expending enormous efforts…

Posted on Wednesday 16 January 2013

I got a bit off track in fleshing out the Akathisia story from the early Prozac days. I found two resources that lay out the narrative using Eli Lilly internal documents – both came from the Bill Forsyth Sr. case that went to trial in 1999 [The Guardian: They said it was safe]:

    But since its launch in January 1988 in the US, and in the UK shortly after, when Prozac was let loose on whole populations rather than on selected patients in clinical trials, there has been a spate of disturbing accounts of violence and suicide committed by people prescribed the drug by their doctors. Some 200 cases have come to court in the US. Victims and families of killers have sued the multi-national Eli Lilly, manufacturers of the world’s most commercially successful drug. Until recently, not one case reached a verdict. Either it was dropped, or Lilly settled out of court, sometimes for millions of dollars – Lilly’s defence has always been the same: blame the disease, not the drug. Depressed people get put on Prozac. Depressed people are often suicidal. Keep on taking the tablets.

    But earlier this year, for the first time, Lilly came up against a family in the US who would not settle. The Forsyths wanted a hearing. Internal documents belonging to Lilly were produced in court. And although Lilly won the case – the jury decided it could not hold it responsible for Bill Forsyth Sr’s death – it may have lost the argument, for those documents showed that Lilly knew as long as 20 years ago that Prozac can produce in some people a strange, agitated state of mind that can trigger in them an unstoppable urge to commit suicide or murder…

    But in December 1992 Bill began to have panic attacks. His doctor prescribed medication, which worried him a little: many years earlier, the self-imposed pressures of his business had led to heavy drinking, and he had not touched a drop for a very long time, so did not like the idea of taking mind-altering drugs. Still, he was the sort of man who wanted to do what the doctor told him, so he took his medicine. But it didn’t work. Let’s try something else, said the doctor. A new drug, Prozac. Obediently, Bill Sr took his pills. The very next day he experienced the Prozac miracle. He felt wonderful. The clouds had cleared. Bill called his doctor to tell him he felt 200% better.

    The next day, the doctor got another call. It was from Bill Jr to tell him that a horrible change had come over his father. Bill Sr himself, who had rarely been in hospital in his life, had urgently demanded to be admitted to a psychiatric hospital. He spent a week in the Castle Medical Center, on the neighbouring island of Oahu, where doctors continued to give him Prozac. On March 3 1993, after 11 days on Prozac, Bill Sr went home at his own request. Bill Jr went round for dinner. Bill Sr and June planned to go out whale-watching with their son the next day. When they didn’t turn up as arranged, he went to the house. He found a scene of carnage: during the night or early in the morning, his father had stabbed his mother 15 times and had then placed a serrated kitchen knife on a stool and impaled himself on it…

This article in The Guardian lays out the way Lilly dealt [or did not deal] with the issue of Akasthisia and suicidality including the involvement of Dr. David Healy as an expert witness. The second resource is the Baum Hedlund timeline prepared for the jury in that case. This is just a small piece from that timeline that relates to the Teicher et al article [Emergence of Intense Suicidal Preoccupation During Fluoxetine Treatment] [see also it’s not our drugs…]:

    8. Jan. 1990 – PROZAC and SELF-DIRECTED VIOLENCE – "We have just received a pre-print of an article [not a letter to ed.] Which we understand is to appear in the February 1990 AMERICAN JOURNAL OF PSYCHIATRY suggesting that Prozac can induce severe, intense, obsessional suicidal ideation." … Exhibit 94
    9. Jan. 30, 1990 – Letter to sales representatives giving the sales people a "heads-up" on the forthcoming Teicher article regarding Prozac and Suicide and instructing them as follows: "Because these issues [suicide] are not part of our current marketing plan, you should not initiate discussions on these articles." …  "Again, because these issues are not part of our current marketing plan, discussions should not be initiated by you." … Exhibit 15 [bottom of second page]

    10. Feb 1990 – Teicher article published "Emergence of Intense Suicidal Preoccupation During Fluoxetine [PROZAC] Treatment" – "The purpose of this report is to suggest the surprising possibility that fluoxetine [Prozac] may induce suicidal ideation in some patients." … "In our experience, this side effect has occurred in 3.5% of patients receiving fluoxetine [Prozac]" … Exhibit 95

