-Caveat Lector-
>From http://www.observer.co.uk/magazine/story/0,11913,706297,00.html
>>>The question becomes: what is worse, the illness or the cure? <<<
}}}>Begin
The chemistry of happiness
Seroxat is set to overtake Prozac as the world's favourite antidepressant. With 100m
prescriptions in more than 100 countries, it is aggressively marketed as the
addiction-free answer to our anxieties. But thousands of patients are now saying their
dependence on the dream drug has all but destroyed their lives
Simon Garfield
Sunday April 28, 2002
The Observer
For some unfathomable reason, the key episodes often occur in supermarkets. Two
years ago, Jenny Stanaway returned home from her work as a cleaner and went for
her big weekly shop in Swindon. Not long in the busy aisles, she was struck by a
panic attack and an urgent desire to flee. She abandoned her shopping but the
attacks persisted. After three or four, she went to her doctor and was told that for a
woman of her age, in the midst of her menopause, such events were not unheard of.
She was prescribed a drug called Seroxat. 'That was the beginning of the end,' she
says. 'If I'd have known what it was, there is no way I would have taken it.'
Ian Allen was in a supermarket in Gloucester when he decided to buy 150 tablets of
paracetamol. The sales assistant told him, quite properly, that he was not allowed to
sell him anything like that amount. 'But I live miles away,' Allen explained.
'I can't come running here every few days.'
Eventually Allen, who is an eloquent 38-year-old wildlife photographer, persuaded the
assistant that he should sell him as much as he wanted.
'Don't tell anyone,' the employee said. 'And don't do anything stupid with them.'
'This was rather ironic,' Allen says now. 'Because that was exactly what I was about
to do.'
The brain remains the great unconquered organ of scientific and medical knowledge.
Ian Allen is fond of saying that if we knew as little about the workings of the heart
as
we do about the brain, then nobody would dare to perform open-heart surgery. When
the brain malfunctions we are often at a loss to detect why, and we are still groping
towards effective treatments. Paracetamol is a blunt tool most often used in the
masking of headaches, but Allen's intended use was for suicide. He believes that this
was a side effect of his doctor prescribing him a drug known as an SSRI - selective
serotonin re-uptake inhibitor - a family of medications once recognised only by the
tradename of Prozac, but now also marketed as Seroxat, Cipramil, Lustral, Efexor,
Dutonin and Faverin. They are most commonly prescribed as treatments for
depression, but each year new applications are being found for them. The molecular
shape of the drugs is designed to be highly specific, but they are often prescribed for
the most unspecific of symptoms: anxiety, insomnia, shyness, natural sadness
following bereavement. The drugs are now so widely used that it is difficult to find
any
community or large organisation without members who are taking them.
In 2000, just under 12m prescriptions of SSRIs were dispensed by the NHS in
England alone, almost 4m more than in 1997. An interesting pattern is emerging
regarding their use, quite aside from the question of why we appear to be getting
more depressed and anxious. The majority of those on the drugs believe their lives
have benefitted from their complex but still unrefined chemistry, but there is also a
growing band of desperately unhappy and angry people who claim the medications
have all but destroyed them. Inevitably, many solicitors are now involved, and there is
the possibility of class actions directed against the pharmaceutical companies who
have made the invention of drugs of the mind one of the top priorities of the new
century.
Ian Allen says he was given his SSRI for acute insomnia. 'I was a normal person who
very rarely visited my doctor. Within a day of taking the drug I was overcome with
what I can only describe as an intense disquiet - the most unpleasant thing that I
have ever experienced in my life. Many of my friends said they just didn't recognise
me.' He says he went back to his GP the next day and told him that the pills were
having devastating effects, and his doctor replied that it was unlikely to be the drug.
SSRIs are designed to enhance the brain's levels of serotonin, a substance involved
in the transmission of nerve impulses and widely thought to be a key element in the
maintenance of a balanced mood. They do not generally take effect for two or three
weeks, so Ian Allen carried on taking them. He lost almost three stone in three
weeks. After a while his employer sat him down and told him he did not consider him
well enough to continue working.
'A lot of time on the drugs you feel nothing, but then suddenly the most minor of
things can drive you to the most catastrophic actions. In three months I tried to kill
myself on six separate occasions, always with lethal intent. The paracetamol tablets.
