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Are the Scottish Government raising the risk of Suicide?

“The Scottish Government’s vision, which is shared by our partners in mental health and suicide prevention, is of a Scotland where suicide is preventable; where help and support is available to anyone contemplating suicide and to those who have lost a loved one to suicide. Suicide prevention is everyone’s business.”

Clare Haughey, Minister for Mental Health – “Scotland’s Suicide Prevention Action Plan”– “Every Life Matters”.

Suicide isn’t what it used to be…..not always. It is now a complex societal, medical and media worthy issue, tragic for the individual and those around them. It was once thought of a cowardly act, the choice of those who found it easier to ignore their survival instinct and eliminate their pain by ending their life. Suicide was a taboo subject and often simply viewed as an easy ‘way out’. Nowadays, we are told suicide is an issue we need to be aware of, talk about and ‘is everyone’s business’, but in attempts to ‘prevent’ suicide and support those ‘contemplating’ it, is the Scottish Government overlooking an opportunity to reduce suicide caused by its very medicalisation?

As Scotland engages with their ‘National Suicide Action Plan’, they might do well to note that since the ‘The National Strategy for Suicide Prevention’ was launched in the United States in 2001, the suicide rate in the United States has steadily risen. Why?

I present evidence that the focus on antidepressants in mental health care raises the risk of suicide on a general population level because of under-recognised adverse effects of the drugs. I propose that addressing avoidable iatrogenic harm from the very drugs used in mental health care can reduce suicide in Scotland.

Governmental investigation into suicide prevention

The Scottish Government has set up and funded a National Suicide Prevention Leadership Group (NSPLG), reporting to Scottish Ministers. Its tasks include; public awareness, training, and support, identifying and facilitating preventative actions targeted at risk groups, developing appropriate reviews into all deaths by suicide and ensuring that the lessons from reviews are acted on.

The fact is that decades of research into suicide prevention has already been done and there are still no effective prevention strategies. Little scientific evidence exists that media campaigns and government strategies reduce suicide and mounting evidence they don’t.

Suicide is an extremely difficult area for researchers to study, however, one factor is blaringly clear; treatment for depression and anxiety is often a precursor to suicide. Suicide never used to be a ‘medical’ issue. Now, 90% of those who end their lives have a ‘mental disorder’. With the diagnosis of a mental disorder comes the very prescribing of drugs; drugs which alter brain chemistry. People who kill themselves have often been prescribed medication.[1]

It is becoming more apparent, the mainstream view that antidepressants and other drugs used in mental health work, and the processes used to establish the categories of mental disorders for which psychotropic drugs are prescribed are questionable. GPs are having to make subjective decisions about medicalising natural responses to the difficulties of everyday life. As Antidepressant prescribing continues to soar in Scotland we are unnecessarily exposing people to drugs which “can throw us temporarily into a foreign state of mind, into an altered version of who we are”.[2] [3]

“Planning” or “contemplating” suicide, as the Scottish Government refer to it, is far removed from the experiences of many who have become suicidal due to the effects of medication.

The Scottish Government say they will facilitate preventative actions targeted at risk groups and evidence shows the highest risk group are those who are medicated. If Governments and the mental health industry insist on relying on communications as a path to reduce suicide, then those communications would be much more effective targeted at those of highest risk of suicide and that includes the millions of people taking antidepressants!

In 2010, Ajit Shah and UK researchers reported on a study of suicide rates in 76 countries. They found suicides were higher in countries with mental health legislation. They reported there was a correlation between higher suicide rates and a higher number of psychiatric beds, psychiatrists and psychiatric nurses; more mental health training from primary care professionals and greater spending on mental health as a percentage of total spending on health in the country.[4]

Four studies around the world have found that increases in mental health legislation, training and services were associated with higher national suicide rates. This they say all points to ‘the medicalisation of suicide’. Awareness campaigns tell people to seek help, antidepressants are prescribed as they are often a GP’s only option.

For patient reports associating antidepressants with suicides, I ask the Scottish Government to visit www.antidepaware.co.uk where there are reports of more than 6750 self-inflicted deaths in England and Wales, all of which are related to use of antidepressants. The real fact is medical solutions – prescribing drugs – are easier than addressing complex socio –economic factors, but those medical solutions have unintended destructive effects of their own.

It all points to one thing; mental health awareness campaigns expose more people to adverse drug reactions. Mental health awareness campaigns are a double-edged sword. By creating awareness and encouraging people to seek mental health treatment we are often exposing them to treatment with antidepressants and other powerful psychiatric drugs – and their adverse effects as well as benefits.

It is now widely acknowledged that prescription drugs can put us at risk of dangerous adverse effects, most notably antidepressants and some other medication can raise the risk of suicide. The National Institute for Health and Care Excellence (NICE) recognises that antidepressants can induce suicidal ideation in patients of all ages. This is why it recommends that antidepressants should be only used for ‘moderate to severe depression’. [5] [6]

Are the Scottish Government aware that ever since they were linked to an increase in suicidal behaviours in young people more than a decade ago, all newer antidepressants, including Paroxetine (Seroxat), have carried a ‘black box’ warning label in the US? Reviewed and approved by the Food and Drug Administration, it states antidepressants increase the risk of suicidal thinking and behaviour in children, teens and young adults under age 25.

