Suicide prevention in England

About a dozen responses.

Every one of the respondents make points which the “ministers” ought to take to heart. And DO something about. I fear that appointing A MINISTER for suicide prevention is a waste of money.

Causes are multiple. Means employed are multiple - and range from slow self-neglect to forced medication, to weapons.

Can the Royal College of Psychiatrists and the British Psychological Society possibly give clear, brief, advice to Her Majesty’s Govt, about the actions the government must take?

With reference to Dr Stavros Saripanidis’s response, Dr Noel Thomas has pointed out the obstructions to religious / spiritual guidance or even discussions, because of the General Medical Council’s edicts. However, there is a way out - howsoever narrow and tortuous.

There are at least three very rich religious denominations in the UK (Islam, Judaism, Christianity).

They could set up outpatient treatment and counselling services for members of the public able and willing to seek their help, using any or all tools at hand. These would include discussion with, guidance from, their qualified priests. The NHS could subsidise.

Perhaps there is a flaw in my thinking?

I would be grateful if it could be flagged up.

1997 was the year I became acquainted with akathisia except I didn’t know it at the time. Akathisia wasn’t part of my vocabulary.

I was admitted to my local psychiatric hospital having abruptly come off Paroxetine. I had little understanding of antidepressant withdrawal and according to my medical notes the psychiatrist in charge of my care though aware of Paroxetine dependency treated what he saw as “intolerable anxiety symptoms”. I was commenced on Venlafaxine along with Thioridazine substituted for Droperidol after I developed postural hypotension. The Droperidol was gradually increased to 20 mgs four times a day. I was put on Thioridazine and Droperidol without benefit of knowing what they were. My psychiatrist expressed amazement that I still had anxiety symptoms. One of the most vivid and abiding memories I have of that time is of pacing the ward corridors praying I’d survive. My notes record I was prescribed Procyclidine for extra pyramidal symptoms, again something that wasn’t explained to me at the time.

In early 2011, within a week of completing a taper from Venlafaxine which I’d begun in late 2010, I felt that terrible symptom return. Many pharmacological interventions were tried and failed. Post-acute withdrawal syndrome persisted until in the summer of 2012 I attempted suicide by taking an overdose of Lorazepam, Diazepam, and Imipramine. A short trial of Moclobemide proved equally fruitless and I was left to taper off Diazepam and Zolpidem. I subsequently suffered severe suicidal ideation and enduring akathisia. These were years when I seriously doubted I would survive. Only my family kept me alive.

I’ve provided this snapshot of what I experienced to illustrate that suicide is an ever present danger because of adverse drug side-effects and when commencing/coming off or adjusting the dose of psychiatric drugs. Antidepressant withdrawal has been known about for decades but it was only at the end of May this year that the Royal College of Psychiatrists finally acknowledged what many patients have been at pains to tell them for some time, that withdrawal symptoms can be severe and long-lasting (1). This historical lack of recognition for severe and protracted withdrawal has led countless GPs and psychiatrists, including my own, to believe in relapse thereby compounding iatrogenic harm, increasing the likelihood of permanent neurological injury and ultimately increasing the risk of suicide. Drug companies I’m appalled to discover, knew that the newer SSRI antidepressants could cause akathisia in some patients as early as 1978 (2). I’ve also seen some of the evidence amassed by Professor David Healy where I note that healthy volunteers in clinical trials have become suicidal on SSRIs which challenges the idea that the problem lies with the patient and not the drugs. I constantly meet people like me on social media and in support forums, sadly, quite a few of them are no longer with us. I want to take this opportunity to warn doctors and psychiatrists that inevitably more will suffer and die if they aren’t willing to have honest conversations about withdrawal, akathisia, neurological injury, and suicide. (3)

1) https://www.socialaudit.org.uk/4200DTAY.htm

2) https://www.theguardian.com/theguardian/1999/oct/30/weekend7.weekend1

3) Huff C. Don’t miss this adverse drug reaction when tapering benzodiazepines. Kevin MD.com 2018 Nov 27

As a psychiatrist working in NHS Scotland I was interested to read this Editorial about suicide prevention in England (1).

In June of this year BBC Scotland reported on official NHS Information Services Division (ISD) figures that confirmed the number of suicides in Scotland had increased by 15% in the previous year. The National mental health charity SAMH was quoted as describing the figures as "devastating" (2).

I am one of the nearly 1 in 5 Scots prescribed an antidepressant. I wonder how many of the 1 in 5 have, like me, been taking antidepressants long term? The dearth of evidence for long term treatment would indicate that such prescribing (greater than 18-24 months) lacks a robust evidence-base.

If the drugs were helpful here, we surely should have seen a dramatic drop in suicides since the 1990s launch of the industry-sponsored 'Defeat Depression Campaign' and the huge rise in antidepressant prescriptions it brought about.

I recently shared my experience of a selective serotonin re-uptake inhibitor in a national newspaper (3) . I have since been overwhelmed by responses with most of those writing to me sharing similar experiences of antidepressants. I concluded my account in the newspaper with this statement: "From my experience, I believe antidepressants can increase the risk of suicide by causing major changes in impulsive behaviour when people are started on them or try to stop them. Yet the medical and scientific professions persist in ignoring this — through what I can only call wilful blindness. "

The seven responses so far to this Editorial would indicate that there has been considerable difficulties in sharing the experience of prescribed drug impulsivity, akathisia and suicidality (4). A clear pattern seems to have shown itself: that the Royal Colleges, National Suicide leads, Suicide charities, opinion leaders, Governments and their officials may not be approaching this potential contributor to suicide by respecting the much quoted dictum that "everyone matters".

