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‘There are Reasons Noah Packed No Clothes’ Book Review
There are Reasons Noah Packed No Clothes
Robert Jacoby
Cloud Books
2012
Reviewed by: Kristen, Pride in Madness
Note: I was sent a copy of this novel from the author to review.
There are Reasons Noah Packed No Clothes by Robert Jacoby is about 19 year old Richard Issych who attempts suicide by overdosing and wakes up in a psychiatric hospital. The novel follows Richard and his interactions with his fellow patients, his doctor , his family and his own mind. The good, the bad and the ugly of the human mind are found within this novel and there is never a dull moment as readers see Richard’s journey from death to life.
I approached this book as an “insider”. I have a history of mental health issues, have attempted suicide myself when I was a few years younger than the novel’s main character and by the same means. I also woke up later on damning myself for being alive although I only ever saw the emergency room. I’m not just judging if Jacoby’s novel is a good read, I’m judging if it is a REAL read.
I found myself nodding, reflecting, sighing and laughing while reading There are Reasons Noah Packed No Clothes which tells me that Jacoby did his homework and was able to reach into a darker part of the human mind and experience. The side of me that experienced this darkness could empathize with Richard’s adamant belief that he is not as “crazy” as the others around him, his disappointment in how his life had turned out and also the shock of when suddenly waking up in the morning wasn’t so bad. Jacoby also addresses controversial and deep mental health rights issues in the novel which I believe is key to writing a good a piece of individuals with mental health issues. Electroconvulsive Therapy (ECT), isolation, competency and compliance, although not discussed at great length are discussed by the characters and the reader is given a glimpse at how these therapies and policies that are set up to “help” and make a person “better” are actually ineffective, hated, and feared by many of the patients at the hospital.
I am a little confused about a few parts of the plot such as Richard’s visions and what exactly happened at the ending. I can accept though that to read this novel there may need to be some level of strangeness and confusion the same way the experience of extreme emotions and visions can be strange and confusing.
While reading There are Reasons Noah Packed No Clothes I became drawn to one character in particular: Eugene. He is a man who sees and hears things others cannot and because of this he is deemed the most “crazy” by the other patients and judging by his acceptance that he will never leave the hospital, the staff believe he is “crazy” as well. What I liked about Eugene was that you never heard about him doing something (ie: harming himself or others) that would lead him to be hospitalized. Eugene simply perceives the world differently and for that those he knew believed it best he was removed from society. For me, Eugene symbolizes how not all mental health issues are problems for the person experiencing them but the problem for everyone else.
I call books like Robert Jacoby’s There are Reasons Noah Packed No Clothes “comfortable reads”. This novel grabbed my attention, I focused on each word, never counting down the pages to the end, each page turn was exciting and I thought of no other book while reading. I recommend this novel to those who have and have not experienced the mental health system and I believe it would serve as a reminder to service providers that there is more to their patients then meets the eye.
Purchase a copy of ‘There are Reasons Noah Packed No Clothes’
What Did it Feel Like?
Talk of suicide
I’m reviewing a fiction novel called “There Are Reasons Noah Packed No Clothes” by Robert Jacoby. It is about a young man named Richard who attempted to kill himself and now he’s in a psychiatric hospital. (Learn more when I write the review)
One of the character’s, Eugene, asked Richard how did it feel trying to kill himself.
That is not one of the standard questions people ask you about your attempt, if they ask you at all.
I’ve gotten:
Why did you do it?
How did you did it?
What were you feeling at the time?
But never, what did it feel like?
It felt like falling asleep. Because I was. Due to the amount of Zyprexa I had consumed my brain was shutting down deeper so I couldn’t think. It felt calm, relaxing, like nothing really. No pain. Just calm, coma, sleep.
Well, I don’t like finding myself in a place of remembering this so I’m going to stop now. Just thought I’d give it a try, you know, open up about something no one asks about, including myself.
Thwarting Suicide With A Cleaner Car
Beauty from Pain Blog brought this to my attention and linked an open letter to Hyundai and the ad company from COPYBOT which told the whole story. COPYBOT shares her experience of seeing this ad for the first time and remembering her Father’s suicide.