I tried to gas myself in a car, I tried hemlock. Paracetamol is an extremely unpleasant
way to kill yourself. It doesn't kill you instantly, and I was found by someone. I
ended
up in hospital with liver and renal failure.' The strangest thing is, he says, when he
woke up in hospital he really couldn't understand why he'd done it.
Allen's recovery began a few weeks after he came off Prozac last August, and he
began a lengthy complaints procedure which has yet to yield him any satisfaction. He
claims the medical profession and the NHS have brushed him off, blaming his own
underlying psychological imbalance rather than the effects of a drug upon it. This is a
dilemma encountered by many of those who have bad experiences with SSRIs:
because it is so difficult to measure emotional and other mental states, it is almost
impossible to show that a worsening condition would not have occurred without
interference. The same, of course, applies to an improvement.
What is clear is that by their very nature, anti-depressants tend to be given to people
who are in a vulnerable situation. Jenny Stanaway remembers her doctor telling her
that she 'needed a little something' to help her through her menopause. She is 52,
and used to enjoy a reasonably active life.
She used to work as a cleaner for 20 hours a week, but has not done so since July
2000, which was when she stopped taking her daily morning dose of 20mg of
Seroxat.
Stanaway's problem on the drug - severe headaches - was nothing to the
predicament she faced when she came off it. 'After 11 months of it I was still getting
very bad headaches and I felt the drug wasn't right. My doctor agreed, and she said
to come off it by taking one every other day and then stop, which is what I did. After
four days I went into withdrawal. It started with leg spasms. I had nightmares. Muscle
weakness. My balance went.'
She saw the duty doctor, who told her to go back on Seroxat. She did this, but the
symptoms continued. After a further month, she says her regular doctor said she was
very sorry about the adverse reaction, and that the withdrawal now seemed
impossible to stop. She came off the drug completely. 'The past 20 months have
been unbearable,' she says. Her husband asks her to try to remember what she was
like before that episode in the supermarket. She has been on incapacity benefit since
January, but only wants to get back to work. 'No one knows how to do this. People
tell me I'll get my balance back eventually, but I'm yet to see it. I feel I need a
miracle.'
Towards the end of last year she saw a newspaper advertisement soliciting for
victims of medical negligence. The person she called referred her on to Mark Harvey
at the Cardiff firm of Hugh James Ford Simey, who was then unaware of the full
extent of the problems linked to Seroxat. But now he is, for he has since heard more
than 100 other stories.
Harvey has conducted many class action medical negligence cases during his
career, beginning with the claims against Eli Lilley, the makers of the occasionally
fatal anti-arthritic Opren in the early 80s. He is currently seeking compensation for
users of Lipobay/Baycol, the anti-cholesterol drug pulled off the market by Bayer after
adverse reactions with other drugs resulted in a number of deaths. The case of
Seroxat is not unexpected, he believes. 'The drugs are all trying to fill that huge gap
in the market - covering anything from mild to serious depression - and if you can
produce something that alleviates the problems and isn't addictive, then you have a
huge winner. People now go to their doctor and say, "But will I be addicted?"
because they've all heard the Valium stories.'
The data sheet that accompanies each packet of Seroxat has a bold claim: 'These
tablets are not addictive.' A little later in the patient instructions, after
information
about not taking it with the popular blood-thinning drug warfarin and other
medications, the reassuring message appears again: 'Remember that you cannot
become addicted to Seroxat.' Many patients now regard this claim as unacceptable.
Mark Harvey says he is still 'shaking the tree' to see how many people are suffering
from the sort of severe withdrawal symptoms afflicting Jenny Stanaway. People are
learning of his interest at the rate of about two a week. The most common story he
hears is that the drug initially worked, but then the difficulties really started. At
present he has 120 people on his books, and he has commenced applications for
legal aid.
The data sheet supplied to doctors by manufacturers GlaxoSmithKline (GSK) does
inform them that withdrawal should be gradual, but Harvey believes that the
language employed deliberately downplays the potential problems. 'However you
dress it up,' he says, 'they're trying to suggest that it's not a major issue. But
I've got
people who have been trying to get off it for four or five years and say, "My life is a
misery." I've heard this argument about [it not being addictive], but I think it's
mischievous. What they're saying is that the body doesn't become so absorbent to
the drug that you have to keep prescribing larger and larger amounts. That may well
be right. But I have to say that if you're a patient and you read your information
sheet
that says "These tablets are not addictive," then they understand that as meaning: "If
I want to come off this drug then I should be able to do so without any problems, like
coming off penicillin." But to say that there's a technical definition to "addiction"
is
wrong. It's bad enough doing it to a doctor, but you certainly shouldn't do it to a
member of the public.'
