Opening Pandora's medicine cabinet

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http://www.nwitimes.com/articles/2003/12/27/news/region_and_state/ce0a7c54403590\

4086256e0600655baf.txt

 

 

Opening Pandora's medicine cabinet

BY JERRY DAVICH

Times Staff Writer

Popular antidepressant drugs like Prozac, Paxil and Effexor offer millions of

people a needed keel to stay afloat in life's choppy waters.

 

Taken daily, these pills typically keep them from capsizing into the depths of

depression. But some users -- with more serious yet undiagnosed mental health

conditions -- have seen their lives pirated by antidepressants and nearly pulled

under by the drug's adverse reactions.

 

In some extreme cases, users have been pushed over the edge into violent

psychotic episodes resulting in murder, suicide or both.

 

Thirty-seven-year-old Frank Kendall of Ogden Dunes is thankful he escaped.

 

On Nov. 1, Kendall " flipped out, " as he put it, causing a 4-1/2-hour standoff

with police and a SWAT team. A local business owner, Kendall began taking two

medications for depression about eight weeks prior to the Nov. 1 standoff.

 

One of the antidepressants, Effexor, turned him into a completely different

person as he tapered off the drug, he said.

 

Effexor was in the news last week when British drug regulators recommended

against prescribing it and five other antidepressants to treat children under

18. Officials there also cautioned that users of Effexor should not stop taking

it too abruptly. This is what possibly happened in Kendall's case.

 

Effexor's maker, Wyeth-Ayerst Laboratories, did not return phone calls for this

story.

 

But in a " Dear doctor " letter dated Aug. 22, 2003, Dr. Victoria Kuslek, the

firm's North American medical director, wrote: " In clinical studies in pediatric

patients, efficacy was not established for major depressive disorder or

generalized anxiety disorder, and there were increased reports among those

patients... of hostility and suicide-related adverse events... and self-harm. "

 

" The warning is for teens, but some adults must heed it also, " said Ann Blake

Tracy, director of the International Coalition for Drug Awareness, a watchdog

group of the pharmaceutical industry.

 

It was Tracy who called comedian Phil Hartman's in-laws the day after he was

killed in 1998 by his wife, who then killed herself. Tracy said Brynn Hartman

was on the antidepressant Zoloft.

 

Tracy, who has testified in dozens of criminal cases involving these drugs, said

few people have recall of what happened when they " flipped out. "

 

After Kendall's incident blew over, he said it all seemed like a bad dream, a

common pattern, Tracy said.

 

" If they do recall, it's as if they are watching themselves on TV and cannot

stop it, " said Tracy, who will be speaking at a government hearing in February,

citing deadly examples why not all patients should be prescribed

antidepressants.

 

Porter County Chief Deputy Prosecutor Brian Gensel said his office will review

Kendall's medical records before deciding if he will face charges.

 

Four years ago, a Connecticut insurance man was acquitted of bank robbery

charges after his lawyer convinced jurors that Xanax and Prozac impaired his

client's judgment. But such court decisions are rare, experts say.

 

Story after story

 

In the summer of 2001, Jack Carson said his 16-year-old son suffered a

" psychotic break from reality " after being on Zoloft for a month. His only son

came home from church one Sunday night, chatted with his family, then went to

his bedroom and unceremoniously ended his life by hanging himself from his

closet rod.

 

" This was a young man with lots of friends, good grades, active in church and

community activities and was a state champion in tae kwan do, " said Carson, of

Richmond, Va. " Nothing could have made me think he would do something like

this. "

 

For months Carson was at a loss to explain things, until he researched adverse

reactions to antidepressants. Then it clicked, he said: " These drugs cannot be

tolerated by a certain percentage of patients, and the risks of their usage are

not clearly laid out in order for patients or in my case, their parents, to make

an informed decision before using them. "

 

A sad footnote to Carson's story is that on the one-year anniversary of his

boy's death, the teen's grieving mother took her own life.

 

" This drug was responsible for the death of the only family I am ever likely to

have, " said Carson, who has since filed a lawsuit against Pfizer, Zoloft's

maker. " I only wish someone would have alerted us about any possible adverse

reactions. The doctor didn't. "

 

Prior to his son's suicide, Carson said his boy's personality changed markedly,

yet other times he seemed perfectly normal. His doctor said he was simply

becoming acclimated to the medication and that, in time, his reaction would

level off.

 

On Internet sites such as www.drugawareness.org, www.antidepressantsfacts.com,

www.prozactruth.com and www.aspire.us, there are page after page of stories like

Carson's, brimming with adverse reaction claims and the lawsuits against

pharmaceutical firms that often follow.

 

Doctors -- the new gatekeepers

 

Antidepressants like Zoloft, Prozac and Paxil belong to a class of drugs known

as selective serotonin reuptake inhibitors, or SSRIs. In addition to depression,

SSRIs are also marketed for obsessive-compulsive disorder, social anxiety

disorder and panic disorder, eating disorders and sleep disturbances, among

other things.

 

SSRIs are designed to block serotonin, a neurotransmitter in the brain, which

then builds up to create overall higher serotonin levels in the brain, typically

a good thing for people with depression and other disorders.

 

Antidepressant naysayers, however, claim the drugs do not belong in the hands of

underinformed and overburdened primary care doctors, who write about 60 percent

of all antidepressant prescriptions, according to the American Psychiatric

Association.

 

With more general practitioners leading the way, there has been a 73 percent

increase in antidepressant drug sales from 1998 to 2002, according to IMS

Health, a pharmaceutical information and consulting firm.

 

" This class of drugs is amongst the most dangerous drugs ever unleashed onto an

unsuspecting public, " said Dawn Rider, a Utah mother whose son also committed

suicide while on antidepressants.

 

" We are lulled into a false sense that the pain of depression... can be swept

away with modern-day magic pills. The truth is that not everyone has the ability

to metabolize these drugs, " said Rider, who started a nonprofit organization for

people to find safer alternatives than pharmaceutical pills.

 

The American Medical Association doesn't make distinctions of which doctors can

or cannot prescribe antidepressants.

 

" All physicians can prescribe prescriptions, as they were trained to do, " said

spokesman Robert Mills.

 

And, he noted, guidelines for prescribing antidepressants are all product

specific.

 

Much of the onus, experts say, is on the patient, who must be honest with

doctors on how they're feeling -- good, bad or ugly -- during the critical early

days and weeks of use.

 

" There are a certain number of patients who have more than just simple

depression, " said Dr. John Kern, medical director of Southlake Center for Mental

Health. " Patients who have depression as part of bipolar disorder, also called

manic-depressive illness, may look like any other depressed patient. "

 

These patients, he said, may only be distinguished by a careful history, which a

busy general practitioner may not have time to do. Or, if this is the beginning

of their illness, it may be impossible to distinguish.

 

" If a depressed person knows they have a history of bipolar or manic-depressive

illness, or if their problems include problems with agitation or hyperactivity,

then they should avoid antidepressants and seek psychiatric care, " he said.

 

Back in the early '90s, when primary care doctors began commonly prescribing

antidepressants, psychiatrists like Kern thought it could help get people the

treatment they need without patients having to stare down the stigma of mental

health care.

 

The hidden by-product of this practice are cases that either were not diagnosed

properly or monitored sufficiently after starting an antidepressant that

possibly wasn't right.

 

" This, " Kern said, " is the downside a decade later. "

 

Jerry Davich can be reached at jdavich or (219) 933-3376.

 

 

 

 

 

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