Hyundai, a car company, released a commercial in the UK to advertise how clean the emissions from their new vehicles are. They did this by showing a man’s suicide attempted being thwarted because the car’s emissions are 100% water…
Here is a link to an article entitled: Hyundai Apologized for UK Ad that Depicts Suicide Attempt. A video of the ad is included. TRIGGER WARNING!
This is a SHAMEFUL ad.
When I see advertisements that show no regard for mental health and the experience (also see Sick Kids Ad) the first thing I think is, “Who thought this was ok?” What idiot was paid to come up with that idea and send it out to air?
Is anyone else wondering how this man is going to attempt next? Is Hyundai trying to be a suicide savior? “Our cars prevent suicide because of our clean emissions!” Dirty… When I attended a lecture on self harm and online research the professor said that on every page of the questionnaire there should be a “help” button, so if someone feels they’re going into a crisis they can be linked to resources. If Hyundai is going to show a suicide attempt in their ad the least they could have a crisis hotline number at the end!
Regardless the conclusion is that this ad should never have existed!
Suicide should NEVER be used to sell something. Death should not be used to sell anything! This is way too far!
Suicide Doesn’t End the Chances of Life Getting Worse…
Whenever my birthday passes I’m glad that I’m still alive to see how good things in my life have become. If I had died when I attempted suicide at 16 then I would have missed out on a lot. I know that in the moment things are horrible and for some they probably have been for a really long time; you just never know what’s going to happen. For some maybe life doesn’t get better and I am sorry for that and not in a pitying way. I am sorry that they fought as hard as they could and still didn’t get what they deserved: happiness, relief, freedom, a chance, calm and things we may never know about.
Drugs that can Trigger & Cause Suicide or Homicide
For the full article and list of drugs by Dr. David Healy please click on the link: Left Hanging
Red stands for the drugs that I’ve done on or currently use. It was while I was on Prozac and Zyprexa that I experience suicidal and homicidal ideations and eventually attempted suicide.
We need to be aware of what we put into a our body. I’m not looking to scare anyone, I’m looking to educate people that there are sometimes horrible consequences to putting chemicals into our body.
Drugs that can Trigger & Cause Suicide or Homicide
|
Stimulants |
|
| Methylphenidate | Ritalin |
| Focalin | |
| Metadate | |
| Concerta | |
| Amphetamine | Dexedrine |
| Adderall | |
| Vyvanse | |
|
Benzodiazepines |
|
| Lorazepam | Ativan |
| Diazepam | Valium |
| Alprazolam | Xanax |
| Chlordiazepoxide | Librium |
| Bromazepam | Lexotan |
| Oxazepam | Serenid, Serax |
| Cloabazam | Frisium |
| Medazepam | Nobrium |
| Clorazepate | Tranxene |
| Clonazepam | Klonopin |
|
Antidepressants |
|
| Citalopram | Cipramil, Celexa |
| Escitalopram | Cipralex, Lexapro |
| Duloxetine | Cymbalta |
| Fluvoxamine | Luvox, Faverin |
| Fluoxetine | Prozac |
| Paroxetine | Paxil, Seroxat, Deroxat, Aropax |
| Sertraline | Zoloft |
| Venlafaxine | Effexor |
| Desvenlafaxine | Pristiq |
| Mirtazapine | Remeron |
| Trazodone | Desyrel |
| Buproprion | Wellbutrin, Zyban |
| Amitriptyline | Tryptizol, Elavil |
| Imipramine | Tofranil |
| Nortriptyline | Allegron, Aventyl |
| Desipramine | Pertrofran, Norpramin |
| Clomipramine | Anafranil |
| Dosulepin | Prothiaden |
| Lofepramine | Gamanil |
| Doxepin | Sinequan |
| Trimipramine | Surmontil |
|
Antipsychotics |
|
| Chlorpromazine | Thorazine, Largactil |
| Perphenazine | Fentazine |
| Trifluoperazine | Stelazine |
| Haloperidol | Haldol |
| Flupenthixol | Fluanxol |
| Pericyazine | Neulactil |
| Sulpiride | Sulpitil |
| Molindone | Moban |
| Aripiprazole | Abilify |
| Olanzapine | Zyprexa |
| Risperidone | Riserpdal |
| Ziprasidone | Geodon |
| Quetiapine | Seroquel |
| Paliperidone | Invega |
| Zotepine | Zoleptil |
| Iloperidone | Fanapt |
| Amisulpiride | Solian |
| Tetrabenazine | Xenazine |
I Was Trying To Make The Shit Stop
Talk of self harm and suicide
“I didn’t try to kill myself…I was trying to make the shit stop.” -Girl, Interrupted
I began cutting, everyday…to try and make the shit stop.