When it comes to prescribing antidepressants to children under 18, additional guidelines have been put in place, so that NICE effectively regards them as a “last resort” option. The Scottish Government say they will ensure that all of the actions of the Suicide Prevention Action Plan consider the needs of children and young people. I urge the Scottish Government to warn people and medical professionals antidepressants might cause suicide ideation.[7]

Antidepressant–induced suicidal ideation, an adverse reaction overlooked in medical error, is an avoidable factor in suicide.

Drug-induced Akathisia, a tortuous symptom

Akathisia, a drug-induced state of acute physical and psychological agitation, puts patients at risk of suicide. Rather than contemplating and planning, Akathisia presents people with a tortuous fight to stay alive. Akathisia is so uncomfortable and so distressing and is so under-recognised by the medical profession that people often turn to suicide as their only option. They literally think they are losing their minds.

Severe anxiety, restlessness, agitation, psychosis caused by medication means a fight for life with little control over one’s mind. Psychiatric drugs are not the only drugs that cause akathisia. People who take drugs such as anti-emetics (anti- nausea drugs), antibiotics, antipsychotics and opioids, may also experience akathisia and become suicidal – people who do not in any way have identifiable psychiatric disorders. [8]

Admittedly most doctors and healthcare workers do not understand Akathisia and symptoms of anxiety, agitation or suicidality are often diagnosed as a recurrence or worsening of illness, rather than to a drug-induced adverse event. Mentally and physically overwhelming, akathisia can make living intolerable to people who find no understanding from the medical profession.

Suicide-inducing akathisia, an adverse reaction to antidepressants and other psychiatric drugs overlooked in medical error, is an avoidable factor for suicide.[9]

Other adverse reactions from antidepressants

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.[10] The brain’s chemistry wants to remain balanced and any disruption from SSRIs or other medications throws the brain off balance. When withdrawing from, changing dose or starting antidepressants what often results from this disturbance is described as like a ‘rollercoaster effect’. A person’s mood goes from consistently depressed to temporarily content to all over the place very quickly. It’s for this reason the Food and Drug Administration requires ‘Black box warnings’ on all SSRIs. In short, the drugs ‘create’ a chemical imbalance rather than ‘cure’ one. It is at times of starting medication, increasing or lowering doses or switching antidepressants the imbalance most often occurs.

Lack of mental health understanding of and support for adverse reactions

Many have lost their fight to stay alive when their mind has been lost, gripped by suicide ideation, akathisia or other adverse effects of antidepressants and other psychiatric drugs. How many have called the Samaritans or NHS 24, to be misunderstood and asked “what is wrong with you?”. They are often people in the Scottish Government’s high risk groups; young and middle-aged men; people in the care of mental health services; people in criminal justice system; doctors, nurses, veterinary workers, farmers and agricultural workers; people with a history of self-harm but almost always they are people who are taking or withdrawing from psychotropic medication. They are ordinary people suffering from drug reactions, finding no help from their doctors or from help lines.

What the Scottish Government can do

It is vital the Scottish Government make it their responsibility to educate GPs, A and E staff, healthcare workers and charity telephone response workers to recognise and understand akathisia and other side effects of prescribed medication. No single theory can explain the complexities of suicide or suicidal behaviour, but recognising drug adverse effects that might cause people to be suicidal will at least remove that source of avoidable injury.

The cry “but those drugs save lives” does not exclude improving clinical care to reduce drug risks. The fact is, until Governments and the Medical Profession acknowledge the dangers of akathisia these drugs will take many more.

“It is about creating a culture that ensures that learning is taken from every death by suicide, in order to help prevent future suicides.” say the Scottish Government. I would like to assist with this and ask anyone in Scotland who believes they have suffered from Akathisia or who may have information about an antidepressant related suicide to contact me at bthorpe@medconsulting.co.uk. I will never disclose confidential information without permission.

[1] https://www.mentalhealth.org.uk/a-to-z/s/suicide

[2] http://cepuk.org/unrecognised-facts/altered-mental-states/

[3] Quoted in Davies J., Cracked:why psychiatry is doing more harm than good (London: 2012))

[4] https://www.ncbi.nlm.nih.gov/pubmed/19610491

[5] http://cepuk.org/unrecognised-facts/long-lasting-negative-effects/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463965/

[7] https://www.pharmaceutical-journal.com/news-and-analysis/news/antidepressants-associated-with-increased-risk-of-suicidal-thoughts-in-healthy-adults/20201834.

[8] https://akathisiainfo.wordpress.com/2012/03/10/akathisia-info/

[9] https://twitter.com/drdavidhealy/status/1009846500787150848

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759281/