Dead if you do, dead if you don’t? Weighing the risks & benefits of medications
I recently watched the documentary Letters From Generation Rx on Amazon Prime, which looked at instances of people experiencing significant side effects while on psychiatric medication, including people who took the lives of either themselves or others while on psychiatric meds.
One man featured in the film was a Canadian Member of Parliament whose teenage daughter had died while taking medication. He expressed his belief that Big Pharma has made its way into “every institution in our society we rely of for critical thought”, echoing the sentiments of another interviewee who believed that coroners investigating drug-related deaths were “the first line of defense for the industry.”
One statistic mentioned by the Member of Parliament was that adverse reactions to pharmaceuticals are the fourth leading cause of death. I was skeptical of that, and turns out this was for good reason. The paper where that statistic originated did some fishy extrapolation to arrive at those numbers; additionally, it looked solely at people who died while in hospital and did not consider deaths occurring in the community.
Two men were interviewed who had killed their children while taking SSRIs. One of them had found out afterwards that because of a genetical polymorphism his body was unable to properly metabolize the Paxil that he had been taking. He was found not criminally responsible for the deaths because of his mental state at the time (this is the Canadian equivalent of the insanity defense). Both of the men interviewed, as well as their families, attributed the violent behaviour to the medication. The film also suggested that mass shootings are often related to psychiatric medication.
A mother and father spoke about their teenager son coming home with a sample pack of the antidepressant Cipralex after going to see his doctor because of a cold. Within a relatively short period of time, he ended up leaving the house while extremely restless, went to buy a rope, and then hanged himself. While of course this is deeply tragic, something is clearly missing here; even the most incompetent physician is not going to give someone an antidepressant to treat a runny nose.
Two parents talked about their daughter, who had been diagnosed with Tourette’s, being given the antipsychotic Haldol (haloperidol), and for them that just crossed the line. They expressed their vehement belief that no 9-year-old should ever be given Haldol. I think it’s problematic to let statements like this slide into a documentary when these parents are entirely unqualified to be making that broad judgment, regardless of whatever side effects their daughter may have had. Haldol is in fact approved for pediatric use for Tourette’s, and while regulators may have their shortcomings they are still in a better position to make these judgments than people with no medical training whatsoever.
Fear-mongering messages like those in this documentary may seem to be helpful in raising awareness about serious side effects, but my sense is they cause more problems than they solve. There is tremendous stigma around psychiatric medications, which makes it more challenging for people struggling with mental illness to make decisions around treatment. It’s more useful to present the risks in a broader context to empower people to make the best decisions for them.
With any sort of treatment, medication or otherwise, there should always be an individual weighing of risks vs benefits. What’s important to consider, especially for psychiatric conditions, is that the risk associated with not getting treatment can be very high, and suicide can become a very real possibility.
All medications carry some level of risk, and the level of risk that’s considered medically acceptable depends on the nature of the illness. With potentially deadly illnesses, the tolerable potential risk is going to be far higher than what would be considered acceptable for a minor ailment. With higher risk medications it is incumbent upon prescribers to make sure they are properly monitoring their patients, and for patients to be proactive in reaching out to the prescriber if things are going wrong.
In 2004, the U.S. Food and Drug Administration (FDA) required a “black box” label on all SSRIs warning that they could increase the risk of suicidal thoughts and behaviour in children and adolescents. This has not been demonstrated in studies of adults using SSRIs. It’s also important not to confuse this with the spike in suicide risk that occurs when someone has started to respond to treatment but their mood hasn’t caught up yet, which means they may have the energy to act on suicidal thoughts that were already present. Again, knowledge is key, and everyone involved needs to understand what to watch out for.
It’s also important to address the cozy relationship between national regulators and Big Pharma, which is described in Letters From Generation Rx. If regulators and Pharma are engaging in any sort of coverup around the frequency of side effects, that means that inaccurate information is getting to prescribers, which impacts that ability to accurately weigh risks and benefits with their patients.
What we need most is not fear. We need factual, unbiased information so that we can make the right decisions for ourselves, and the more openly we can all talk about it, the better. Personally, the risks associated with taking my medications for depression are far outweighed by the very really risk of suicide if I don’t take them. We’re all different, but that’s me.
Originally published at mentalhealthathome.org on January 31, 2019.