I began smoking cigarettes…to try and make the shit stop.
I began smoking so much pot I couldn’t see straight or walk home…to try and make the shit stop.
I began drinking until I blacked out…to try and make the shit stop.
I began overdosing on prescription and over the counter pills…to try and make the shit stop.
I began having sex…to try and make the shit stop.
I began burning myself…to try and make the shit stop.
I began mixing pills and alcohol…to try and make the shit stop.
I began to withhold food…to try and make the shit stop.
I finally attempted suicide…to try and make the shit stop.
None of this made the shit stop.
Love…made the shit stop.
Acceptance…made the shit stop.
Hard work…made the shit stop.
Beauty…made the shit stop.
Education…made the shit stop.
Support…made the shit stop.
Understanding…made the shit stop.
Purpose…made the shit stop.
Change…made the shit stop.
I made the shit stop.
The Hurt Yourself Less Workbook: Things and People
Previously: YOU
Things and People Who Have Made You Who You Are
You may want to include family, friends, teachers, pets, illnesses, jobs, institutions, religion and beliefs, money, housing- anything you think is important.
My immediate family (Mom, Dad, sisters and grandmother)
My bestie
Social Work
The Madvocates
Elementary, High School and Post Secondary Education
My field placements
My Ex’s (B, R, and R, more notably)
Sex
My Current Partner
Depression
Self Harm
BPD
Books
Writing
Singing
Musical Theatre
Music
Suicide
Anti Oppression
Unnamed Trauma
My Mental Friends Forever (MFF, thx for fun term!!)
Advocacy
The Kids I Work With
Warning!
Talk of suicide
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).
The letter continues to say that this risk is increase for children and youth.
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!
Took Me A Few Years But I Get It Now
In grade 10 I dated a guy for 7 months who I’ll call B. He was the basically the second “real” boyfriend I had, had. He was funny, cute, smart, athletic, caring and I couldn’t believe my luck. Everyone thought we were the perfect couple. We never fought. B made me feel amazing, like I was worth it.
It was while I was with B that I was eventually, and finally, diagnosed with dysthymia (chronic depression) so I was not in the 
best place during this relationship. I spent a lot of time crying or completely shut down. It was not an odd occurrence for him to hold me down on his bed while I fought him trying to get to my purse so I could grab my blade and cut. I was happy with him just not happy with myself.
The break up hit me like a freight train. The boy I loved didn’t want me anymore. My friends and I couldn’t understand why he would leave me. B and I never fought so that should have meant that everything was alright. I had seen him that day at my friend’s house. We were going to have some drinks but then he just disappeared. I called his house and no one was picking up. I waited. He eventually called me at my friend’s house and explained that he had gotten a ride home because he couldn’t be with me anymore. I was angry. B explained that he had been thinking about breaking up for a bit and that he had even called Kid’s Help Phone (or something similar) to ask for help. He told the counsellor on the phone that he thought I would kill myself if he broke up with me. The counsellor told him that he was not my therapist and not responsible for my actions.
I was horribly offended that he thought I would kill myself if he left me and I was angry that the bitch that told him he wasn’t my therapist. B was my boyfriend which meant that he had to fix me. If he loved me then he wouldn’t leave and he would fix me. Just like in the movies.
It took me a year to get over that break up and B and I haven’t spoken since (about 7 years).
A few years ago, when I was older and understood myself more, I realized that B did the right thing. I’m not angry at him anymore. I’m angry at myself (but constructively). We were 15 years old. Neither of us should have had to handle what we did. It wasn’t up to him to fix me, only I could do that. I wasn’t fair to him. I am very sorry. I feel terrible that he felt I would harm myself if he left me. That must have been a heavy burden to carry.
