Washington, DC: Medical experts have long known that the side effect associated with the class of antidepressants known as the selective serotonin reuptake inhibitors most likely to drive people to suicide or violence against others is “akathisia”.
Akathisia is but one in a long list of side effects that SSRI makers were able to keep hidden, as they settled thousands of lawsuits out of court, by obtaining court orders to seal documents produced in litigation. For instance, a 1984 Eli Lilly document showed akathisia occurred in at least 1% of patients long before Prozac was approved.
In a paper entitled, “Suicides and Homicides in Patients Taking Paxil, Prozac, and Zoloft: Why They Keep Happening – And Why They Will Continue,” Dr Jay Cohen points out that, as soon SSRI’s arrived on the market in the late 1980s, reports of sudden, unexpected suicides and homicides by patients taking the drugs began to come in.
The DSM-IV acknowledges the association of akathisia with suicidality and states: “Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts.”
According to Dr Cohen, SSRI’s can create a combination of side effects that reduce impulse control and cause severe agitation or restlessness that may become intolerable. He says, impulsive behavior coupled with impaired cognitive functioning can be dangerous.
A 1998 article on akathisia associated with Prozac and its link to suicidal ideation in the Journal of Psychopharmacology, by Roger Lane, who was working for Pfizer at the time, states in part:
“It may be less of a question of patients experiencing fluoxetine-induced suicidal ideation than patients feeling that ‘death is a welcome result’ when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders.
“Hamilton and Opler (1992) stated that the term ‘suicidal ideation’ to describe the apparent suicidality associated with akathisia was misleading, as the ‘suicidal ideation’ reported in patients receiving fluoxetine was a reaction to the side-effect of akathisia (i.e., unbearable discomfort and restlessness) and not true suicidal ideation as is typically described by depressed patients experiencing suicidal ideation.”
Dr Joseph Glenmullen, author of “Prozac Backlash” and “The Antidepressant Solution,” obtained a Lilly document dated November 13, 1990, from Claude Bouchy, a Lilly employee in Germany, to three executives at Lilly’s Indianapolis headquarters, complaining about directions to change the identification of events as they are reported to doctors from “suicide attempt” to “overdose” and “suicidal ideation” to “depression”.
“I do not think I could explain to the BGA, to a judge, to a reporter or even to my family,” Mr Bouchy wrote, “why we would do this especially on the sensitive issue of suicide and suicide ideation.”
Dr Glenmullen says akathisia makes people profoundly agitated, uncomfortable in their own skin and impulsive. It erodes judgment and can lower their threshold to become violent toward themselves or others, he states.
Dr Martin Teicher, an associate professor at Harvard Medical School and McLean Hospital researcher at the time, co-authored a paper with psychiatrist and psychopharmacologist Jonathan Cole on the link between Prozac and suicide back in 1990, which found that 3.5% of patients on Prozac either attempted or committed suicide due to severe agitation from akathisia.
In the paper, the authors discussed 6 cases of patients who became intensely preoccupied with suicide after taking Prozac. Dr Cole said, in an affidavit submitted in litigation on April 20, 2000, “Our purpose in writing this article was to alert the profession to an alarming, probable drug side effect which we had observed.”
“There was a very clear association,” he said, “not merely temporal, between the ingestion of Prozac and the patients’ suicidality.”
“I have also seen patients and reviewed cases,” Dr Cole stated, “where an SSRI unmistakably precipitated a driven preoccupation with suicide.”
“The SSRI drugs, as a class,” he advised, “clearly have the potential to cause, and in reasonable medical probability or certainty do cause, akathisia in some patients.”
“Although in 1997,” Dr Cole notes, “practicing physicians undoubtedly varied in their level of sophistication and knowledge about the phenomenon, the potential to cause akathisia and its potential, in turn, to trigger suicidal behavior.”
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