1

Antidepressant Medication

Critical Appraisal

2

Preface

Antidepressants are prescribed on the evidence provided by pharmaceutical

companies; this is a dubious source for reliable information due to conflict of

interests.
Whilst some antidepressant physical

Adverse Drug Reactions (ADRs) are

recognised by UK

Health and Social Care Practitioners (HSCPs),

psychological ADRs remain unknown, primarily due to selective reporting by UK

reputable medical sources.
Consequently incomplete antidepressant information filters through mainstream

literature and ‘acceptable’ channels to HSCPs, patients and carers. This is

unacceptable, as these sources do not provide the full picture exposed by

antidepressant research.
This document provides a balanced and transparent report including depression

hypothesis, antidepressant science, similarities between antidepressants and street

drugs, psychological ADRs informed consent and the politics of medication within

UK

NICE, NHS and DH.

3

Contents Page 1

Antidepressant ‘Science’

Chemical Imbalance Theory of Depression

……………………………..………………….….…

6

Dangers re: Serotonin Selective Reuptake Inhibitor Antidepressants

….

8

Antidepressants and Placebo

……………………………………………………………………………..………

9

Street Drug Effects and SSRI Reactions

……………………………..…………….……………...

10

Antidepressant ‘Safety’ Issues

……………………………………………………………...………….…….

11

Antidepressant Long Term Issues
Pharmaceutical Drug Trials

………………………………………………………………………….……….…

13

Long-Term Medication and the Brain

………………………………………………………..……....

14

4

Contents Page 2

Suppressed History of Antidepressants

………………………………………………………...…

15

History of Antidepressants

……………………………………………………………………………...………..

18

Children and Adolescents

…………………………………………………………………………………………

19

Consent to Treatment

…….…………………………………………………………………….……….……………..

21

Being Fully Informed

…………………………………………………………………………………………………..

22

Healthcare Professionals, Pharmacogenetics and Antidepressants

……..

24

Best Possible Healthcare

…………………………...……………………………………..………………………..

26

Patient Safety

……………………………………………………………………………………...…………………………..

27

Patient Properly Informed Consent

………………………………………………..………...……….…

28

5

Contents Page 3

Reasons for Not Being Fully Informed

……………………………………………………………..

29

British National Formulary (BNF)

……………………………………………...……………………….

31

Choice and Medication

…………………………………………………………….………………………………..

33

Doctors’ Training

……………………………………………………………………………………...…………………..

35

UK Government

…………………………………………………………………………………………………………….

37

Inappropriate Professional Behaviour

…………………………………………...…………………...

38

Local Policies

………………………………………………………………………………….………………………………

39

Collective Suppression of information

…………………………………………...………………….

40

Influence of the Pharmaceutical Industry

….…………………………………...…………………

42

Horizons beyond the UK DH and NHS

..…………………………………………………..………

47

References

………………………………………………………………………………………………………...………..………..

49

6

Antidepressant “Science”

Chemical Imbalance Theory of Depression

Even though neurotransmitter theories for depression have shifted over time,

pharmaceutical companies perpetually promote the chemical imbalance

theory for depression.

1

Although an enormous amount of money and time

has been spent in this quest,

2

each time a new hypothesis for imbalance

arose, it was later proven false.

3

There has been no convincing evidence that monoamine deficiency or pre-

existing imbalance of serotonin, dopamine or norepinephrine, have ever been

clearly or consistently confirmed as a source of depression.

2 - 5

The uncertainty of how antidepressants work is depicted in both Eli Lilly’s

Cymbalta website,

6

and The Royal College of Psychiatrists (RCP).

7

Since

there is no technique for measuring precise levels of neurotransmitters

within the brain, claims about chemical imbalances remain unfeasible.

1

7

Chemical Imbalance Theory of Depression

In the 1970 & 1980 the serotonin excess hypothesis was absolute

8 - 10

but “If it

is possible for excessive serotonin transmission to contribute to psychological

dysfunction then antidepressants - both serotonergic and noradrenergic - could

be quite harmful since they all appear to induce prolonged elevations in the

production of and release of serotonin.”