A former friend of mine kept telling me she would see B around her campus (about 4 or 5 years later) which prompted me to send him a “Hello” message on Facebook. The rare occasion I would get information about him it would sound like I did some damage to him or whatever. Maybe I’m being completely narcissistic. I didn’t get a response so I figured it was better to leave it alone but I have been wondering if I should try again but this time just flat out say, “I’m sorry, you were right.”
Then I start wondering why I want to do this. What do I hope to accomplish? I don’t want to reconnect and/or hang out. If I didn’t get a response I wouldn’t even care. I just think it might be important for him to know and for me to know that I said it.
I’m open to suggestions.
When Will We Start Doing Something?!
I have known that this could happen since 2005! Research has known about this since the 80′s and 90′s! Can we start doing something about psychiatric medication killing people!
Adult antidepressants suspected in suicides of Canadian kids
Staff Reporters
Powerful antidepressant and antipsychotic drugs approved only for use in adults are suspected of harming — in some cases killing — Canadian children.
Though Health Canada and the drug makers acknowledge the drugs are not approved for use in anyone under 18, doctors — often general practitioners with little psychiatric training — are prescribing these medications with little oversight.
Health Canada told the Star it has no jurisdiction to deal with the problem.
The regulator concedes the drugs may hurt kids but said it is up to drug companies to communicate the risks and doctors to safely prescribe the medications.
A Star investigation has found nearly 400 cases of children and teens suffering serious, sometimes fatal side effects suspected to have been caused by these drugs since 2002.
A 9-year-old boy’s breath shortened, stomach twisted and balance faltered before he died while on three different antipsychotics.
A 15-year-old boy experienced an irregular heartbeat and convulsed before killing himself while on antipsychotic Seroquel.
A 15-year-old girl on Prozac took her life in 2011.
Twenty-eight cases resulted in death, including the suicide of a 9-year-old boy three weeks after he started taking Zoloft, an antidepressant, in 2006. Convulsions and suicide attempts were among the most frequently reported suspected side effects.
“The prescribing of drugs falls within the practice of medicine . . . (Doctors’) professional judgment includes prescribing a drug to treat a condition for which it is not specifically authorized by Health Canada,” the country’s health watchdog told the Star.
Pfizer Canada, maker of Zoloft and Effexor XR, also an antidepressant, and three other drugs reviewed by the Star, said: “These medicines have not been approved for pediatric use by Health Canada. Pfizer Canada cannot recommend the use of any of its medications outside of product labelling.”
In about 35 per cent of the cases reviewed by the Star, kids 12 and younger were reported to have suffered serious side effects, including a 5-year-old girl who suffered seizures while on the antidepressant paroxetine (a generic version of Paxil), and a 6-year-old girl who experienced aggression, panic and personality disorder while on antidepressant Effexor XR.
“I am gobsmacked when I hear that. Why on Earth is a doctor putting a 5- or 6-year-old on a psychotropic drug? They’d better have a good reason,” said Dr. David Juurlink, head of the clinical pharmacology department at Toronto’s Sunnybrook hospital and a drug safety researcher.
So little is known about how these powerful drugs affect youth that the product pamphlets say the pills are not recommended for those younger than 18.
Pfizer and other drug companies say a lack of “sufficient clinical experience” or proven “safety and efficacy” are reasons why the drugs are not approved for kids. GlaxoSmithKline, maker of antidepressant Paxil, said “clinical studies . . . failed to demonstrate efficacy.”
Yet doctors are allowed to prescribe these drugs in what is known as an “off-label” use of the medication.
Each of the nearly 400 adverse reaction reports reviewed by the Star is the opinion of the doctor, pharmacist or parent that a particular drug has caused a side effect. Patients’ names and locations are taken out of the reports to protect their privacy.
About 75 per cent of the side-effect reports reviewed by the Star were made by doctors and other health-care professionals, and done so voluntarily. Canada’s flawed federal drug safety law does not require doctors to report side effects, even serious ones.
