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Suicides and Homicides in Patients Taking Paxil, Prozac, and Zoloft: Why They Keep Happening
MedicationSense.com ^ | February 12, 2013 | Jay S. Cohen M.D.

Posted on 02/13/2013 11:12:14 AM PST by Jyotishi

Suicides and Homicides in Patients Taking Paxil, Prozac, and Zoloft: Why They Keep Happening -- And Why They Will Continue

Underlying Causes That Continue to Be Ignored by Mainstream Medicine and the Media

From almost the day that they were introduced in the late 1980s and early 1990s, sudden, unexpected suicides and homicides have been reported in patients taking serotonin-enhancing antidepressants such as Prozac, Paxil, and Zoloft. I'm not surprised this problem hasn't disappeared, nor will it unless we look deeper.

I never hesitate to say that these drugs -- selective serotonin reuptake inhibitors (SSRIs) -- help millions of people. But any drug that can cause positive changes in people's brains can also cause negative ones unless care is taken to avoid it. We do not take such care. So it was no surprise to me when, in August 2003, more headlines appeared. These were based on reports by British authorities and the U.S. Food and Drug Administration about unpublished studies showing an increased risk of suicide in children and teenagers taking Paxil (1-3).

Prior reports of suicidal and homicidal acts in adults taking SSRIs have been explained away by drug industry defenders and mainstream doctors, who claim that suicide is common in depression anyway. And that no type of antidepressant helps everyone. Some depressed patients don't get better and choose suicide. That's true sometimes, unfortunately. But these reports describe more impulsive, violent acts than expected. As I said fifteen years ago at the time of the first reports and again in Over Dose in 2001 (4), SSRIs could create a unique combination of side effects that might severely impair judgment and impulse control. This has been described by others as well (5-16).

Psychosis After Three Days of Treatment
One of my first cases with Prozac involved a 35 year-old woman with a job and family, who had a mild depression with no suicidal tendencies. This changed after just three days on Prozac, when she became acutely psychotic. Any psychiatrist will tell you that excessive doses of antidepressants can cause brain dysfunctions including disorientation, confusion, and cognitive disturbances. This was commonly seen with old-time antidepressants like Elavil and Tofranil (17). But more than the older drugs, SSRIs can also cause a severe degree of agitation or restlessness that may become intolerable and reduce impulse control (5-6A). Impulsive behavior, especially if coupled with impaired cognitive functioning, can be dangerous.

Antidepressants can also trigger similar, manic-like symptoms in people whose depression is part of a manic-depressive syndrome, which often gets overlooked when people are given SSRIs. "Some of these individuals may have serious adverse reactions to antidepressants including irritability, aggression, and mania," wrote Dr. Ronald Pies, professor of psychiatry at Tufts University (18).

The Devil Is in the Dosage
My book Over Dose opens with a man whose anxiety and depressive symptoms got much worse rather than better with the standard 20-mg starting dose of Prozac (4). A letter to the editor in the August 11, 2003, issue of the New York Times described a similar reaction to Celexa:


"During the first month, I experienced extreme, almost manic tendencies. My mind raced, I was restless, I couldn't sleep. Eventually that restlessness subsided (18)."


Sometimes the symptoms don't subside. Sometimes the symptoms get out of hand. The writer of the letter made an another important point: "They need new dosing and treatment strategies to counteract the manic effect." Exactly.

These reactions are occurring because the standard starting doses of many antidepressants are excessively strong for many people. One clue is that most of these reactions occur shortly after people have been started on SSRIs or after the dosage has been bumped up. These are called "first-dose" reactions by mainstream medicine, and they almost always indicate a mismatch between the patient and the dosage. With the Paxil study, the New York Times reported:


"Some experts suspect that in the first few weeks of therapy, drugs like Paxil can shove a small number of patients toward a mental precipice, perhaps because they can cause a severe form of restlessness known as akathisia. Patients who make it through the first weeks of drug therapy uneventfully do fine on the medication on the long term, these experts say (3)."


But it doesn't have to be a sink or swim situation. Merely reduce the dose awhile, allow patients to adapt to the medicine, and then increase it again gradually. Sometimes it doesn't need to be increased, because lower doses work for many patients.