11

Despite there being no consistent body of evidence to demonstrate low

serotonin and noradrenaline neurotransmitter levels cause, rather than arise

from changes in mood thought and behaviour,

11

antidepressants are still

prescribed.
Serotonin Selective Reuptake Inhibitor (SSRI) and Norepinephrine

Selective Reuptake Inhibitor (SNRI) antidepressant disruption of serotonin

and noradrenaline neurotransmitters

12

could account for the harmful

psychological adverse effects, e.g. neuropsychiatric suicide,

13, 14

mania,

15, 16

hallucinations and psychosis.

16

8

Dangers Involving SSRI Antidepressants

In a lecture (Gothenburg, Sweden 2009), the 2000 Nobel prize laureate,

Arvid Carlsson, “promoted the use of ‘kinder’ medicines than the ones

resulting from his own findings, the SSRI medicines (i.e. Prozac, etc).”

“There are too many strong and harsh medicines… the ‘diagnostic

science’ used in the psychotropic medicine field is no more a ‘science’

than someone experimenting with spices in their own kitchen.”

“One tries this and that, and the diagnosis is very often arbitrary”.

17

9

Antidepressants and Placebo

Articles exposing drug companies’ undisclosed reports of clinical

trials

18, 19

show that antidepressants work no better than placebo

20 – 22

This pertinent information is not taken into account by NICE Clinical

Guidelines for Depression,

23

which is an acknowledged leading source

of authority for treatment of depression.

The suitability of antidepressant medication prescribing is questionable

when antidepressants, with all the “side effects” which many patients

find difficult to endure, are no better than a harmless placebo.

10

Street Drug Effects and SSRI Reactions

LSD, PCP and other psychedelic drugs are taken with the objective of inducing

hallucinatory ‘effects’. Street drugs are serotonin releasers,

24

and are therefore

serotonergic drugs, resulting in serotonin toxicity due to serotonin increase.

Since SSRIs are also serotonergic drugs causing serotonin increase,

25

there is

potential for SSRIs to induce hallucinatory effects.

12

Just as psychedelic hallucinatory ‘effects’ are unpredictable,

26

the current

unpredictability of SSRIs in provoking hallucinatory ‘effects’ is left to chance

due to lack of genetic metabolism testing, to ascertain SSRIs can be metabolised

efficiently prior to prescribing.
Both SSRI drugs and LSD use can cause serotonin syndrome, resulting from

serotonin toxicity.

27

Because of the similarities between SSRI and LSD ‘effects’ caused by serotonin

toxicities; ‘effects’ are more appropriately redefined as

ADR (Adverse Drug

Reactions).

11

Antidepressant ‘Safety’ Issues

Pharmaceutical Industry funded publications are more likely to show

favourable outcomes. The incomplete data and lack of information on

the quality of industry drug trial design have thwarted researchers in

being able to determine whether medications are effective or safe.

28, 29

Data outside main-stream literature depicts serious antidepressant

psychological ADRs,

30

including neuropsychiatric mania and psychosis,

altered personality, violence, aggression and suicidality.

11

Other

neuropsychiatric ADRs include suicide, completed suicide

31

and self-

harming behaviour.

32

Long lasting depression may result from antidepressant use due to

chemical disruption.

11

12

Antidepressant ‘Safety’ Issues

The mischaracterisation of antidepressant safety is encapsulated by

personal experience:

“…(people) assert there has never been anything like that in their minds

before and yet now they have suddenly become excessively concerned

with suicide and may even do it”

33

The risks of antidepressants for some people far outweigh any perceived

benefit.

Dr. David Healy, estimated that ''probably 50,000 people have committed

suicide on Prozac since its launch, over and above the number who would have

done so if left untreated.''

34

13

Antidepressant Long Term Issues

Pharmaceutical Drug Trials

Antidepressant drug trials are conducted for a relatively short time period,

usually 6-8 weeks

35

in comparison with the length of time a person

medicates with antidepressants. Pharmaceutical literature data depicts

short-term ADRs only and the industry fails to take into account the long-

term ADRs that occur due to brain changes - “plasticity” - in adapting to

repeated use of antidepressants.