Health Canada and drug companies say side-effect reports show only a suspected connection between the drug and side effect but no medical proof that one caused the other.
The Star’s data analysis showed antipsychotic risperidone was named as the suspected cause in nearly 70 serious side-effect reports — more than any other drug reviewed by the Star.
Paxil was listed as the suspected cause in more than 50 cases, including six deaths.
Earlier this year, the U.S. Justice Department slapped GlaxoSmithKline, maker of Paxil, with $3 billion in fines following government allegations that, among other things, the company promoted the drug for use in kids while concealing evidence that it was ineffective.
Australian child psychiatrist Jon Jureidini, who has extensively researched Paxil’s safety and effectiveness in youth, said, “none of the antidepressant trials in children show any clinical advantage of the drug over a placebo. The ones that claim to have (shown such an advantage) have all got flaws in them, either scientific or in the way that they’re presented. That means we have no evidence at all to support the use of antidepressants in children.”
The problem is that many doctors, as well as Health Canada — which sends advisories and warnings about drugs to the medical community — do not know very much about the medications.
“We don’t know a lot about it simply because there is still a lot we don’t know about the brain. You will find fewer studies that look at this age group compared to adults with depression,” said Dr. Amy Cheung, a psychiatrist at Sunnybrook hospital who treats teens with depression. “There’s enough research data out there to show antidepressants are beneficial in the majority of teens with depression but in a small percentage of cases, patients can experience serious side effects.”
Some kids need the drugs. Dr. Cheung said she has seen children under 12 developing serious, debilitating mental illness such as anxiety, depression or schizophrenia and requiring medication.
Relying on their own experience practicing medicine, scientific journal articles and other sources, doctors can prescribe these drugs to kids. Many of the drugs are dispensed with pamphlets that warn of suicidal thinking and actions, and other possible side effects.
British Columbia’s government has issued guidelines for physicians diagnosing and treating children with depression. Doctors are directed to try “basic interventions” and therapy before resorting to prescribing pills.
In Ontario, however, neither the Ministry of Health nor the College of Physicians has a policy specifically on prescribing these unapproved drugs to children. (Non-regulatory professional associations such as the Canadian Academy of Child and Adolescent Psychiatry issue practice guidelines.)
Meanwhile:
• More and more kids are taking these drugs. Health Canada estimates prescriptions of antipsychotic drugs to children and teens in Canada spiked 114 per cent from 2005 to 2009.
• Health regulators around the world have published warnings that antidepressants may increase the risk of suicidal behaviour in kids and teens. The Star found these drugs were associated with 17 youth suicides and 28 suicide attempts in Canada since 2002.
To see a child psychiatrist can take more than a year in some parts of the province, and in less urban areas access to expertise is even more restricted, said Dr. Cheung, who added that talk therapy is often only available to those with private health insurance.
“Most family doctors have only a small proportion of their medical training focused on mental health compared to the training they receive in the diagnosis and management of physical illnesses,” she said. “But a large proportion of their child and adolescent cases are actually related to mental health issues.
“When a patient comes to you, depressed for three years and considering taking their own life, you try to do what you can for that teenager. Medication is one of the things you should consider as part of the treatment plan along with talk therapy.”
Depression experts urge caution when reviewing side-effect reports because depressed kids, before starting medication, are already at greater risk of suicidal behaviour. As a result, it can be difficult to tell whether suicidal thinking is caused by a teen’s depression or the drug used to treat the depression.
Still, doctors worry about their widespread use.
“The next time a girl is in your office crying that her boyfriend broke up with her, that’s not a reason to prescribe an antidepressant,” said drug safety expert Dr. Juurlink. “Doctors are part of the problem. We are way too free with our prescription pads. Partly we have a desire to do something helpful and partly we have a desire to get to the next patient.”
It is crucial that doctors closely monitor young patients, especially during the first few weeks of medication. “That’s when the “s— tends to hit the fan,” Juurlink said.
In 99 cases, the Star found children and teens suffered suspected serious side effects a month or less after starting the drug. In one case, an 8-year-old boy developed facial spasms and his muscles began to involuntarily twist and contract three days after he began taking risperidone, an antipsychotic.