When my patient became psychotic in 1988, I researched the problem and found an article that shocked me. This large study, published before Prozac was marketed, showed that 54% of the patients with severe depression improved with just 5 mg -- one-quarter of the standard 20 mg starting dose (19). But Prozac wasn't marketed with a 5 mg recommended dose. 20 mg was the recommended initial dose for everyone -- 400% more than many people needed -- a huge difference pharmacologically. No wonder these reactions were occurring.

I wasn't the only expert to recognize the problem. A 1993 study concluded "that starting fluoxetine [Prozac] at doses lower than 20 mg is a useful strategy because of the substantial fraction of patients who cannot tolerate a 20-mg dose but appear to benefit from lower doses (20)." Similar dosing problems have been seen with and other SSRIs.

Informed Consent Means Having Enough Information to Make an Intelligent Choice
Unfortunately, most doctors don't understand that many problems with SSRIs are caused by standard doses that are excessive for substantial numbers of patients. And although Prozac, Zoloft, and other SSRIs now come in lower doses, many doctors still start patients on the stronger, standard doses.

As I've said when invited to speak at the FDA and at other major conferences, drug companies must define the lowest, safest, effective doses of drugs. They must include this information in package inserts and the Physicians' Desk Reference, and they must market pills that make lower dosing possible. And they must do it from the start.

Unfortunately, marketing trends in recent decades have gone in the other direction. Many drugs are marketed one-size-fits-all. Many drugs are dosed exactly the same for big and small, young and old, healthy and frail. The same strong doses are prescribed to people taking no other medications and people taking a dozen. Such methods defy medical sense and common sense.

Shortly after the reports from the British authorities and U.S. FDA about higher incidences of suicide in youngsters taking Paxil, Dr. Richard Friedman, director of the psychopharmacology clinic at Weill Medical College of Cornell University, wrote:


"For too long, drug companies have been allowed to tell us only the good news about their products. Now we're ready for the whole story (21)."


The whole story begins with patients and their doctors knowing about the lowest, safest, effective doses of drugs. Most people don't like taking medications. If they must, they prefer taking as little as possible. But this isn't possible if we aren't given adequate information. Informed consent is denied when information is withheld. We need to know the full range of effective doses, and we need enough pill sizes to make individualized dosing possible. Prevention begins with complete information.

In the meantime, you have to be your own researcher, using books and the Internet, learning enough to choose selectively from the information you see. Since 1996, I have published 15 medical journal articles and Over Dose to help inform you and your doctor about lower, safer, proven-effective drug doses because such information was unavailable to most people. Using all of the resources available today, you can learn a lot, and when you do, tell your doctor -- doctors respect good, scientifically-based information -- so that your doctor can inform others following you.

