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…
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  relationship to murder and  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…