References:

(1 ) Suicide Prevention in England, 13 August 2019; BMJ 2019;366:l5102

(2) "'Devastating' increase in Scotland's suicide rate'"BBC Scotland, 24 June 2019; https://www.bbc.co.uk/news/uk-scotland-48770610

(3) I hope others can be spared the hell I went through with depression pills, by an NHS psychiatrist who says coming off them left him suicidal. 1 July 2019; Dr Peter J Gordon; https://www.dailymail.co.uk/health/article-7202413/I-hope-spared-hell-we...

(4) Rapid responses to Suicide Prevention in England, 13 August 2019; BMJ 2019;366:l5102; https://www.bmj.com/content/366/bmj.l5102/rapid-responses

Scotland as an example; why Governments are getting it so wrong.
Paradoxically speaking……. more drugs, more suicide.

A paradoxical reaction or paradoxical effect is an effect of medical treatment, usually a drug, opposite to the effect which would normally be expected. An example of a paradoxical reaction is suicidal ideation caused by antidepressants. It is now widely acknowledged, prescription drugs can put us at risk of dangerous adverse effects, most notably, antidepressants and some other medication can raise the risk of suicide.

At events run by Samaritans Scotland, NHS Scotland and the Health and Social Care Alliance Scotland, people directly affected by or who engage with those affected by suicide were asked to ‘share their views on suicide prevention’. The events aimed to influence the development of the Scottish Government’s next Suicide Prevention Action Plan, published in Spring 2018. The findings of the consultations were presented to Scotland's Mental Health Minister, Maureen Watt.

I personally attended the consultation in Inverness on January 18th, 2018. I respectfully made the point that any Suicide Prevention Strategy discussions must include discussions about the adverse effects of antidepressants and other other prescription medication. The Suicide Prevention Strategy 2013-2016 included the statistics that 59% of the 5,119 people who died by suicide between 2009 and 2015 in Scotland had at least one mental health drug prescription dispensed within 12 months of death. 82% were prescribed an antidepressant alone or in combination with another drug. Why were alarm bells not ringing?

I was disheartened but not surprised to find, as with the Mental Health Strategy 2017-2027, the Suicide Prevention Report failed to mention our ever increasing dependence on the medication 59% of people who died had been prescribed.

SSRI antidepressants have different names throughout the world but the mechanism of action is the same. They are generally prescribed on the basis they cure a ‘chemical imbalance’. No chemical imbalances have ever been proven to exist. No tests exist to support this theory, and it is a societal belief based on pharmaceutical marketing.

Animal studies demonstrate when initially given Fluoxetine (Prozac), an SSRI Antidepressant , the brain shuts down its own production of serotonin, causing a paradoxical effect or opposite effect on the level of serotonin. The brain’s chemistry wants to remain balanced and any disruption from SSRIs or other medications throws the brain off balance. For this reason the Food and Drug Administration requires “Black box warnings” on all SSRIs, stating very clearly that they double suicide rates from two per 1,000 to four per 1,000 in children and adolescents.

“Instead of correcting biochemical imbalances, the drugs cause biochemical imbalances. Deterioration seen in many patients is not caused by an inherent disease process within the brain, rather a by toxic exposures to psychiatric medication. Every psychoactive medication disrupts the normal homeostatis of the brain, causing additional biochemical distortions within the brain as the organ attempts to overcome or compensate for the drug-induced disruption of normal function.” (Andrews, Kornstein, Halberstadt, Gardner, & Neale, 2011; Breggin, 1991,2008a; Breggin and Breggin, 2004; Science Daily, 2011a).

In short, the drugs ‘create’ a chemical imbalance rather than ‘cure’ one. It is at times of starting medication or increasing or decreasing doses the imbalance most often occurs.

Certain behaviors are known to be associated with these drugs, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania. Any of these adverse effects can cause both suicide and violence.

SSRI Stories (www.ssristories.org) is a collection of over 6,000 “stories” in which prescription drugs are mentioned and the drugs may be linked to a variety of adverse outcomes including suicide and violence. There are over 1300 harrowing deaths reported in detail in the suicide section, all of which were linked to Prescription medication, in particular SSRIs. There are many untold “stories”; for years families have claimed that antidepressant medication drove their loved ones to commit suicide, but have been continually dismissed by medical companies and doctors who claimed a link was unproven. There are also landmark settlements by pharmaceutical companies to families who were brave enough to pursue their claims.

Maureen Watt said “every suicide is a tragedy with a far-reaching impact on family, friends and the community long after a person has died.” The story of 16 year old Scot, Britney Mazzoncini is added to the ever growing list of suicides caused by prescription medication. She went to her GP with depression and was prescribed a month's supply of Propanolol, a Beta-blocker / anti-anxiety drug. She left the surgery with 84 x 40mg tablets and was advised to return in 28 days. 16 days later, she took an overdose and died at their family home in Glasgow. What we do know is Beta-blockers, particularly the more lipophilic, nonselective beta-blockers, like propranolol can cause major depressive episodes after initiation of therapy. Her mother had no knowledge her daughter was taking the medication. She lodged a petition at the Scottish Parliament asking for a rethink of the way GPs treat mental health conditions in young people. She wants GPs to be unable to prescribe anti-depressants to under-18s without the knowledge of a parent or guardian.

Don’t we owe it to Britney and her mother and all the others who have lost loved ones to include discussions about the adverse and often paradoxical effects of antidepressants and other prescription medication if we are to effectively influence the development of any Government’s Suicide Prevention Action Plan?