References
1. Waechter, F. Paroxetine must not be given to patients under 18. BMJ, June 14, 2003;326:1282.
2. FDA statement regarding the antidepressant Paxil for pediatric population. U.S. Food and Drug Administration, June 19, 2003:www.fda.gov -- accessed 9/18/O3.
3. Harris, G. Debate Resumes on the Safety of Depression's Wonder Drugs. New York Times, Aug. 7, 2003:nytimes.com.
4. Cohen, JS. Over Dose: The Case Against The Drug Companies. Prescription Drugs, Side Effects, and Your Health. Tarcher/Putnam, New York: October 2001.
5. Medawar, C, Herxheimer, A, Bell, A, et al. Paroxetine, Panorama, and user reporting of ADRs: consumer intelligence matters in clinical practice and post-marketing drug surveillance. International Journal of Risk & Safety in Medicine 2002;15:161-169.
6. Donovan, S, Clayton, A, Beeharry, M, et al. Deliberate self-harm and antidepressant drugs. Investigation of a possible link. British Journal of Psychiatry, 2000;177:551-6.
6A. Rogers, L, Waterhouse, R. Prozac Makers Told to Warn of Side-Effects. The Sunday Times [Britain], July 8, 2001:www.sunday-times.co.uk/news.
7. Glenmullen, J. Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives. Simon and Schuster, March 2000.
8. Healy, D. The Antidepressant Era. Harvard University Press, Sept. 1997.
9. Hickling, L. Questions Persist concerning Prozac's Role in Suicide Risk. Www.drkoop.com Health News, May 11, 2000: www.drkoop.com/dyncon/article.asp?at=N&id=11009.
10. Teicher, MH, Glod, C, Cole, JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. American Journal of Psychiatry, 1990;147(2):207.
11. Fichter, CG, Jobe, TH, Braun, BG. Does fluoxetine have a therapeutic window? Lancet 1991;338.
12. Anderson GM; Segman RH; King RA. Serotonin and suicidality: the impact of fluoxetine administration. II: Acute neurobiological effects. Israel Journal of Psychiatry and Related Sciences, 1995, 32(1):44-50.
13. Lancon, C, Bernard, D, Bougerol, T. [Fluoxetine, akathisia and suicide]. Encephale, 1997 May-Jun, 23(3):218-23. Abstract.
14. Liu, CY, Yang, YY, et al. Fluoxetine-related suicidality and muscle aches in a patient with poststroke depression [letter]. Journal of Clinical Psychopharmacology, 1996 Dec, 16(6):466-7.
15. Jackson, A. Drug Turned Loving Man into a Killer, Says Judge. Sidney Morning Herald, Fri., May 25, 2001:www.smh.com.au/
16. Donovan, S, Clayton, A, et al. Deliberate self-harm and antidepressant drugs. Investigation of a possible link. British Journal of Psychiatry, 2000;177:551-6.
17. American Society of Hospital Pharmacists. American Hospital Formulary Service, Drug Information 1999. Gerald K. McEvoy, Editor. Bethesda: 1999.
18. The Debate Over Antidepressants (5 Letters). Letters to the Editor. New York Times, 8/11/O3:nytimes.com.
19. Wernicke, JF, Dunlop, SR, Dornseif, BE, et al. Low-dose fluoxetine therapy for depression. Psychopharmacology Bulletin 1988;24(1):183-188.
20. Louie, AK, Lewis, TB, Lannon, MD. Use of low-dose fluoxetine in major depression and panic disorder. Journal of Clinical Psychiatry 1993;54(1):435-438.
21. Richard A. Friedman. What You Do Know Can't Hurt You. New York Times, 8/12/O3:nytimes.com.



NOTE TO READERS: The purpose of this E-Letter is solely informational and educational. Theinformation herein should not be considered to be a substitute forthe direct medical advice of your doctor, nor is it meant to encourage the diagnosis or treatment of any illness, disease, or other medical problem by laypersons. If you are under a physician's care for any condition, he or she can advise you whether the information in this E-Letter is suitable for you. Readers should not make any changes in drugs, doses, or any other aspects of their medical treatment unless specifically directed to do so by their own doctors.

If you have questions about your medications or medical care, Dr. Cohen is available for consultation at his office or by telephone.

If you find this article informative, please tell your friends, family members, colleagues, and doctors about www.MedicationSense.com and the free MedicationSense E-Newsletter.

Copyright, Jay S. Cohen, M.D. All rights reserved. Readers have permission to copy and disseminate all or part of these articles if it is clearly identified as the work of: Jay S. Cohen, M.D., the MedicationSense E-Newsletter, www.MedicationSense.com. You may not use this work for commercial purposes.


TOPICS: Government; Health/Medicine; Politics; Society
KEYWORDS: homicide; medicine; paxil; prozac; ssri; suicide; zoloft
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Complete title: Suicides and Homicides in Patients Taking Paxil, Prozac, and Zoloft: Why They Keep Happening -- And Why They Will Continue
1 posted on 02/13/2013 11:12:26 AM PST by Jyotishi
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To: Jyotishi

For one thing they are prescribed to people that are down and depressed to begin with


2 posted on 02/13/2013 11:21:37 AM PST by al baby (Hi Mom)
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To: al baby

“For one thing they are prescribed to people that are down and depressed to begin with”

Is there a study where they dose normal, undepressed people? That would be interesting.

Likewise MDMA, which enhances serotonin.


3 posted on 02/13/2013 11:25:58 AM PST by DBrow
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To: Jyotishi
I took Prozac for a short period of time back in the 1990s. At first the drug evened me out. Not sad, not happy, just mellow. But then I became lethargic and developed an I don't care attitude about life. I suspect that if I had continued, depression would have really set in and I might have offed myself.