17, 36

Once a drug is accepted and marketed there is no incentive for drug

companies to research into the long-term ADRs, therefore long-term

industry sponsored drug trials do not take place. Consequently in

mainstream literature the potential long-term ADRs from long-term

exposure to antidepressants are unknown to HSCPs and patients.

14

Long- term Medication and the Brain

The “plasticity” brain changes resulting from long-term antidepressant use can

be found in epidemiology studies

36

and include:

"…changes in receptor density, changes in receptor sensitivity, and changes in

the cellular processes which control neurochemical synthesis and release.”

36

“...chemical therapies alter gene expression and re-wire brain circuits in ways

that can result in delayed or persistent harm"

36

Scientific literature rarely discusses how psychiatric medication causes

Chronic Brain Impairment syndrome

37

resulting in long-term ADRs such as

chronic neuropsychiatric physical conditions such as Dementia, Strokes and

Parkinsons disease,

36, 38

which by nature of the conditions may incur

depression.
These long-term “side effects” indicate antidepressants taken long term are not

safe medications.

15

Suppressed History of Antidepressants

“The possibility that medications designed to alleviate depression and thoughts

of suicide might paradoxically induce them, has been known by the medical

profession, the pharmaceutical industry and Govt. (FDA) for more than 40

years”

11

Drug companies minimise the truth about psychological ADRs or keep them

hidden. GlaxoSmithKline practiced selective drug reporting as suicidal

thoughts and negative behaviour are hidden by the umbrella term ‘emotional

lability’ and mania being edited out.

39, 40

From the mid –1980s Elli Lilly tried to hide its own evidence of the link with

Prozac and suicide by misrepresenting the truth: “Internal documents show

that in 1990, Lilly scientists were pressured by corporate executives to alter

records on physician experiences with Prozac, changing mentions of suicide

attempt to "overdose" and suicidal thoughts to "depression."

34

16

Suppressed History of Antidepressants

In 2000, prior to Prozac patent expiry, Lilly internal documents showed

“ … previously nonsuicidal patients who took the drug had a fivefold

higher rate of suicides and suicide attempts than those on older

antidepressants, and a threefold higher rate than those taking placebos.

34

In 2001, as the patent on Prozac was about to expire, Eli Lilly, prepared

to launch a new and improved Prozac called R-fluoxetine, which would

not produce several exiting significant side effects such as ''inner

restlessness (akathisia), suicidal thoughts and self-mutilation''.

34

17

Suppressed History of Antidepressants

Despite Lilly’s dispute about Prozac significant side effects, some 200

lawsuits were made against Lilly over the past decade, most of which

were settled out of court with the terms kept confidential.

34

It is ironic that Lilly’s own studies say otherwise and to compound the

situation, Lilly has aggressively sought to discredit researchers who

published data linking Prozac to suicide, such as Dr. Joseph

Glenmullen, whose book ''Prozac Backlash''

3

has upset and angered

Lilly executives.

The new improved Prozac (R-Fluoxetine) was never developed by Lilly

whose Prozac drug monogram

16

reports suicidal thoughts hallucinations,

psychosis and mania which are all significant psychological ADRs.

18

History of Antidepressants

Following the 2002 BBC Panorama on “Secrets of Seroxat”

41 BBC

GlaxoSmithKline was asked to clarify the issue of the SSRI miscoded

suicides.

Subsequently in 2003, in response to the information received, stern

warnings were issued to clinicians in the UK.

42

“Seroxat must not be

used for treatment of children…shows increase in rate of self harm and

potentially suicidal behaviour…”

43

2003 Wyeth, who produce SNRI Venlafaxine, voluntarily stated that “In

paediatric clinical trials, there were increased reports of “hostility”

and…suicide related adverse events such as suicidal ideation and self-

harm” with Venlafaxine.

44

19

Children and Adolescents

2003 A Medicines and Healthcare products Regulatory Agency (MHRA)

press release contraindicated paroxetine (seroxat), venlafaxine, sertraline,

citalopram and escitalopram… in the under 18s because the risks of

treatment outweighed the benefits in this age group;

45

risks referring to

induced psychiatric disorders depicted in drug monographs such as suicidal

adverse events, delusions, hallucinations, hypomania and psychosis.
According to MHRA Prozac is suitable for children 8-18 years as it “appears

to have a positive balance of risks and benefits in the treatment of depressive

illness...”

