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SSRI-Induced Akathisia's Link To Suicide and Violence

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Washington, DCMedical 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.

Akathisia suicidal victimIn 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."

Additional evidence showing Lilly knew about the akathisia-induced suicide surfaced in an application for a patent for a second-generation Prozac pill which claimed that the new-and-improved Prozac would decrease the side effects of, "inner restlessness (akathisia), suicidal thoughts and self-mutilation."

Besides the concealment of this adverse effect by the drug companies, another major problem in getting the word out, according to Vince Boehm, who tracks all studies and research published on SSRI's, is that the FDA refuses to fully acknowledge the role of drug-induced akathisia in what he refers to as "this hideous equation."

"Akathisia is up to 6 times more likely to trigger a suicide," he states, "than any form of depression caused by life's circumstances alone."

"The minds inner turmoil is so intense that a person will do anything to escape it," he says.

"The Brits, the Aussies, Canada, and the European Union," he points out, "have all gone on record recognizing this phenomenon for all age groups."

Judging by internal FDA documents which have surfaced in litigation, Mr Boehm appears to be correct. For instance, in a September 11, 1990, memo, FDA scientist Dr David Graham found that Lilly's data on Prozac was insufficient to prove the drug was safe, stating: "Because of apparent large-scale underreporting, the firm's analysis cannot be considered as proving that fluoxetine and violent behavior are unrelated."

A more recent study in the September 2006 journal Public Library of Science (PLoS) has further verified the warnings made by many other experts, when it reported that, in addition to self-harm, SSRI's cause some patients to become violent and homicidal.

Dr David Healy, described as "one of the three most eminent academic clinical psychiatrists in the UK," professor David Menkes, from Cardiff University in Britain, and Andrew Herxheimer, from the Cochrane Centre, did the study to determine the risk of violent behavior in people taking SSRI's.

As part of their investigation, the researchers reviewed all available clinical data on SSRI's and summarized a series of "medico-legal" court cases involving patients who had became violent on SSRI's.

One case discussed dated back to 2001, when Dr Healy testified at a wrongful death trial in Wyoming, after a 60-year-old man on Paxil shot and killed his wife, daughter and infant granddaughter before turning the gun on himself in 1998.

At trial, the jury returned a verdict for the man's son-in-law after Dr Healy presented the jury with a summary of an unpublished company study that found incidents of serious aggression in 80 patients on Paxil, including 25 that involved homicide, and proved that the drug maker knew about the violence and suicide risks before the 1998 shootings.

Dr Healy points out a rechallenge study by Rothschild and Locke in McLean Hospital where the authors found Prozac-induced emergent suicidality associated with akathisia in several patients. In order to test whether suicidality was coincidental or associated with Prozac, they withdrew Prozac, then re-administered it, and in all three cases, the patients experienced the exact same effect. "All three patients developed severe akathisia during treatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts."

However, even more alarming, one set of patients who became suicidal on Prozac were described as follows: "[n]one had a history of significant suicidal behavior; all described their distress as an intense and novel somatic-emotional state; all reported an urge to pace that paralleled the intensity of the distress; all experienced suicidal thoughts at the peak of their restless agitation; and all experienced a remission of their agitation, restlessness, pacing urge, and suicidality after the fluoxetine was discontinued."


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Posted by

I started having akathisia when I was eighteen. My dad took me to a psychiatrist to complain that I am heterosexual and that I like this man who isn’t white. So I was forced to take trilofon. I paced a long time. The panic attacks lasted for over thirty years. Can I get a lawsuit over big pharma ink?

Posted by

"How exactly does a drug just "make" you suicidal!?"

Akathisia happens when there is a build up of drugs (prescription or otherwise) because either/or the enzyme system cytochrome P450 is blocked by common food stuffs/herbs or the genetic expression means the phenotype is the enzymes can not adequately break down the drugs and you become toxic. You can also go into akathisia when benzodiazapines are suddenly withdrawn or the dose is suddenly lowered, so no tapering at all. That said benzo's can attenuate the experience of akathisia to a near bearable level, but bring terrible experiences of addiction and memory loss all of there own. Akathisia is most correlated to antipsychotic and antidepressant drugs.

