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Dr. Terry Lynch sends letter to Irish government regarding psychiatric drug prescribing

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This recent letter by Dr. Lynch was addressed to An Taoiseach, Leo Veradkar; Minister for Health, Simon Harris.

 

It is well worth reading in its entirety. It summarizes the problems of psychiatric drug prescribing, going back to validity of diagnosis and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It contains citations for its assertions.

 

pdf here https://convertkit.s3.amazonaws.com/assets/documents/1795/1368380/Letter_draft_Taoiseach_and_MInister_for_Health.pdf

 

One section:
 

Quote

 

(xi) The debacle of prescribed drug dependence

 

All of the issues raised in this letter are important and are likely to create considerable repercussions for those presiding over our mental health services. This is also true in relation to the thorny issue of prescribed drug dependence.

Psychiatry and general practice has a long track record of denying and minimising the issue of prescribed drug dependence. This attitude over a period of more than 70 years – and its legacy – has been well described. 18

 

In relation to benzodiazepines, the medical profession was extraordinarily reluctant to admit that these substances that they enthusiastically prescribed in copious amounts were drugs of dependence. This reluctance greatly added to the numbers of people who found themselves dependent upon these substances. Only when the evidence against this stubbornly-held position became incontrovertible did psychiatry and general practice reluctantly and belatedly admit to the dependence- creating nature of benzodiazepines.

 

This powerful medical resistance to and denial of benzodiazepine drug dependence resulted in thousands of people having difficulty coming off these substances having nowhere to go for understanding and support, a dreadful scenario that came to public notice through the work of UK broadcaster Esther Rantzen.

 

In 1980, Esther Rantzen’s ‘That’s Life’ programme touched on dependency problems with benzodiazepines. The public response to this program was overwhelming; Esther Rantzen subsequently stated that issues of withdrawing from Valium and other benzodiazepines provoked the biggest response in that programme’s 21-year history. 19 Esther Rantzen said:

 

‘We were absolutely astonished after we mentioned that problem in one programme that we were deluged with response from our audience, and we suddenly thought this is happening to thousands of people, and this was with harmless prescribed drugs, things that had become household names, Valium, Mogadon.’ 20

 

Note Esther Rantzen’s referral to Valium and Mogadon as ‘harmless prescribed drugs’ – which was what they were then – and SSRIs now are – asserted to be by their enthusiastic prescribers. Twenty-one years later, expressing her surprise regarding how little meaningful progress had been made on this issue, Esther Rantzen said, ‘How can a serious problem like this, which was revealed to millions of people and the professionals 20 years ago, how can it still be going on?’ The answer to this question, I believe, relates again to the medical – and perhaps operational – reluctance to admit to the scale and seriousness of the problem, because of possible repercussions for them – another example of prioritising self- and group-interest rather than the public interest.

 

Given this growing pressure in relation to benzodiazepines, the arrival of the substances popularly known as SSRI antidepressants in the late 1980s provided great distraction and relief for the medical profession, who then set up a ‘good drug/bad drug’ narrative. Within this narrative, SSRI antidepressants were widely proclaimed and promoted as good drugs with only minor associated problems, facilitating the description of benzodiazepines as bad drugs, yesterday’s drugs.

 

One might reasonably assume that, following the benzodiazepine drug dependence debacle, the medical profession would become more aware of the risks of drug dependence with new drugs. One might expect the medical profession to become more alerted to and exercise great care in relation to this issue. The opposite was the case.