45

despite MHRA reports of suicidal-related behaviour in this age

group.

46

The age range is confirmed in Lilly’s Prozac Patient Information

Leaflet (PIL), which states Prozac can “ be offered” to children 8 year and

above,

47

but is contraindicated in Lilly’s Prozac Drug monogram

16

which

states “ Prozac is not indicated for use for children under 18 year of age.”

20

Children and Adolescents

Despite the strong links between SSRIs and induced suicide,

35, 48- 50

which is more common compared with suicide in tricyclic

antidepressant treatment,

51

and the many anecdotal experiences of

suicide in adults taking antidepressants,

50, 52

the MHRA does not

recognise the risks of SSRI treatment outweigh the benefits in adults.

Whether under or over 18 years of age, if a person is unable to

genetically process/metabolise antidepressants efficiently, mania,

hallucinations, psychosis and suicidal susceptibility will continue.

Age does not change genetic metabolising status.

21

Consent to Treatment

All mental health and social care practitioners - doctors, psychologists, social

workers and nurses - need to be fully informed about antidepressant treatment

because they are the primary contact for health advice, information and

treatment for patients. Patients see HSCPs as authoritative and trustworthy.
Prescribers need to be fully informed about antidepressant ADRs before

prescribing, to ascertain the chosen antidepressant medication is safe for the

patient; they are responsible for writing prescriptions and accountable to

patients when treatment causes ‘medical accidents.’
Being fully aware of potential antidepressant negative psychological and

physical drug reactions,

30, 38

all HSCPs are in a position to be transparent with

patients.
When patients are fully informed they are in a position to weigh up the balance

of antidepressant ‘risks versus benefits’, thereby enabling a fully informed

choice in consent to treatment.

22

Being Fully Informed

The difficulty is all patients and health practitioners

are not

aware of all

the associated antidepressant adverse psychological ADRs, i.e.

psychosis, mania, hallucinations and suicide

13-16

long-term adverse

physical ADRs

36, 37

and vulnerability to recurrent depression.

11

Consequently this results in some health practitioners and patients

not

being fully informed.

Practitioners’ lack of awareness of adverse negative psychological

ADRs and additionally withdrawal effects is likely to cause confusion

over interpretation of patients’ presentation. Negative behavioural

conditions - ADRs during treatment could be regarded as psychosomatic

when they should be attributable to medication.

23

Being Fully Informed

Naivety about all the antidepressant adverse psychological ADRs is due

to selective drug company reporting and UK reputable bodies such as

Choice and Medication,

53

NICE Guidelines for Depression,

23

Rethink

54

and

Patient UK

,

55

being ‘economical’ with the truth.

It is understandable, but not excusable, adverse negative psychological

ADRs are attributed to the patient and not the medication.

24

Healthcare Professionals, Pharmacogenetics and

Antidepressants

Health providers’ main area for naivety about treatment lies with the

association of how ADRs are related to pharmacogenetics.
Pharmacogenetics is the science of how medications are metabolised or

broken down in the body. 75% of all psychotropic drugs are

metabolised through CYP450 2D6 enzyme pathway found mainly in the

liver.

56

Metabolism is determined genetically and variations in the individual

affect medication therapeutic response and ADRs.

57, 58

Most antidepressants are metabolised through CYP450 2D6 which is a

highly variable enzyme regarding different rates of metabolism.

25

Healthcare Professionals, Pharmacogenetics and

Antidepressants

Susceptibility to ADRs is due to genetic slower rates of metabolism,

which incurs a build up of antidepressant toxicities. Medication

toxicities appear as ADRs and include serotonin syndrome,

59, 60

mania

and psychosis

15

or suicide.

13, 14

Inefficient metabolising enzyme pathways could account for 60% of

depressed patients not responding completely to antidepressants with up

to 30% who do not respond at all.

61

It is generally unknown there is a significant rate of hospital admissions

due to antidepressant-associated adverse behavioural effects.