Medications are worthwhile for a slew of physical maladies, but I'm not so sure they are always good for mental or emotional problems. I derived more benefit and incurred a lot less risk from counseling.

4 posted on 02/13/2013 11:27:50 AM PST by fatnotlazy
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To: al baby

“For one thing they are prescribed to people that are down and depressed to begin with”

Yeah, it’s a kind of crap-shoot. Seems like Docs try various things and see how it goes. Like switching foods for a pet that is a finicky eater.


5 posted on 02/13/2013 11:29:02 AM PST by USMCPOP (Father of LCpl. Karl Linn, KIA 1/26/2005 Al Haqlaniyah, Iraq)
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To: al baby

I was at a suicide where the guy had done himself in with Budweiser and Elavil (amitriptyline).

The ME picked up the empty bottle, looked at me and said, “This sh*t’s killed more people than ever made ‘em happy.”


6 posted on 02/13/2013 11:33:21 AM PST by Stormdog (A rifle transforms one from subject to Citizen)
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To: al baby

I theorize that they are prescribed and then the patient is not helped to work through their issues. The drug is supposed to take care of it. So they don’t have to confront their problems, work out coping skills, change any attitude, remove themselves from any situations.


7 posted on 02/13/2013 11:35:10 AM PST by Persevero (Homeschooling for Excellence since 1992)
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To: fatnotlazy

I took Zoloft same complaint also I know TMI I could not finish sexualely at all while on it no matter what we did


8 posted on 02/13/2013 11:35:41 AM PST by al baby (Hi Mom)
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To: Jyotishi

Most psychiatric drugs mimic the effects of marijuana on the brain. Don’t remember many pot smokers killing themsevles. They must have really screwed up. God put it there for a purpose.


9 posted on 02/13/2013 11:42:02 AM PST by TheRhinelander
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To: Jyotishi
I remember reading an article about a meeting of psychiatrists at the advent of these kind of antidepressants. The announcer waxed eloquent while describing how these drugs would revolutionize psychiatry. Also described was the fact that a lot of money would be made from them.

A lot of people who go into a doctor and complain of being depressed actually just need to talk it out. Sometimes they know why they are blue, sometimes they don't. But it seems as though if someone is lucid enough to have a conversation maybe they would benefit from talking it out.

Taking a drug is much easier, but is it the most responsible thing in putting a salve over an unknown leg ulcer?

10 posted on 02/13/2013 11:44:17 AM PST by Slyfox (The key to Marxism is medicine - Vladimir Lenin)
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To: Jyotishi
I have seen Serotonin Syndrome happen to a person. It was like she had taken a very powerful halucigentic. I'm not a doctor but it was me and her not six doctors who caught it and properly diagnosed it.

There is a higher risk in some patients for this especially ones who suffer neurological disorders which can contribute to depression and anxiety to start with. I also find it insanity that government, media, and many doctors in ignorance fear safer medications like Valium, Xanax, Klopinin, Librium, etc mainly due to the fact they improperly prescribe dosage vs bloodstream life. I'm a 18 year daily user of Xanax and my wife a 28 year user. It can be done. Neither one of us can take any form of any antidepressant in any strength.

Here is a side affect you likely never heard of and Paxil is the worse for it. In males it can block your bladder. No joke not making it up been there, done that, & had a catheter nearly two weeks till the stuff left my bloodstream. This causes a condition where you don't have too much time to act called Dysreflexia. Basically it's shock and can lead to stroke and death.

11 posted on 02/13/2013 11:46:41 AM PST by cva66snipe (Two Choices left for U.S. One Nation Under GOD or One Nation Under Judgment? Which one say ye?)
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To: cva66snipe

Xanax is a god send for my panic attacks when i can get it prescribed


12 posted on 02/13/2013 11:55:47 AM PST by al baby (Hi Mom)
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To: DBrow; Jyotishi

As I understand it, one of the quickest ways to get SSI disability is to tell them you are crazy. So people go get on psych meds to have that paper trail.

I would bet a large number of “normal” people find that taking the stuff, especially if the dosage is large, really does make them crazy.