Overworked or inexperienced doctors, however, may not closely track their patients, or the patient may skip follow-up appointments.
“Medical clinics are often not set up to allow doctors to closely track patients who miss appointments. Doctors also cannot force teens to return for appointments,” Dr. Cheung said. “It is critical that families try to help ensure these teens make it to their appointments.”
A recent review of the effect of risperidone and other antipsychotics on children found an increased risk of weight gain and movement disorders when compared to kids on placebos.
Calgary doctor and researcher Tamara Pringsheim, who did the study with funding from the Canadian Institutes of Health Research, said doctors and families of patients need to aggressively monitor kids on these powerful drugs.
“The most common reason an antipsychotic is being prescribed is not for schizophrenia but for ADHD,” she told the Star, adding that she has developed and is now promoting guidelines doctors should follow to detect side effects. “I felt physicians do need some guidance on how to keep it safe.”
Some countries take regulation of these drugs seriously.
In the GlaxoSmithKline case, the company pleaded guilty to criminal charges stemming from its failure to report safety data and “unlawful promotion” of certain drugs.
Part of the U.S. investigators’ case focused on the now infamous Study 329 on Paxil.
In a 2001 report, Study 329’s authors claimed their research showed Paxil was “generally well tolerated and effective for major depression in adolescents.”
The report became one of the most cited pieces of medical literature in support of antidepressants for youth, and an internal memo to Paxil’s sales representatives lauded it as a “landmark study” that “demonstrates REMARKABLE Efficacy and Safety (sic).”
But the results were skewed by selective reporting, said Dr. Jureidini, who co-authored a 2008 journal article on Study 329’s inaccuracies.
Study 329’s authors exaggerated findings on Paxil’s effectiveness and downplayed serious adverse reactions, Jureidini and his colleagues found.
Last year alone, Paxil was named the suspected cause of serious side effects in youth in eight reported cases.
“If you look at the science of Paxil, it says it shouldn’t be used at all in children,” Jureidini said. He said it’s “surprising and disappointing” that Canadian doctors are still prescribing the drug to kids and teens.
GlaxoSmithKline said Study 329’s authors “fairly presented the results” of the study and the company disputes “allegations that the … (2001) article on Study 329 was false or misleading.”
GSK said its plea with the U.S. Department of Justice regarding Paxil concerned only “some occasions when GSK sales representatives in the U.S. promoted the use of Paxil to physicians for patients under the age of 18, an unapproved use.
“The matters resolved as part of this settlement do not reflect the company we are today.”
In the U.K., the health regulator issued a blunt statement to doctors in 2003 that many antidepressants “are not suitable” for those younger than 18.
Many of the product pamphlets say the drugs “should not be used” by youth. Meanwhile, in Canada the language in the pamphlets distributed to doctors and patients is less forceful. They say the drugs are “not recommended,” “not indicated” or “not for use” in youth.
“The difference in language is probably a major deterrent,” said Dr. Juurlink. “When a doctor is told they should not do something, they generally don’t do it, or they think long and hard before they actually do. Simple changes in the wording are important.”
Several doctors told the Star that Health Canada is not doing enough to ensure drugs prescribed for unapproved uses are safe or effective.
Health Canada should track these off-label uses of drugs and check whether the unapproved treatments are medically sound, said Dr. Tewodros Eguale of McGill University.
Eguale led a recent study that found 11 per cent of roughly 250,000 prescriptions given to Quebec patients from 2005 to 2009 were for unapproved uses.
The study found antipsychotic drugs quetiapine and olanzapine were most often prescribed for unapproved treatments, such as depression and mood disorders, for which there is no strong evidence they are effective.
Without an effective treatment, a patient’s depression could worsen and lead to self-harm, he said.
Health Canada is “responsible for the safety and effectiveness of the drug and they’re also responsible for the general public’s health,” Eguale said. “It’s time to really look at the effect of when these drugs are used off-label.”
For Dr. Juurlink, the problem is more fundamental. “We would be facing a much less grave situation with regard to drug safety concerns if physicians were simply less eager to prescribe medications and patients less eager to take them.”