15

26

Best Possible Healthcare

Patients put their trust in their doctors and professional experts to

provide the best possible health care.

It is inconceivable to patients that prescribed medications may

worsen health, as they would in people who are genetically unable to

break down medications efficiently.

Treatment related deaths due to unintentional drug related poisoning,

when the cause of death remains unclear could be explained by

pharmacogenetics.

60

27

Patient Safety

When prescribers are fully informed about the association of ADRs with

antidepressants they will be in a better position to prevent ‘medical

accidents’.

Due to the severe nature of antidepressant ADRs that can occur with

these medications, a lot of suffering can be avoided by checking the

pharmacogenetic status of patients is compatible with the prescribed

antidepressant.

This ensures patient safety and potential misdiagnosis that could occur

due to antidepressant psychological ADRs - the neuro-psychiatric

reactions of suicidality, hallucinations, mania and psychosis mimicking

psychiatric symptoms - is avoided.

28

Patient Properly Informed Consent

Fully informed consent to medication for all patients is

currently not possible because doctors are not fully informed

and the relevant full information is extremely hard to come by.

29

Reasons for Not Being Fully Informed

There are many facets that contribute to the current mainstream limited

availability of antidepressant and pharmacogenetic information for

HCSPs and patients.

Drug companies provide the primary source of antidepressant

information. Before marketing in the EU, medicines have to be licensed

by the European Medicines Agency (EMA).

Following the assessment within the MHRA by the Commission on

Human Medicines (CHM) that investigates ADRs and advises

accordingly on medicine safety, MHRA approves use of medicines in

the UK.

30

Reasons for Not Being Fully Informed

Both the EMA and the MHRA rely heavily upon pharmaceutical industry

funding receiving 75% and 100% of their funds from the industry. This

together with academic institutions also accepting industry-sponsored research

funding

62, 63

compromises relationships to the point of being incestuous. Such

situations are not in the interests of patients, since the industry has a conflict of

interests which can result in doctors and patients having little understanding of

pharmacogenetics; risking unnecessary antidepressant psychological ADRs.

Within the industry, pharmacogenetics has been known about for 60 years

64

and is used in drug trials to industries’ advantage. Yet drug companies do not

incorporate pharmacogenetic information into their Summaries of

Product

Characteristics (SmPCs)

65

and PILs

66

which are required for each licensed

medicine.

31

British National Formulary

The main source of medication information used by UK prescribers is the

British National Formulary (BNF),

67

The BNF in turn has as it’s basis the

SmPC provided by the pharmaceutical industry. As mentioned earlier drug

companies exclude pharmacogenetic information leaving prescribers in

ignorance about potential medication/gene interaction leading to serotonin

toxicities and ADRs.
There are noticeable inconsistencies associated with the information

contained within the BNF, SmPC and PILs. In Lilly’s Prozac PIL,

68

the

psychological ADRs, namely hallucinations, psychosis and mania are

reported. However in Lilly’s SMPC,

69

Lilly omits psychosis although does

report hallucinations, a symptom of psychosis.
The BNF remarkably fails to include Lilly’s psychosis ADR which is

reported in Lilly’s PIL.

68

32

British National Formulary

The BNF is compiled by two reputable medical bodies - The Royal

Pharmaceutical Society (RPS)

70

and the British Medical Association

(BMA).

71

The RPS aspirations include recognition of pharmacists being “experts in

medicine” and “advancement of science, practice and education in

pharmacy”, whilst the BMA claims to “work closely with the Government

and strive to make an impact on policy which affects you and your patients."

These aspirations appear to support their own professions in defending

doctors’ interests and the development of pharmacists to fulfil their

professional potential. However one cannot help noting HSCPs, carers and

patients would be better served if pharmacogenetics was brought to the fore

in the BNF.
The question needs to be begged –

How trustworthy is the BNF for the benefit of patients?

33

Choice and Medication

Choice & Medication, (C&M) provides “information about

medications used in the mental health setting to help people make

informed decisions...”, and purports to provide “quality assured content,

written by clinical experts based upon published data you can trust.”

53

When C&M do not acknowledge antidepressant-induced psychosis,

mania, suicide, or include pharmacogentic information, (despite having

been made aware of this issue), it is questionable how much trust can be

afforded to this organisation.

