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Rapid Responses: Rapid Responses published:
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It's all numbers to me
- Sundeep Nayak (20 June 2001)
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SSRIs, court and appropriate research
- John Gall (22 June 2001)
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Is Healy's Work Scientific or Ethical?
- James C Coyne (6 July 2001)
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SSRI-Induced Suicidality is a Real Phenomenon
- Darian Balcom (24 September 2001)
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No Relationship Between Homicide-Suicides and Use of SSRIs
- Donna Cohen (30 September 2001)
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Sundeep Nayak, Staff Neuroradiologist VAMC Fresno
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"The jury awarded $6.4m (£4.6m) to the surviving family of Donald Schell, a 60 year old man who killed his wife, daughter, and granddaughter before killing himself. The jury found that the drug was 80% responsible for the four deaths." After picking self up from floor, continue utterly curious as to how the jury decided on 80% as opposed to 79% or 81%. |
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John Gall, Consultant Forensic Physician Melbourne, Australia
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The outcome of this case raises many concerns, not only for the drug companies but also for the treating doctors. Whether or not paroxetine actually contributed to an adverse outcome is not always adequately answered by the courts in an adversarial system - and from the limited information in the report by Deborah Josefson, may not have been answered in this case. What is required is evidence from appropriate and correctly conducted scientific research. Too often in court, one hears of either private research findings or the experience of 'experts' regarding certain issues that on further investigation, often outside court, reveal opinions based on flawed research and limited or biased experience. Suspicion always arises when 'small studies' are referred to, particularly if the results remain unpublished or are not published in refereed, reputable journals. I trust Dr Healy's research has been appropriately conducted and scrutinized. As a regularly prescriber of antidepressants, and particularly SSRIs, I find Dr Healy's results surprising. |
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James C Coyne, Professor, Department of Psychiatry University of Pennsylvania
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Healy’s "research" was published in Primary Care Psychiatry, which is difficult to find because it not indexed in Medline. The "study" involved his giving antidepressants to twenty persons who were not depressed and who worked at a hospital where he has an administrative role. For reasons of both ethics and potential bias, one typically does not conduct research on colleagues and particularly not subordinates Furthermore, If one is truly interested in distinguishing the effects of different medications on qualty of life, as he claims he was, it is imperative to have many more than twenty research participants . Dr. Healy claims he found that 2/20 of the persons taking an antidepressant became suicidal. The most recent statistics indicate that 11% of Ontario’s elderly received an antidepressant in a one year period. This is higher than the rate of depression and undoubtedly, many of these elderly are not depressed. If Dr. Healy is to be believed, they should be jumping out nursing home windows in droves. It is of course standard practice to provide a proportion of research participants a placebo without either the participants or the researchers to knowing who is getting a medication and who is getting the placebo. Dr. Healy did not include this safeguard. Healy had already made quite a reputation with his claims about the alleged dangers of antidepressants and quite a lot of money for appearances to make this point as an expert witness in lawsuits. Dr, Healy’s associates taking part in the study were undoubtedly aware of his expectations and it may have influenced their reports when they were debriefed by him. As a paid expert witness, Dr. Healy. had a financial interest in the outcome of this "study" and he had a responsibility to inform readers of his article of this. |
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Darian Balcom, N/A N/A
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Dr. James Coyne says that if Dr. Healy's estimates of the rate of suicidality among patients on SSRIs are accurate, the elderly in Ontario should be jumping out windows in droves. On National Public Radio here in the U.S., there was recently a report on the skyrocketing of the murder-suicide rate among the elderly in Florida in the past decade. They interviewed Dr. Donna Cohen at the University of South Florida, who studies murder-suicides in the elderly. Here is an excerpt from a newspaper article: "Florida is believed to be the nation's leader in murder-suicides, especially among older couples, with the numbers on the rise. So far this year, there have been 38 cases, on pace to exceed last year's total by 50 percent. The most common scenario: A depressed elderly man with a sick, suffering wife. "We're in the middle of an epidemic here," said Donna Cohen, a psychologist and professor at the University of South Florida's Department of Aging and Mental Health." AND http://www.fmhi.usf.edu/institute/news/1998/op-ed-cohen.html "Homicide-suicides among older couples are becoming a silent epidemic." |
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Donna Cohen, Professor University of South Florida
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We have conducted and published our research findings on the epidemiology and clinical patterns of homicide-suicide in older and younger populations for several years. There is an increase in homicide- suicide rates in older not younger persons in Florida, but there is no evidence that this is related to the use of SSRIs. Indeed, the prominent finding from our research is that older men,the majority of persons 55 years and older, who perpetrate these events, are depressed and are not being treated. None of the perpetrators in our research tested positive for SSRI's in postmortem toxicology results.Readers are cautioned to equate the increasing rates of homicide- suicide with the use of SSRI's. |
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