Terence Young, one of the panelists at “You and Your Meds: Are They Safe?“, during his 10 minute presentation spoke about prescription drug warnings and how the FDA (USA) and Health Canada share different information.
He showed us a slide of an example of the Paxil information leaflet that Americans who take the drug receive from their pharmacist a leaflet that up front tells users that Paxil can cause suicidal thoughts and ideation. This does not happen in Canada (in all honesty I fell confident that even my American followers will say that they had no idea their medications could cause this). The example of a Canadian Paxil leaflet included the usual list of side effects we are all used to seeing, the whole constipation, fatigue, dizziness, insomnia etc. That’s what my Prozac and Cipralex leaflet from the pharmacy said and that is what my child psychiatrist told me.
It is obviously a problem if Health Canada is not requiring information about suicidality be known to the users of any SSRI’s and other psychiatric medications! BUT, unfortunately we can not blame just the drug companies because they do in fact have this information on their websites.
On the USA GSK website it is easier to find the information about increased risk of suicidality while on Paxil. I googled “USA Paxil leaflet” and the first link took me to a PDF from GSK where the first thing I saw was:
On top of that it is very easy to get to this information!
I went on to the Canadian GSK website and was less impressed. I can find the suicidality information but it takes much more clicking and scrolling. You can the information here under “Warnings and Precautions” and here under “June 2, 2004 – Important safety information regarding SSRIs and other newer anti-depressants including Paroxetine”.
I prefer the more “in your face” approach by GSK USA but at least the information is there.
Young talked about how these “black box warnings” are there so if a user of an SSRI says, “HEY! Your drug made me attempt suicide!” GSK, Eli Lilly, Pfizer etc can point to their companies leaflet which shows the warning that suicidality can occur. They are legally covering their asses. These warnings are there for the same reason Niagara Falls has these signs on the fence near the falls.
If those signs are not there and someone climbs over the fence then the city is in major shit for not making sure they did everything in their power to prevent an injury or death. With these signs up, if someone goes over then it is their fault and not the city’s. If we’re experience suicidality while on Paxil, Prozac or Zoloft etc. that drug company is essentially removed of any legal obligation because we were warned.
I was not warned. Were any of you warned?
My psychiatrist never informed me or my parents of the increased risk of suicidal thoughts and actions when according to the above June 2004 link on the GSK website and a letter to healthcare professionals I found on the Eli Lilly website this potential risk was acknowledged for 1 year before I was put on an SSRI at 16 (an age not recommended to SSRI use, which the drug companies also warn against).
So, the drug companies, aside from making the drugs that cause this horrible side effect, have done their part to wash their hands of any wrong doing.
Did my psychiatrist miss the memo? He must have!
As I progressively got worse on Prozac (and eventually Prozac and Zyprexa combo) my psychiatrist continued to increase my dose. Que suicide attempt and other self harming before I had not experienced before (ie: overdosing).
We trust our doctors. It is very discouraging to know that doctors are either withholding this information, do not know or do not believe that SSRI’s can cause suicidality.
I encourage everyone, regardless of medication, to do their own research. Know the good and the bad about your medication and listen to what your body tells you. The internet has given us access to information we didn’t have even 15-20 years ago and we need to take advantage of it! We need to hold our doctors accountable and do what feels right for us. We are our best advocates!
I haven’t really been thinking about anything a lot lately. I think about many things all are fairly dominant in my mind. I did in my 2nd year of university write an op’ed piece on abortion access in Canada which got me an alright mark but a 5/5 for passion!
I can write a little about that I guess.
Ireland: Savita Halappanavar, 31 years old and 17 weeks pregnant, died after experiencing a miscarriage and septicemia. Savita and her husband requested a termination of the pregnancy, which would have ended the agony she was experiencing, but they were told by doctors, “This is a Catholic country.” There is now a huge backlash against the Irish government to allow legal abortions to save the life of the mother.
I am lucky that we do not have this issue in Canada. Abortion is legal in Canada. I know where at least two clinics are in Toronto that will provide the service to women (one of them is NOT Planned Parenthood by the way). I will say it again though, I am lucky. Not every major city or every province/territory has access to abortion clinics.
I find is odd that despite the legal nature of abortions in Canada women and couples are still resorting to drastic measures to terminate an unwanted pregnancy. A year ago, a 14 year old girl from Prince Edward Island (PEI) put herself through 2 weeks of horrible self harm in an attempt to terminate her pregnancy. She ingested toxic chemicals, threw herself down stairs, rammed her stomach into tables and got drunk. PEI does not have an abortion clinic or a hospital that provides the service. The girls and women of PEI have to travel to another province to get the service which then costs money (ie: transportation).
Although legal in Canada, abortions are faced with the same moral beliefs as we’ve seen around the world. Dr. Henry Morgentaler, the first doctor to open an abortion clinic in Canada, during an opening of a clinic in Toronto was attacked by man with garden shears. A Winnipeg abortion provider was shot in his home 15 years ago and has written a memoir on the experience, “They Shoot Doctors Don’t They?” These personal threats and attacks of violence have driven many aspiring doctors to not pursue providing this important aspect of Canadian healthcare! This is leading to a shortage of providers across the country.
Abortion is funded mostly by provincial healthcare, especially if performed in a hospital. This means that every woman who is a Canadian citizen or permanent resident of the country has access to free abortions. This is still unfortunate because women from the USA who may be looking for abortion and come to Canada will expect to pay over $300 for the procedure (and the prices vary depending how far along in the pregnancy you are). I’m not even including the cost of coming and staying in this country for the procedure.