To make a “fully informed” choice through C&M is impossible because

of relevant medication omissions, which could negatively impact upon

patients.

34

Choice and Medication

C&M is a “spin off” from the CMHP

72

which has a corporate partnership with

Janssen, Lundbeck UK, Masters and Shire pharmaceutical industries. The

CMPH evolved from The United Kingdom Psychiatric Pharmacy Group

(UKPPG) that had members who declared receiving honoraria and fees, as

well as monies to attend international conferences.
AstraZeneca funded the Maudsley Hospital psychotropic medication help line,

which was actually the UKPPG helpline until 2007 when funding was

withdrawn.
C&M and CMHP are popular sources used by UK mental health professionals,

carers and patients and many would be unaware both these organisations have

shortcomings in providing full information about antidepressants. Readers may

be potentially misled into a false sense of security about the benefits as

opposed to the serious risks of antidepressants incurred by some patients.

35

Doctors’ Training

British Medical Schools do not address pharmacogenetics in

undergraduate training. Consequently, newly qualified doctors do not

realise patients can have genetic susceptibility to ADRs.
Considering thousands of prescriptions are written daily, this is a huge

gap in doctors’ primary training.
After graduation doctors are required to undergo further training - the

obligatory Foundation Programme

73

where doctors are required to

“understand” the ‘genetic susceptibility to adverse reactions’. This one

line is slotted in with many of the Safe prescribing competences; there is

no indication that conveys ADRs are

toxicities from medication due to

genetic susceptibility. The term pharmacogenetics is absent from the

entire curriculum, and therefore remains covert.

36

Doctors’ Training

The depth and transparency of specialist lecturers’ pharmacogenetic

knowledge can only be speculated, particularly when some members of

the General Medical Council are concerned about the amount of

pharmaceutical company sponsorship available for doctors’ training.

Corporate influence is not always in the best interest of patients.

74

37

UK Government

The Health Minister Andrew Lansley and Deputy Prime Minister Nick Clegg,

have received literature about pharmacogenetics, neuropsychiatric psychological

and long-term physical “side effects” and iatrogenic depression caused by

antidepressant drugs; depicted in “

Drug Induced DEMENTIA- a perfect

crime

”

36

a copy of which was given to Norman Lamb, Liberal Democrat

Shadow Health Secretary and The Royal College of Psychiatrists in 2010.
UK Government and Professionals:

Key Opinion Leaders (KOL) who lead DH polices have consistently down

played the importance of pharmacogenetics. This occurred in DH Mental Health

Policies i.e.

New Ways of Working for Mental Health Pharmacists,

75

Improving Access to Psychological Therapies (IAPT),

76

Medicines

Management: Everybody’s Business

77

and

NICE.

23

NICE and IAPT members received information about antidepressant long-term

physical ADRs and antidepressant iatrogenic depression.

38

Inappropriate Professional Behaviour

Attitudes and behaviour of some KOL leading DH policies, contribute

to maintaining naivety.
When presented with research from ‘Drug Induced Dementia’

36

responses included from ‘You can’t believe everything you read’ to

‘NICE cannot know every thing’. Yet NICE is self acclaimed for its

‘clinical excellence’. ‘Antidepressant ADRs are not incorporated in

IAPT and yet in the remit, treatment includes antidepressant medication.
Antidepressant “side effects” were dismissed by HSCPs as ‘No worse

than breathing in the atmosphere’s toxicities’ and ‘If patients knew

everything about “side effects” they would not take medication’.

39

Local Policies

KOL working in Care Trusts have influential power over local policy

decisions, e.g. the prolific posting of yellow leaflets proclaiming: ‘There

are no secrets about medicines’. Some acute wards provide general

patient medication leaflets, many of which are selective about ADRs as

professionally perceived ‘damaging’ details, which would likely deter

patients from taking medications, are omitted. Another unscrupulous

policy practice is for staff to address “side effects” which patients

experience, but only on patient request. When staff are duty bound to

support polices, for fear of reprisals lack of transparency clearly indicates:

‘There are secrets about medication’

Medications and secrecy have a history that is steeped in power firmly

in the hands of the professional leaving patients powerless.