    11. February 7, 1990 – Leigh Thompson Memo – "Anything that happens in the UK [England] can threaten this drug [Prozac] in the US and worldwide. We are now expending enormous efforts fending off attacks because of [1] relationship to murder and [2] inducing suicidal ideation." … Exhibit 97
    12. February 7, 1990 – Leigh Thompson Memo – "I am concerned about reports I get re UK attitude toward Prozac safety. Leber [FDA] suggested a few minute ago we using CSM database to compare Prozac aggression and suicidal ideation with other antidepressants in UK. Although he is a fan of Prozac and believes a lot of this is garbage, he is clearly a political creature and will have to respond to pressures. I hope Patrick realizes that Lilly can go down the tubes if we lose Prozac and just one event in the UK can cost us that." … Exhibit 98

Both The Guardian article and Baum Hedlund timeline quote extensively from internal Eli Lilly documents. They are even more incriminating than the emails I started with [foul…]. They document Lilly’s systematic attempt to deny the Akathisia or Suicidality caused by Prozac. It’s not that they were trying to figure out how to soften the blow – they were determined to say "that there is no ‘causal relationship between Prozac and suicidality [ideation or acts]’", in spite of their own evidence to the contrary. I couldn’t possibly summarize these articles. Each piece is worse than the one before. So just read these two documents if you don’t know this story.

I pulled out items 8. through 12. also because of those last two points [11. and 12.]. Leigh Thompson, chief scientist at Lilly is saying that the fate of the Eli Lilly company literally rests on success with Prozac ["… that Lilly can go down the tubes if we lose Prozac and just one event in the UK can cost us that"]. I don’t know how to look further into Lilly’s corporate situation in those days, but the desperateness of their strategy certainly does have a life or death quality [on top of the greed]. The subsequent behavior of their stock displays the fruits of their labors [Lilly performance compared to the Dow Jones Industrial Average]:


As you read through the timeline, also note the amount of help they were getting from Paul Leber who was at the time the Director of the Division of Neuropharmacological Drug Products in the FDA. My take on all of this is that the reason they were so invested in fighting the Akathisia issue at all costs is that any kind of suicide-esque warning would’ve made Prozac a drug to be used with caution. They didn’t want that. They needed it to be a miracle drug prescribed with wild abandon, a blockbuster. In the end, they got what they wanted for an additional 13 years from the 1991 FDA Hearing with negative findings until the 2004 FDA Hearing with a Warning
    January 17, 2013 | 12:19 AM

    Ya, I just read the Forsyth case history in Healy’s “Let Them Eat Prozac.”

    I work in Community Mental Health as an MFT Intern, and what renewed my interest in this topic was encountering four instances of highly suspicious SI in four months, all of which were nearly identical. All involved intrusive, obsessive thoughts about sharp objects (oddly, all four were kitchen knives) that were completely out of character and came out of nowhere, three of the individuals used Prozac and the other used Celexa. I did not assess for, or ask about, akasthisia b/c I did not know about it then.

    (I am also very interested in PSSD, and Audrey Bahrick’s work, but that’s a different conversation.)

    For reasons of confidentiality, I won’t disclose whether these were friends or clients or a combination of both, but my caseload is only about 25 people, and I have about 25 friends who are close enough to reveal their medication history, so this was… er, disturbing, to say the least. Correlation does not prove causality, obviously there was a lot of coincidence and bad luck involved, but… hell, I never heard of anything like this even back in college when half the people I knew were taking hallucinogens. The closest thing to it I have observed, in terms of how similar the drug-induced delusions, obsessions, or ideations were, was some stuff that happens with folks using crystal meth… there was a specificity to the paranoia that was really striking. (Always about the neighbors, something from outside the dwelling being projected inside, or from inside projecting outside– images, smoke, audio or video, and so on.)

    There are two things that I would like to assemble quickly:

    1) A quick reference list. I could probably assemble this myself, and it would include the Lilly e-mails referenced in the “foul” post, the Issacson retraction from Acta Psychiatrica Scandinavia and associated letters, and a few references from Healy’s LTEP. Any additional references, particularly ones that have broken recently, would be helpful.

