Antidepressants: a deadly treatment?

If pilots can't fly under the influence of cocaine, why are antidepressants OK?

The crash of Germanwings Flight 9525, allegedly the intentional act of co-pilot Andreas Lubitz, and the deaths of all 150 people on board is indeed a tragedy. But some good may come out of it if it induces people to take another look at those substances the pharmaceutical industry calls "antidepressants."

The link between antidepressants and violence, including suicide and homicide, is well established.

In 1961, Doctors Arnold Beisser and James Blanchard of the Metropolitan State Hospital in Norwalk, Ca., reported that patient suicides soared as soon as antidepressants were introduced into practice there — and that the increase was due solely to patients taking those drugs. Other clinicians reported similar trends. After Prozac, the first of a new generation of antidepressants, was approved for use in this country, the FDA was flooded with tales of suicidal and homicidal behavior in patients who had no previous history of violence. And in 2003, psychiatrist David Healy and statistician Chris Whitaker published a meta-analysis of industry-sponsored randomized clinical trials of eight antidepressants and found that these drugs were correlated with a doubling of the rate of suicide attempts and an astonishing four-fold increase in the number of actual suicides.

The evidence linking antidepressants and violence continues to mount. A 2010 study published in PloS One analyzed adverse drug event reports submitted to the FDA for a five-year period. Only drugs for which at least 200 adverse events were reported were included in the analysis — a total of 484 drugs in all, 11 of which were antidepressants. For each drug, the authors tabulated the incidence of violence case reports, which they defined as physical abuse, physical assault, homicidal ideation and homicide. For the majority of these 484 drugs, there were no violence case reports. For most of the rest, there were only one or two such reports. The 11 antidepressants stood out from the pack with a whopping 578 violence case reports, or 30 percent of the total. The proportion of violence cases reported for these drugs was eight times the average of all other drugs. Only the stop-smoking drug Chantix had a stronger violence signal.

Still not convinced? Go look up the toxic effects of cocaine and methamphetamine, and then look at the prescribing information for Prozac. Reported toxic effects for all three drugs include anxiety, agitation, paranoia, hallucinations — and violence.

When German authorities reported finding antidepressants in Andreas Lubitz's home, the psychopharmaceutical industry went into full spin mode, with experts pontificating about the need to avoid "stigmatizing" the depressed.

The New York Times quoted Ron Honberg, director of policy and legal affairs at the National Alliance on Mental Illness (an organization which receives massive funding from the drug companies): "These kinds of stories reinforce the anxiety, the doubts, the concerns that people have that 'I have to keep my symptoms concealed at all costs,' and that doesn't benefit anyone." Another Times article written by Richard Friedman, director of the Psychopharmacology Clinic at Weill Cornell Medical College, proclaimed "Horrifying outliers, like this case, create the false impression that psychiatric patients are dangerous when we know the overwhelming amount of violence is perpetrated by normal people in the grip of normal human emotion."

But these experts are kicking over a straw man. We don't allow pilots to fly airplanes under the influence of cocaine or methamphetamine. Why do we allow them to do so under the influence of drugs with a known link to violent behavior going back more than 50 years?

Moreover, it's an open question as to whether the psychopharmaceutical industry is actually helping those folks who identify themselves as depressed. In his 2010 blockbuster work of nonfiction, "Anatomy of an Epidemic, author Robert Whitaker demonstrates, by means of official facts and figures easily available on the Internet, that the proportion of Americans disabled by depression has skyrocketed since the modern-day psychotropic drugs were introduced. That makes no sense at all if you believe these drugs are curing mental illness. It makes perfect sense if you accept that these drugs cause mental illness.

Mr. Whitaker's tome was the subject of a laudatory review in the New York Review of Books by Marcia Angell, senior lecturer in the Harvard Medical School, former editor-in-chief of the New England Journal of Medicine and author of "The Truth About the Drug Companies." The NYRB also published a reply by no less a luminary than Dr. Friedman himself. And how did Dr. Friedman deal with the central thesis of Mr. Whitaker's explosive, potentially fatal critique of biological psychiatry? He didn't. He didn't cite any studies that show that these drugs produce any long-term benefits that outweigh the well-documented harms. He didn't even assert that such studies exist; he merely proclaimed that psychiatric medicines are "safe and effective" and "life-saving."

That's cold comfort for the surviving family members of those killed in the crash of Germanwings Flight 9525.

Patrick D. Hahn is an affiliate professor of Biology at Loyola University Maryland and a graduate student in Science Writing at Johns Hopkins University. His email is patrickhahn@hotmail.com.

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