Non-psychiatric drugs linked to suicidal behaviour and depression in new study

Adverse side effects of medicines can be underestimated and often not recognised as such. 110 drugs prescribed on the NHS have been linked to depression, self-harm and suicidal behaviour in a scientific study of patient Yellow Cards drug reaction reports sent to the Medicine’s Regulatory agency, the MHRA.

The paper published this September 2014 in the journal BMC Pharmacology & Toxicology is believed to be the first UK systematic review of psychiatric side-effects. Researchers found reports of 11,000 cases of depression, self injurious and suicidal behaviour following prescribed drug use between 1964 and 2011. This number covered 1.65% of all reports received in this time period.

Anti-depressants, acne, smoking cessation and weight-loss drugs were most frequently linked with serious psychiatric adverse drug reactions (ADRs). Clozapine, the anti-psychotic drug, had the highest reporting rate of suicide, with 78 reports between 1998 and 2011 linking the fatality to the drug.

Both nervous system and non-nervous system drugs met the study’s thresholds of at least 20 reports for depression, 10 for non-fatal suicide and 5 for fatal suicide between 1998 and 2011. Topping the charts with most frequent reports of depression were smoking cessation medicine, varenicline (Champix / Chantix) and bupriopion (Wellbutrin / Zyban), followed by paroxetine (Seroxat or Paxil), the SSRI antidepressant. Also high on the list of drugs linked to depression were the acne treatment, isotretinoin (Roaccutane / Accutane), and rimonabant (Acomplia), a drug for weight loss. For suicidal and self injurious behaviour, SSRIs, varenicline and clozapine occurred most often.

Figures found in the study are likely to underrepresent the true count of iatrogenic effects (drug-induced side effects) as the Yellow Card reporting system remains relatively underused by both patients and healthcare professionals.

The paper recommends the drugs most commonly arising in patient reports for grave psychiatric conditions need further analysis to understand the reasons why these drugs might be causing undue harm.

When a drug is licensed for prescription, pre-market trials do not undergo full powered studies into adverse drug reactions (ADRs) as this would require larger numbers of participants. Post-marketing pharmacovigilance using the Yellow Card reporting system and its careful analysis is therefore one of the main ways we can achieve a fuller picture into the neglected area of patient experience with medication.

Due to poor publicity and the underpowered studies of iatrogenic effects, psychiatric drug reactions and withdrawal effects are neither sufficiently well recognised nor analysed in the medical community. A study published in 2004 found that fewer than half of pharmacy programmes and medical schools provided students with a guide to reporting ADRs. Yet NHS Education for Scotland (NES), in a press release published in June 2014, stated that 7% of acute hospital admissions were due to ADRs. The NES have thus launched six new e-learning modules to support healthcare professionals identifying and reporting iatrogenic symptoms. Clinical pharmacologist Dr Simon Maxwell published an article reporting that undergraduate study is in urgent need of review to improve the safe and effective use of drugs in patients. 74% of medical students felt the amount of teaching in this area of safe prescribing  was ‘too little’ or ‘far too little’, and most disagreed that their assessment ‘thoroughly tested knowledge and skills’.

If we are to reduce the effect of ADRs on the population, and their economic impact that costs the NHS an estimated £2 billion each year, healthcare professionals and pharmaceutical companies need to make best use of new information made available by patient reporting.

Jacqueline Bond blogging for APRIL

A small victory for families who have campaigned since tragic suicides linked to Roaccutane.

A small victory for families who have campaigned since tragic suicides linked to Roaccutane

.http://www.dailymail.co.uk/health/article-2615052/Controversial-acne-drug-Roaccutane-reviewed-government-panel-blamed-spate-suicides-depression.html#comments

The article in Mail on Line states there will be a review of Roaccutane (isotretinoin) by the Commission on Human Medicines. 

We have tried for years to persuade a Professor of pharmacogenetics to do a study to find a genetic test and discover why a drug, so popular with those it has helped with acne problems, yet has a devastating adverse effects for those it harms and for their families.

We even went so far, with the help of the Medland family who are featured in the article, as to have a meeting in Liverpool with dermatologists, the professor and others about how to go about this study.

We found family members where one had a severe adverse reaction and the other did not. In the case of twins, one rushed to hospital in a life threatening condition and the other not after taking Roaccutane.

The drug is derived from vitamin A which is a linked to severe psychiatric and other reactions in high doses. The fact that some people may be slow metabolisers and therefore may have toxic levels of Roaccuane due to the drug not dispersing quickly, seems to be seldom considered.

Please read the article and take into account that in the case of Jon Medland, his problem was not a severe case of acne and he was not really a person who should have been prescribed the drug. He was however a medical student at the time and therefore slipped through the net.

Others who have been prescribed were also not classic severe cases where many other treatments had failed. In some dermatology clinics, there is careful monitoring. In some cases no monitoring of the patient's mood. 

I was at an  inquest where the dermatologist not only shrugged off his responsibility and even prescribed Dianette to a depressed girl who was deeply concerned about the harm Roaccutane was doing by seriously drying up her skin. 

I asked him why he prescribed Dianette and he responded " I couldn't risk her getting pregnant on Roaccutane" (the drug is known to cause deformity in foetus). I said to him " but Dianette is not licensed as a contraceptive" to which he did not respond. This man runs a private practice in Harley Street and did not know Dianette is linked to depression and not licensed for contraception due to higher risk of blood clots than other drugs for this purpose. It is licensed for acne. 

The poor girl who died was also prescribed by other doctors = Prozac and Zopiclone...a potent cocktail for a deeply depressed vulnerable girl - her name was Angela Lee and the coroner just brushed asside the cocktail of drugs in the jury inquest I attended.

I personally know a young man who was an A grade student, he dropped out and later told me he thought Roaccutane had caused his depression. Sadly his family shunned his concerns and considered him a failure. Tragic and it still upsets me to think he understood the cause of his problems and yet got no support from his family. He is not the only person in this situation and many others have written to me with similar stories.

I just want to say how strongly I support the Medland family and all those family members who do not give up in their efforts to save other lives. We do understand why some families shut themselves away in their grief but if we all did that there would be no changes in patient safety issues. 

Angela Lee suicide

Angela Lee 'staggered' and fell in front of a train according to the shocked female train driver of a train travelling at 90 miles per hour. Angela had left a note and felt that the acne drug ro-accutane (isotretionoin) had caused lasting problems. I can confirm that many people who contact me say depression, which they believe was caused by roaccutane lasts for months and years after they stop taking the drug. Angela was prescribed fluoxetine (Prozac) and Zopiclone which she was taking at the time of her death.

I sat in the Walthamstow Coroner's court and heard the evidence given to the jury and was also shocked to hear that Angela was given Dianette at the same time as she was prescribed Roaccutane. None of the journalists commented on this cocktail of drugs - all linked to causing suicidal feelings.

Another problem was the failure of health professionals who cared for Angela, to communicate by picking up a telephone to speak to each other and discuss how best to protect her from harm.