13 posted on 02/13/2013 11:57:18 AM PST by bigheadfred
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To: windcliff

ping


14 posted on 02/13/2013 12:00:47 PM PST by onedoug
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To: Persevero
I theorize that they are prescribed and then the patient is not helped to work through their issues. The drug is supposed to take care of it. So they don’t have to confront their problems, work out coping skills, change any attitude, remove themselves from any situations.

They are also used too often in cases where the primary care doctor did not do an extensive medical history work up and check for underlying physical ailments of which anxiety and depression are secondary symptoms. Vestibular Disorders and sensory processing related disorders are one of the biggest in that respect.

I'm diagnosed as having General Anxiety Disorder. That diagnosesd came 18 years ago. The protocol treatment is usually antidepressants. But it took several years before I linked my G.A.D. to my life long Inner Ear and sensory related ailments. Antidepressants almost drove me off the deep end and did do so to my wife who is a quadriplegic.

We can take Xanax correction we must take Xanax I use it to help tone down my sensory system to control seizure activity from sensory induced stimulation. Doctors wanted to hand me antidepressants like candy but panicked over a .5mg {half a mg} pill of Xanax four times a day.

In many cases seeing what is called a Therapist helps. They are much more smarter than a typical Shrink. The Shrink says here take these and see you in three months.

I've had PTSD as has my wife I saw one nearly 5 years. It was a learning experience for me and him. I taught him about Vestibular Disorder induced Panic Disorder and he helped me with the PTSD. Both had hit me at the same time. The PTSD went away. The other I'll have for life. No cures as it is neurological damage.

15 posted on 02/13/2013 12:04:55 PM PST by cva66snipe (Two Choices left for U.S. One Nation Under GOD or One Nation Under Judgment? Which one say ye?)
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To: fatnotlazy

I was put on it for a short time in the mid-90s. I developed the same symptoms and went off of it after discussing it with my doctor. I have a history of depression in the family. My maternal grandmother was bi-polar and my mom’s brother was diagnosed with depression several years ago. I have not medicated since, but thankfully I am able to keep things under control with prayer and a good husband who keeps an eye on me.


16 posted on 02/13/2013 12:06:41 PM PST by Hoosier Catholic Momma (How long till my Arkansas drawl fades into the twang of southeast Ohio?)
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To: al baby
Xanax is a god send for my panic attacks when i can get it prescribed

Does certain sounds and visual events trigger it but it really doesn't seem to be a fear as such but rather just iriates you? You want away from the noise? Loss of concentration is also common. I have upper torso spasms{seizures} from this. Certain sounds for example drive me nuts and trigger seizures if i don't get away from them. If so you are likely a Vestibular Patient and the Inner Ear is triggering the attacks. It does take a different medication approach than antidepressants and most doctors and especially Shrinks are clueless too it.

17 posted on 02/13/2013 12:12:44 PM PST by cva66snipe (Two Choices left for U.S. One Nation Under GOD or One Nation Under Judgment? Which one say ye?)
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To: al baby
Xanax in small doses works wonders. I take it occasionally for insomnia. It gets lumped in with antidepressants and SSRIs but it does not deserve the bad rep.

I can tell horror stories abot Ambien and hypnotics, though. Ugh.

18 posted on 02/13/2013 12:25:24 PM PST by jboot (This isn't your father's America. Stay safe and keep your powder dry.)
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To: jboot
The secret to safe ongoing use of Xanax is in the dosage. It needs to be real low but for long term use low and consistent in the bloodstream. My doctor started me out on 2 MG twice a day. Half the time it worked then I was waiting out the other six hours it didn't. After a couple of years I found a doctor who knew what he was doing. He said no more antidepressants it doesn't work on what you have. He changed my dosage to .5 mg four times a day.

It doesn't always do the trick but allows me to function now at least at home. For example I'm fixing to go to The Cracker Barrel for supper. Between taking an extra pill before leaving and turning my hearing aids way down I can stand being there LOL.

19 posted on 02/13/2013 12:59:07 PM PST by cva66snipe (Two Choices left for U.S. One Nation Under GOD or One Nation Under Judgment? Which one say ye?)
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To: Jyotishi
Prozac had a paradoxical effect upon me. It was like taking ten Viagras at once. Once I quit taking it, I went back to normal (?).
20 posted on 02/13/2013 2:27:30 PM PST by vetvetdoug
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