSRIs) might make people feel suicidal first started to be discussed by people like David Healy, I admit I was sceptical. It didn’t seem to me the drugs had much effect at all, and I couldn’t understand how a chemical substance could produce a specific thought. Since that time, however, the evidence has accumulated, and moreover, it is clear that the suicidal thoughts and behaviours usually occur in the context of a state of intense tension and agitation that the drugs seem to precipitate in some individuals, especially the young. It seems this state can be so unpleasant as to make people impulsively harm themselves, and some evidence suggests it may lead to aggressive behaviour as well.
Because these effects did not show up in randomised controlled trials, however, they were dismissed and few efforts were made to study them properly. Then some large meta-analyses, which combined results from different trials, started to find an association between the use of modern antidepressants and suicidal thoughts and actions, especially in children.
The latest large meta-analysis, conducted by a group of researchers from the Nordic Cochrane centre in Denmark, confirms the association between suicidality and SSRI use in children, and also finds evidence of an association with aggression in this age group (http://www.bmj.com/content/352/bmj.i65). This is the first meta-analysis to report an association between SSRI use and aggression, and confirms other evidence described by David Healy and colleagues in 2006 (http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030372).
In my commentary on the study, I highlight how the analysis also points to why such findings have taken such a long time to be confirmed (http://www.bmj.com/content/352/bmj.i217). The analysis used data gleaned from Clinical Study Reports prepared by drug companies for the purposes of regulatory approval. Looking in the appendices of these reports revealed many incidences of suicidal behaviour that were not recorded as adverse events in the Result section of the reports, and were presumably not reported in published articles either.
I have been asked whether I think this is evidence of a conspiracy by drug companies to suppress evidence of the dangers of their products. It may be, but it is also evidence of a more systemic failing. The advice from leading psychiatrists is to not take too much notice and to carry on prescribing (http://www.sciencemediacentre.org/expert-reaction-to-antidepressant-use-and-suicidality/). With a few exceptions, psychopharmacology researchers have shown no interest in studying the way these drugs alter normal mental functions and emotions. We know very little therefore about the state of agitation that SSRIs can induce, how often it happens, in what circumstances and what sort of thoughts and behaviours it can give rise to.
Why the reluctance to investigate this matter properly? Financial conflicts of interest is one answer, of course. Other factors include psychiatrists’ professional insecurity, and doctors’ perceived need to have something to offer the people who queue up daily in the hope of a remedy for their distress. I hope the publicity this latest study has received will spur the research community into action, and make doctors think more carefully about reaching for the prescription pad.
Joanna Moncrieff 
I think you hit the nail on the head suggesting professional insecurity.
I was at a conference in 2002 where a presentation was made on the emerging evidence linking SSRIs with youth suicidality. At the tea-break I spoke to (or eavesdropped on) several of the psychiatrists in attendance. Only a couple questioned the evidence, with most accepting that, on the balance, SSRIs do increase the risk of suicide in the young. But none indicated they’d be changing their prescribing practices.
Some seemed to think it was only the other guys whose prescriptions increased suicide risk. Their own care and clinical expertise ensured that they would only prescribe SSRIs to those who would benefit from them.
One senior psychiatrist explained it to me this way. “The kids I see are suffering and desperate. I can’t just do nothing.” So apparently he would rather do something with a high risk of increasing their suffering and desperation.
It’s the psychiatrists who are suffering and desperate. Deep down most of them know the discipline they’ve committed to is not a science and had little to offer patients. The pills are to hide the truth from themselves.
Hello Joanna, thanks for your article. I will have a look at it later as I am at work. You mention David Healy. What do you think about him using the term/crime “Rape” in relation to mental health treatment and processes ? I find it is confusing and will alienate any public influence potential. A sort of showboating. Practically could Jeremy Corbyn, for example, in all seriousness debate mental health issues in parliament with the term Rape. I doubt it. Are we trying to win , or just become notorious, famous etc.. Darren Treacy
On Tue, Feb 2, 2016 at 9:21 AM, Joanna Moncrieff wrote:
> joannamoncrieff posted: “When the idea that selective serotonin re-uptake > inhibitors (SSRIs) might make people feel suicidal first started to be > discussed by people like David Healy, I admit I was sceptical. It didn’t > seem to me the drugs had much effect at all, and I couldn’t un” >
Perhaps this parliament “wish” is not that likely or practical, my instinct says it is though, but that change will happen in the specific legal location of psychiatry/mental health services…And so I look forward to your thoughts. Am reading The Bitterest Pills book by yourself ofcourse and it is helping me get to grips with the “brain chemistry” of psychiatry..it would seem that this is the legal-medical battleground.
In fact I had a “meeting” (well monologue) with consultant recently. Dr Carlo Longitardo (or similar..his monologue..)And I put forward alternative models to the biological-chemical-(psycho surgical) model and he looked crestfallen, as a small child that anyone could question Authoritarian Contemporary Psychiatrty And well he came up with the word “Chemistry” being at issue..In passing, yet serious, I am looking for an (NHS) psychiatrist to support my legal case to be withdrawn/detoxed from medication as soon as is possible. Is this the sort of thing you might be interested in? Or any indications of psychiatrists you know who would be interested in this strategy/process?