This is my analogy of Akathisia:

Imagine being in a living room at ground level and all of a sudden a gas canister with tear gas comes smashing through the window. Immediately your environment has been changed and you are in panic, choking and in a very agitated state to change this sudden situation and get the gas out or get yourself out of the situation, you have the option to run outside, maybe you open windows, turn on fans but are overwhelmed and have to run out. That is the movement disorder expression of akathisia, but your compelling need is to get outside of yourself, out of your own head. The difference is that you can not unless the drugs - that you don't even know are causing the situation - are tappered off and stopped, it's more like being in one of the trade towers on 9/11, the horror is so intense throwing yourself out the window is the best option. That is the suicide ideation and completed suicide. Homicide ideation and completed homicide is also reported but I did not have this.

This is what is going on AND when a solution/prevention is known. The parmacogenetics test Cytochrome P450 is available but it seems not in the UK. Most of the common food/herb interactions of cytochrome P450 are known, there is - to my mind - absolutely no reason why a doctor can not give a patient a list of these foods and herbs to avoid. And cytochrome P450 testing really needs to happen in UK and sooner rather than later.

Posted by

I've been on so many psych meds and I always wondered to myself when I read the side effects on the leaflet:
How exactly does a drug just "make" you suicidal!?
I assumed it was just when the drug made you even more depressed than before, I never experienced a worsening in suicidal ideation from any meds until I had a very bad reaction to one in particular, got akathisia, and instantly I understood.
Even a mentally healthy person might not survive Akathisia. I still have nightmares about it.

Posted by

Hello, 25 F England. Akathisia changed my life. Please read my account, thank you. My first and only real suicide attempt was because of Akathisia. It's so important to get across that Akathisia is almost impossible to describe or understand without having experienced it first hand. It made my lifetime of severe mental illness seem minor in comparison. Before experiencing Akathisia I literally could not have imagined a pain so intense. It was (by far) the worst thing I have EVER felt and it amazed me in the worst possible way. If you don't keep your body in constant motion 24/7 you feel like your muscles are burning, stiff and itching at the same time. The mental component is harder to explain, as if your actual MIND can't sit still either, unable to concentrate on anything for more than a few seconds but staying idle is absolutely not tolerable either. It also makes you feel desperate and distant from reality, I have never felt anything like it (and I have experienced SO many awful side effects from previous drugs but nothing close to this). Couldn't stay still or concentrate long enough to eat or sleep, all I did was cry, but "restlessness" is to "Akathisia" as "cold" is to "liquid nitrogen". I feel like it goes undiagnosed because of the sheer difficulty of describing it. All my doctors thought it was just either psychosomatic or a worsening of my usual symptoms and no one could give me any information about what was happening to me. I felt alone and terrified because for all I knew, it could be permanent. I KNEW this was not part of my mental illness, I could sort of, feel, that it was heavily neurological rather than psychological. Akathisia is even more common with antipsychotics. I had Akathisia for over 6 months due to one single depot injection of flupenthixol (depixol) (my 12th psychiatric medication). When it finally subsided my outlook on life had changed. I was able just to sit still and form full thoughts again. I have never been more grateful, but I also became phobic of medication and lost my faith in doctors, not in their integrity but in their knowledge of certain conditions. I believe that if doctors could experience Akathisia, it would change the way they prescribe. My doctors now think I am non compliant because I don't dare try any new medication. I realised that I had never been truly suicidal until Akathisia. I felt a blissful happiness when I decided to end my life instead of the usual fear and uncertainty. I was hospitalised where luckily one nurse understood what it was. I don't know how I pulled through, I'm not exaggerating, someone could kill my dog and I still wouldn't wish Akathisia upon them. I would go as far as to say that if Akathisia was used instead of prison, there would be no crime. If I could find a way I would devote my time to spreading awareness of Akathisia, no other ailment has ever felt so urgent and important to me. Every day I wake up grateful that I am no longer suffering although I sometimes don't feel 100% and the only other side effect from that particular drug was sexual dysfunction which is STILL with me 2 years on but I count myself lucky that it's not worse.

Posted by

One 10mg pill of Lexapro gave me permanent brain damage. Akathisia lasted for 2.5 years. It still comes back sometimes. That drug ruined my life. 4.5 years of college, a career, a house, a nice car, my savings, my girlfriend, my great credit score, no debt....and my good health all GONE.

Posted by

This drug caused my daughter to feel suicidal and changed her whole personality. The first drug Cipralex led to label after label and hospitalisation. I have seen adverse reactions to all the drugs and not one doctor could care less.

Posted by

Could you contact me by ph 601-665-5497 and writh me on to connect with other people who have the same experience with ssris and benzo address 786 Madison miss 39130

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