Harvey is not the sort of hot-headed litigator we may be familiar with from the
movies; he does not distrust Big Medicine per se. He acknowledges that a lot of
people benefit from Seroxat, and he has a moderate suggestion that falls well short
of any grandiose attempt to have the drug withdrawn. 'If [GSK] were sensible, they
would sit down and go, "We don't accept any legal liability but we recognise that we
could improve the information that we give to the patient and the doctor."'
People become aware of Harvey's involvement principally through the internet, which
has recently developed into a vast arena of anti-SSRI campaigning and sad stories
from depressives. Websites cater for all types of anxiety and melancholy, and they
provide a self-help community for those troubled by their treatments. On the popular
'HealingWell' site, which caters for all ailments, the diabetes message board had
recently attracted 406 postings, and the one for multiple sclerosis 261. By the same
day in mid-April, the message board for anxiety and panic disorders had received
8,208 and the depression board 9,392.
The postings have titles like 'In A Deep Hole and I'm Sinking Again'. Some consider
how to withdraw from SSRIs, but others have gone beyond that. One recent
message from Sally186 said: 'I've had a horrible weekend. Been more and more
anxious lately - pending divorce and my mother-in-law is dying and I love her and it's
too much like when my dad died two years ago. Started feeling horrible suicidal
urges late last week and only stayed out of the hospital when my therapist agreed to
call me twice a day to make sure I was OK. I don't want to hurt my children. God help
me. If I'm not in chat tonight you'll know where I am. Sally.'
There was an immediate response: 'Dear Sally, Your thinking is all negative. You've
been handed your fate - you can turn it into something good. It really doesn't have to
be as bad as you are making it.'
Depression is not a modern affliction; indeed, it was recognised as a treatable illness
by Hippocrates. But only recently have we begun to diagnose the scale of the
problem, and only in our lifetime has medical science been able to approximate its
biological causes. The World Health Organisation estimates that depression is soon
to become the second leading cause of disability - behind ischaemic heart disease
and ahead of road traffic accidents. Extensive surveys report that major depressive
illness occurs in 3-10 per cent of the adult population, with the prevalence in women
two to three times higher than in men. A report published in 1997 suggests that
major depression is prevalent in 2.3 per cent of the UK population, and mild
depression in 7.7 per cent. Thirty to 50 per cent of cases are believed to go
undetected.
By themselves, these figures mean little, particularly to those who are not
depressives themselves. In the past decade a few graphic memoirs have thrown light
on the true nature of severe illness, and the one thing they make plain from the start
is that they are not suffering with a bad, common case of the blues. The American
novelist William Styron ventured that 'depression' has been devalued, a word that
has 'slithered through the language like a slug, leaving little trace of its intrinsic
malevolence'. In his peerless book The Noonday Demon, Andrew Solomon gives an
unnerving description of being unable to raise himself from his bed to answer the
phone; even a journey to the bathroom becomes a multi-step struggle. On a broader
plain, 'the first thing that goes is happiness', Solomon explains. 'You cannot gain
pleasure from anything... Your mind is leached until you seem dim-witted even to
yourself. If you hair has always been thin, it seems thinner; if you have always had
bad skin it gets worse. You smell sour even to yourself. You lose the ability to trust
anyone, to be touched, to grieve. Eventually, you are simply absent from yourself.'
Even the best literary descriptions do not help the best scientific minds, nor can they
explain the ideal balance in treatment between the several types of psychotherapy
and the many types of chemical medications. As with all psychiatric disorders, each
case of depression must be judged by its own manifestations and causes. Should
we, therefore, be suspicious of the voracious marketing of drugs that claim to cure
depression, anxiety, panic and post-traumatic stress in one tiny pill? And what should
we make of the news that Seroxat has taken over from Prozac as the bestselling
anti-depressant on the market, or that the NHS is currently dispensing 60 per cent
more SSRI compounds in England than it was four years ago? Should we be
worried, or should we be grateful?
Guardian Unlimited © Guardian Newspapers Limited 2002
End<{{{
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