On Tue, Feb 2, 2016 at 2:55 PM, Darren Treacy wrote:
> Hello Joanna, thanks for your article. I will have a look at it later as I > am at work. You mention David Healy. What do you think about him using the > term/crime “Rape” in relation to mental health treatment and processes > ? I find it is confusing and will alienate any public influence potential. > A sort of showboating. Practically could Jeremy Corbyn, for example, in all > seriousness debate mental health issues in parliament with the term Rape. I > doubt it. Are we trying to win , or just become notorious, famous etc.. > Darren Treacy > > On Tue, Feb 2, 2016 at 9:21 AM, Joanna Moncrieff comment-reply@wordpress.com> wrote: > >> joannamoncrieff posted: “When the idea that selective serotonin re-uptake >> inhibitors (SSRIs) might make people feel suicidal first started to be >> discussed by people like David Healy, I admit I was sceptical. It didn’t >> seem to me the drugs had much effect at all, and I couldn’t un” >>
Sorry, I meant to refer to biological-electrical (psycho surgical) models. The last , psycho surgery, I and others are finding it difficult to confirm if there is still psycho surgery, and as to how many..I had read a couple of years ago it was as little as ten.
On Tue, Feb 2, 2016 at 4:26 PM, Darren Treacy wrote:
> Perhaps this parliament “wish” is not that likely or practical, my > instinct says it is though, but that change will happen in the specific > legal location of psychiatry/mental health services…And so I look forward > to your thoughts. Am reading The Bitterest Pills book by yourself ofcourse > and it is helping me get to grips with the “brain chemistry” of > psychiatry..it would seem that this is the legal-medical battleground. > > In fact I had a “meeting” (well monologue) with consultant recently. Dr > Carlo Longitardo (or similar..his monologue..)And I put forward alternative > models to the biological-chemical-(psycho surgical) model and he looked > crestfallen, as a small child that anyone could question Authoritarian > Contemporary Psychiatrty And well he came up with the word “Chemistry” > being at issue..In passing, yet serious, I am looking for an (NHS) > psychiatrist to support my legal case to be withdrawn/detoxed from > medication as soon as is possible. Is this the sort of thing you might be > interested in? Or any indications of psychiatrists you know who would be > interested in this strategy/process? > > On Tue, Feb 2, 2016 at 2:55 PM, Darren Treacy > wrote: > >> Hello Joanna, thanks for your article. I will have a look at it later as >> I am at work. You mention David Healy. What do you think about him using >> the term/crime “Rape” in relation to mental health treatment and processes >> ? I find it is confusing and will alienate any public influence >> potential. A sort of showboating. Practically could Jeremy Corbyn, for >> example, in all seriousness debate mental health issues in parliament with >> the term Rape. I doubt it. Are we trying to win , or just become notorious, >> famous etc.. Darren Treacy >> >> On Tue, Feb 2, 2016 at 9:21 AM, Joanna Moncrieff > comment-reply@wordpress.com> wrote: >> >>> joannamoncrieff posted: “When the idea that selective serotonin >>> re-uptake inhibitors (SSRIs) might make people feel suicidal first started >>> to be discussed by people like David Healy, I admit I was sceptical. It >>> didn’t seem to me the drugs had much effect at all, and I couldn’t un” >>>
Thanks for your illumination of these truths, which gives integrative psychiatrists like me sustenance. Otherwise, our practice of reducing antidepressant dosages instead of bumping them up, or our encouraging people to wean off these drugs instead of switching them to another antidepressant or adding a second, draws fire from colleagues. Because the culture is shifting and people are better informed, these colleagues are increasingly insecure and dogmatic in their practice of biological psychiatry. For me that fire was a notification to the medical Board by other psychiatrists in that service, (which took 4 years, and a performance assessment before I was found by AHPRA to be safe and competent) and recently being sacked from my 2-day-a week community psychiatric clinic outside Melbourne. So I take heart from your writings,from the work of my GP colleagues at the National Institute of Integrative Medicine and from integrative, holistic, truth-seeking doctors everywhere.
Sorry to hear about how you have been treated. It is competely outrageous that doctors can prescribe potentially life-threatening drugs with impunity, but are criticised for trying to help people to reduce or avoid them.
This is my experience of Akathisia :
Akathisia happens when there is a build up of drugs (prescription or otherwise) because either/or the enzyme system cytochrome P450 is blocked by common food stuffs/herbs or the genetic expression means the phenotype is poor..so the enzymes can not adequately break down the drugs and you become toxic. You can also go into akathisia when benzodiazapines are suddenly withdrawn or the dose is suddenly lowered, so no tapering at all. The Crisis Team did that to me abruptly stopping Lorazepam and a suddenly changing the type and amount of sleeping tablets. They just came round and took the tablets off me. It happened just before I went into hospital for an emergency operation, I went into akathisia during that time in hospital, pacing up and down in pain. Without doubt the most horrendously horrific time of my life. That said benzo’s can attenuate the experience of akathisia to a near bearable level, but bring terrible experiences of addiction and memory loss all of there own. Akathisia is most correlated to antipsychotic and antidepressant drugs.
Most people who have had akathisa, can not describe it with words in a direct way, neither can I. This is my analogy of Akathisia:
Imagine being in a living room at ground level and all of a sudden a gas canister with tear gas comes smashing through the window. Immediately your environment has been changed and you are in panic, choking and in a very agitated state to change this sudden situation and get the gas out or get yourself out of the situation, you have the option to run outside, maybe you open windows, turn on fans but are overwhelmed and have to run out. That is the movement disorder expression of akathisia, but your compelling need is to get outside of yourself, out of your own head. The difference is that you can not unless the drugs – that you don’t even know are causing the situation – are tappered off and stopped, it’s more like being in one of the trade towers on 9/11, the horror is so intense throwing yourself out the window is the best option. That is the suicide ideation and completed suicide. Homicide ideation and completed homicide is also reported but I did not have this.
If you want, another visual representation – for me – of Akathisia going off in the head:
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