 

In 1980, the then current edition of the DSM (the DSM-III) – often referred to as the psychiatrist’s bible, which sets standards of psychiatric understanding and practice internationally – defined drug dependence as the presence of either tolerance (needing more of the drug to get the same effect) or withdrawal symptoms. Consistent with this definition of drug dependence, in 1990, according to the American Psychiatric Association, “The presence of a predictable abstinence syndrome following abrupt discontinuance of benzodiazepines is evidence of the development of physiological dependence”. 21

 

In a subsequent edition, the DSM-IV (1994), the American Psychiatric Association changed the definition of drug dependence, making it more difficult to define drugs as addictive/dependency- creating. They now defined drug dependence as the presence of both tolerance and withdrawal. Rather than become more alert to the important issue of dependence to prescribed drugs as one might expect a responsible profession to do, the American Psychiatric Association both moved the goalposts and heightened the bar. As Charles Medawar subsequently commented, ‘This definition would exclude all but the most exceptional cases of dependence on benzodiazepines’. 22 This definition also results in the gross under-recognition of drug dependence problems with SSRI antidepressants.

 

The World Health Organisation’s view of drug dependence has contrasted with that of the American Psychiatric Association. According to the World Health Organisation in 1998, in relation to the SSRIs, “When the person needs to take repeated doses of the drug to avoid bad feelings caused by withdrawal reactions, the person is dependent on the drug”. 23 Regrettably, this common-sense definition of drug dependence has been largely ignored by the medical profession.

 

The interests of the public would have been served by seriously evaluating the risk of drug dependence with SSRIs before they were unleashed upon the public. On the contrary, medical and drug co interests prevailed. These substances were launched without any evaluation of their dependence- creating potential, and when people quickly reported problems coming off them, this was euphemistically called ‘discontinuation syndrome’.

 

It has been clear to me for twenty years that SSRIs frequently cause withdrawal problems, a reality that has been vociferously denied by the vast majority of prescribing doctors, a mass denial that will likely come back to haunt both the medical profession and governments. To give you one of many such examples:

 

In a 2001 article in the Independent entitled ‘World Health watchdog warns of addiction risk for Prozac users’, Professor Ralph Edwards (of the World Health Organisation’s unit monitoring drug adverse effects) expressed considerable concern that, with regard to the SSRI antidepressants, ‘the issue of dependence and withdrawal has become much more serious’.24 I was subsequently asked to speak on Radio One’s Liveline programme about this with Marian Finucane, the then host of that very popular show. On the show I expressed my concerns about SSRI withdrawal and drug dependence. Both my concerns and those of the WHO expert were summarily dismissed on the show by GP Dr. James Reilly, then a senior figure in the Irish Medical Organisation, subsequently Irish Minister for Health. Marian Finucane, speaking to James Reilly, said ‘surely all this was checked prior to the launch of Prozac’, to which James Reilly replied (and I quote) ‘Your point is well made’. In fact, none of the SSRI substances were tested for their dependency-creating potential prior to launch. Upon reviewing the drug company literature, global pharmaceutical expert, psychiatrist David Healy identified evidence of drug dependence in initial trials of these substances, prior to their launch, that ‘healthy volunteers were suffering withdrawal symptoms after taking the drug for just a couple of weeks’.25

 

While benzodiazepine drug dependence continues to be a major problem, the issue of SSRI-induced prescribed drug dependence is a major bomb waiting to explode. When it does, serious questions will be asked of those entrusted with overseeing our mental health services. The wagons are already circling. Currently there is Petition in front of the Scottish Petition Committee about Prescribed Drug Dependence, in which both antidepressants and benzodiazepines are implicated.26 This petition is gathering pace. I have made four submissions to this Committee, and my submissions have been specifically mentioned during videotaping of the Committee proceedings. The Committee has expressed great surprise at the number of submissions received. The Convenor of this Committee has stated that this Petition has received far more submissions than any other petition in which she has been involved. Currently there is a similar petition happening in Wales.27 In England in January 2018, the Parliamentary Under Secretary of State for Public Health and Primary Care officially commissioned Public Health England to ‘to review the evidence for dependence on, and withdrawal from, prescribed medicines’.28

 

Is the Irish Government doing anything to assess the real – as opposed to the medically-claimed – levels of prescribed drug dependency in Ireland, antidepressants included?

 

 

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