78-80

40

Collective Suppression of Information

To date, Ministers, DH and KOL have merely shelved the information.

These bodies have taken a fully informed decision not to disclose the

importance of the relevant critical information about pharmacogenetics and

the ‘unknown’ short and long-term antidepressant neuropsychiatric effects.
Denial, defensiveness, arrogance, inflexibility and a ‘need-to-know’ stance

enable DH conflicted initiatives to grow into mental health policies that are

not upfront with fellow practitioners and patients.

81

Collective irresponsible attitudes and behaviour all contribute to maintain

doctors’ and patients’ ignorance about the true picture of antidepressants

and pharmacogenetics.
When the ultimate safety of patients is forsaken; ‘jobs worth’ within the

DH and the Government seems to become far more important.

41

Collectively, the public and health & social care

practitioners are being misguided into thinking

antidepressants are safe to use for all people with

depression.

42

Influence of the Pharmaceutical Industry

82

The Influence of the Pharmaceutical Industry

Fourth Report of Session 2004–05

House of commons

Health Committee

43

In 2005 this UK Govt. Green Paper stated …

“

Our consumption of drugs is vast and is increasing. About

650million prescriptions are written each year by GPs alone.

Medicines cost the NHS in England over £7 billion every

year, 80% of which is spent on branded (patented) products.

The industry which has produced these drugs has

understandably been described as “world class and a jewel in

the crown of the UK economy”. It is the third most profitable

economic activity after tourism and finance.”

Extract from the House of Commons Health Committee 2004-05

44

The report continues…

“The consequences of lax oversight is that the industry’s influence has

expanded and a number of practices have developed which act against the

public interest. The industry affects every level of healthcare provision, from

the drugs that are initially discovered and developed through clinical trials, to

the promotion of drugs to the prescriber and the patient groups, to the

prescription of medicines and the compilation of clinical guidelines.
We heard allegations that clinical trials were not adequately designed – that

they could be designed to show the new drug in the best light – and sometimes

fail to indicate the true effects of a medicine on health outcomes relevant to the

patient. We were informed of several high-profile cases of suppression of trial

results. We also heard of selective publication strategies and ghost-writing.

The suppression of negative clinical trial findings leads to a body of evidence

that does not reflect the true risk: benefit profile of the medicine in question.”

Extract from the House of Commons Health Committee 2004-05

45

Furthermore…

“

…Inappropriate prescription of medicines by GPs is of particular

concern. Some have prescribed SSRIs, for instance, on a grand scale.

This is in part due to inadequacies in the education of medical

practitioners which has meant that too few non-specialists are able

to make objective assessments of the merits of drugs and too many

seem not to recognise how little is known about the properties of a

drug at the time of licensing, particularly about its adverse

consequences…

… We recommend that more research be undertaken into the adverse

effects of drugs, both during drug development and medicines

licensing. The Government should, as a matter of urgency, fund

research into the costs of drug-induced illness.”

Extract from the House of Commons Health Committee 2004-05

46

As a result of this government

Green Paper

very little has changed.

47

Horizons beyond the UK DH and NHS

International Coalition for drug awareness

http://www.drugawareness.org/

The Center for the Study of Empathic Therapy, Education and Living.

http://www.empathictherapy.org/

Law Project for Psychiatric Rights:

http://psychrights.org/index.htm

MindFreedom International

http://mindfreedom.org/

48

Horizons beyond the UK DH and NHS

Working to Recovery

http://www.workingtorecovery.co.uk/

Asylum Associates

http://www.asylumonline.net/

Hearing Voices Network

http://www.hearing-voices.org/

Crazydiamond training and consultancy

www.crazydiamond.org.uk

49

References:

(1) Philip Owen, psychologist “Sad script for the stressed,” Daily Telegraph (Sydney, Australia)

Letters to the Editor, 2 Sept. 2003.

(2) Jonathan

Leo & Jeffrey R. Lacasse.

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Contributors:

Catherine Clarke SRN, SCM, MSSCH, MBChA

Jan Evans MCSP. Grad Dip Phys

January 2013