    2) A list of warning signs– as specific as possible– that could indicate the presence of SSRI-induced akathisia. Questions to ask, behaviors to look for, etc. I’m kind of cobbling together something myself, but I think I’ve only seen this in the consulting room a couple of times, and I would rather get some input and guidance on this from people who have more experience with it. (And a lot of the information here is spread out over multiple posts.)

    I can either provide attribution or anonymity– I really don’t care, I’m not interested in making a name for myself or anyone else, but I do want to move on this quickly. And I know that some of my colleagues (and possibly a few department heads) will at least hear me out.

    Just this week, I heard of someone being put on Vybriid and reporting really extreme sleep disturbances, waking up in some ghastly twilight state, didn’t know where they were or what was going on, intense hallucinations. Did a little poking around, and there are terrifying posts describing something very similar. Fortunately, the prescribing psychiatrist listened to his patient, switched back to fluoxetine, but this just seems like madness. Very difficult to get any psychotherapy done in this kind of climate.



    berit bj
    January 17, 2013 | 6:29 AM

    Thank you for unveiling Eli Lilly fraud and FDA as accomplice, an exposition of the fraud and corruption possible in industrial, global modern medicine.

    Medicine and its arm bio-bio-bio-psychiatry is not to be trusted until our governments decide to take control and protect the population by way of total transparancy, and reinstate scientific curiosity and integrity as motivation – instead of greed.

    The pressure for change is coming from the citizens in many locations and honest professionals here and there demanding that our government regulate and punish crime.

    Criminal fines are too feeble. There must be sentencing of the conspiratorial CEOs, scientists and bureaucrats responsible for this debacle, rooted in their (all too common) immorality, cynicism, ambition and greed. The ball is ours to play till responsible politicians enforce the necessary change.

    Mr Boring Old Man is doing great!

    berit bj
    January 17, 2013 | 10:53 AM

    Pfizer CEO Ian Read avoided testifying in Chantix trial, thereby avoiding truthtelling or perjury. The company struck a deal with the claimant who got the judge to order Read to the witnessstand. Source: FiercePharma 2012.12.13.

    And the FDA played down the risks of heart attack and SI, saying smoking is risky. I’d rather take advice from our King Harald. After quitting smoking because of health issues, some form of cancer I think it was, he uttered words of uncorrupted wisdom.
    “It was disappointingly easy.”

    January 17, 2013 | 4:34 PM

    Success of the antidepressants (and later, antipsychotics) has indeed been important to the huge unprecedented profits reaped by big pharma for the last 20 years.

    The big prize for lying was many, many billions of profit $$$, personal fortunes for top pharma management, and lucrative contracts for psychiatry consultants. The history of US capitalism is replete with scams for far less. Who would doubt the motivation here?

    January 17, 2013 | 9:14 PM

    Again, some have successfully benefited from psychotropics. Unfortunately, the lie of the “biochemical imbalance” has permeated the society to such perverse depths, no one wants to see truth, just get better but not whole, not healthy and functional.

    And so many on so many levels have bought the business model to health care.

    Ironic comment there, eh?

    berit bj
    January 18, 2013 | 6:42 AM

    Dr Hassman. What you are saying is, I guess, what you see from your angle in your country.
    I, from my angle and my little place in the world, see a different picture. Lots of everyday people are trying to “see the truth” in order to become whole and healthy and functional, but many do give up the struggle to see through the fog of professional and political lies, the struggle for safe directions, and safe tracks to transport ourselves to firm ground, leaving that hornets nest behind — the business model of health care and everything else, water, air, soil, food, science, education. That inhumane model invites rampant corruption. But it’s unsustainable. It will burst and crumble. Life is so much more. We can wait or get engaged. But since the majority of us are in the mess together, I prefer the active option. I dare to think that you do too, doctor Hassman.
    I read a few select blogs, like this one, madinamerica.com, naked capitalism, to keep heart and keep going, antidote to MSM. Lots of good people around- lots of good Americans too!

Sorry, the comment form is closed at this time.