Overall, if Canada recognizes that abortion is a legal right of a woman then it needs to show it more! As it stands right now I could get illegal drugs easier than I could get a legal abortion. If it is legal then it should not be so difficult to get! If it is legal people should stop discriminating against the women and doctors who chose that path!
The 7 Sins of Psychopharmacology
1. The 3 D’s
- Diagnosis: not providing a comprehensive diagnostic evaluation before a medical decision is made. There is a need to go beyond the DSM and context, family background, prior symptoms, psychology profile etc need to be taken into consideration.
- Dose: sometimes prescribing not enough or too much. Each patient is unique and that needs to be taken into account when deciding a medication amount. To find the correct dose requires an interactive approach between doctor and patient.
- Durtation: some doses are lowered or stopped too soon. Some medications need to be used longer than others to see or sustain positive effects.
- Using more than more than one drug from the same class. There is no proof that this is helpful. This can just cause more problems.
3. Not Talking to the Patient
- Patients respond better to medications when they feel there is an understanding between them and their doctor.
4. Is There Better Living Through Chemistry?
- Medications are not always the solution!Doctors should not use medications to please a patient or to make their own jobs easier.
5. Lack of Communication with Other Physicians
- Prescribers need to know the health status of their patient before giving medications.
6. Lack of Communication with Other Mental Health Providers or Family
- This is necessary, especially if therapist is not physician! Everyone needs to be kept in the loop!
7. Not Keeping Up with the Literature
- Reading the wrong literature, reading parts,only the abstract or misreading, or even worse, not reading the literature at all! There is a great need to stay updated!
I stopped answering these questions because thinking about them made me upset so I took a long break. Question 1 was answered April 8, 2012 and can be found here.
I encourage you to share your answers in the comment box or just think about them in your head
This is all one question I’m just breaking it up so it’s less confusing (I was having difficulty following).
According to the DSM, a mental disorder is an illness only if it “causes you clinically significant impairment or distress.” (170) This means, the author says, that “for the most part, it’s up to you to decide if you are impaired or distressed; a mental illness is an illness only if it is a problem for you.” (170) How does this definition of disease compare to yours?
Are you concerned about subjectivity in make medical decisions?
Are you concerned that doctors must make their diagnosis based on what patients tell them, rather than on what they can determine from medical tests?
This definition of disease (it is one if it causes you personal significant impairments) doesn’t sit well with me. I like to think that a disease should be one no matter what. Just because someone with cancer lives their life to the fullest and doesn’t let it stop them doesn’t make the cancer less of an issue. They still have cancer, they still have a disease. It seems strange to me that mental health would be the only medical issue that is in the eye of the beholder so to speak. That decreases its validity to me.
I am very concerned about the subjectivity found in mental health. I like to think that medicine is based on hard facts, that my doctors have a high level of knowledge indicative of their level of education, pay and specialty. This is in no way to discredit the power of lived experience and personal knowledge of ones own illness but what are doctors good for if they know the same amount or less than what we do about our illnesses?
I have always been very bothered that doctors have not used physical medical tests to diagnose me. I feel this especially when I’m told that brain scans or spinal fluid can answer questions about my mental health. I am bothered that after only an hour appointment a person claims to have me figured out and send me a way with a diagnosis and prescription. To go off of only what I say is risky because I could lie and I have lied! Again, not to discredit personal knowledge because it is so important, and clearly all we have in this area of medicine, but mental health “medicine” seems to be so different from other areas of medicine that I am skeptical. Tests come in the form of multiple choice and a rating scale instead of blood tests, urine tests, scans etc. But maybe I am being discriminatory and saying that only the physical proof is important much like how it is easier to understand a physical disability or a mental one?
Sometimes you don’t help.
Sometimes you are the reason people with mental health issues are stigmatized.
You create stigma when you label yourself as experts. Claiming that you know more about my life than I do. You are the reason every person who took a psychology course at one point in their life feels they can now diagnose everyone and understand what mental illness is. I hate it when random people play “expert” and tell me what my symptoms are and what treatments I should consider because “I took a psychology class once.” If you have not lived it you will never get it. When you don’t listen to me when I say that something isn’t working because you can’t trust the judgement of someone who is “crazy”. You create stigma by taking away my right to choose all because you are the “expert”.
When you withhold valuable information on side effects you are creating stigma. You are keeping all knowledge to yourself and not sharing it with those who deserve to hear it; those taking the medications and treatments you offer. You keep us in the dark so we need to look up to you and trust you because we don’t have access to this information ourselves. You have the power. We become powerless.
When you blame the disease and not the drug, you are creating stigma. It is a horrible feeling to think that you are so sick that not even the industries “wonder drugs” can help you. This leads to “common” knowledge being that these medications WILL help and if they do not then you are a lost cause. This also creates a fear for those who have mental health issues but are not on psychiatric medication, such as myself. “Rarer than corpses are the unmedicated Mad” (Terrence McKenna). We must be truly crazy and out of control since we are not on medication. Maybe this is because we’re thrown into an industry that can’t admit it’s flaws. Only patients fail. The Industry can only succeed. Stop spreading this lie.
“Experts”, when you don’t take us seriously you create stigma. I was talking to my Mother last night about my Prozac-induced suicide attempt at 16 years old and how I’m afraid to talk about it on national TV. She began telling me that the hospital just waved off my attempt. They had always waved me off claiming it wasn’t a big deal. I got worse. If those who are supposed to help us cannot take us seriously then who will? And why should they?
What, you may ask, should you do about this? “Experts”, stop being experts. Value our insight, value our knowledge, value our lives. See us as equals, see us as valid. We should be your partners, your answers to everything you want to know.
We cannot be helped, we cannot recover if those who help us are apart of the problem.