Nottingham: Warning That Newer Antidepressants (SSRIs) May Cause Elderly Serious Health Problems: BMJ

3 Aug



5m drug prescriptions for mental health a year

MORE than five million prescriptions for powerful drugs to treat depression, psychosis, anxiety or lack of sleep are being written every year, costing in excess of €110 million, official figures have revealed.

The true extent of so-called “pill-popping” in Ireland, however, is much more as the only figures recorded are for medical card holders and people claiming through drug payment schemes, which accounts for less than half the population.

Figures compiled by the Irish Examiner from the HSE’s 2009 Primary Care Reimbursement Service show 14,000 prescriptions for anti-depressants, benzodiazepines (addictive tranquillising pills), anti- psychotics and sleeping tablets were being written every day, at a cost of €113m. The drugs are now being prescribed as often as common antacid tablets.

A report in 2002 found 11.6% of the adult medical card population were using benzodiazepines.

Since that report, the prescribing of Valium and Xanax, both used to treat anxiety and panic, have increased dramatically, with 399,798 prescriptions written for Xanax in 2009, compared with 283,000 in 2005.

The Mental Health Commission, during the inspections of 2010, found the use of benzodiazepine in both acute and long-stay units was widespread. In total, 57% of in-patients were prescribed benzodiazepines. Of these, 62% were on regular doses of the highly addictive drugs.

Nine anti-depressants, most of which are selective serotonin re-uptake inhibitors (SSRIs), were prescribed more than 2.2 million times in 2009.

Basil Miller, director of communications at the Wellbeing Foundation, said it is clear from the data that anti-depressants are grossly over-prescribed.

“This is largely down to inappropriate prescribing, where anti-depressant scripts are written as first recourse for depression when all the guidelines state that they are not to be used as a first treatment for depression and are not appropriate for mild to moderate depression.

“Because counselling and talk therapy, which work better for depression, are not widely available in the general medical service and are costly in private practice, pills are prescribed which should not be prescribed,” he said.

“Virtually everyone who presents with depression gets a pill. As severe depression is diagnosed in only 5% of cases, this means that 95% of patients are being given anti-depressants contrary to guidelines.

“If the guidelines were followed, the bill for anti- depressants would be €3m, not €60m. It’s time to spend that €57m on talk therapies which work, rather than lining the pockets of the drug companies by paying for the wrong — and ineffective — treatment.”

In relation to anti-psychotic drugs, usually prescribed for schizophrenia, bipolar disorder or to manage psychosis, former mental health inspector Dr Dermot Walsh maintains that second generation anti-psychotics — such as the current most commonly prescribed olanzapine (better known as Zyprexa) — cause “substantial adverse effects”, compromising life expectancy in psychiatric patients.

Dr Walsh said that there is emerging evidence that some changes in the structure of the brain, previously thought to be the consequence of the schizophrenic process, may actually be treatment-related.


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Newer antidepressants may increase the risk of serious health problems in older people …

Newer antidepressants may increase the risk of serious health problems in older people compared to older pills, researchers have said.

Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause death and issues such as heart attack, stroke, falls and seizures than older tricyclic antidepressants (TCAs), according to a study published in the British Medical Journal (BMJ).

Researchers from the universities of Nottingham and East Anglia analysed data for more than 60,000 people diagnosed with depression between 1996 and 2007. All were aged 65 and over.

Those patients not taking any antidepressants had a 7% risk of dying from any cause but this rose to 8.1% for those taking TCAs and 10.6% for SSRIs. The risk was even higher for other types of antidepressants, at 11.4%.

The risks of stroke and fracture were noticeably higher in those taking SSRIs compared to TCAs and SSRIs were linked to the most falls of any drugs.

The risk to the patient was highest in the first 28 days after starting an antidepressant, and in the first 28 days after stopping taking the drugs.

The findings held true even when other factors were taken into account, including age, sex, severity of depression, other illnesses and use of other medications.

One theory put forward by the researchers is that TCAs tended to be prescribed at lower doses than SSRIs and other antidepressants, which may partly explain the findings.

They warn that the risks and benefits of different antidepressants should be carefully evaluated when they are prescribed to older people.

In an accompanying editorial, Professor Ian Hickie from the University of Sydney said: “Given the potential harms, the decision to prescribe for an older person with depression should not be taken lightly.”


Breaking The Silence: Youth and Broader Society In Conflict:

The Dark Side Of The ‘Happy Pills’:


Lost Children in the Wilderness ©

By J. P. Anderson (International registered copyright of the author 2006)

Youth And Broader Society In Conflict

The first juvenile court:

The establishment of the first juvenile court in Cook County, Illinois, USA in 1899 climaxed many years of legal and humanitarian concerns for the welfare of children held to be in violation of the law and concerns with the criteria by which they might be so adjudged.

This legislation created a new kind of machinery outside the criminal law, for handling juvenile offenders. Every state in the United States of America and virtually all modern or developed society’s have since established special legal procedures for handling juvenile offenders.

The defining, features of the juvenile court are in its informality, as compared to the rigorously formal procedures of the criminal court, with its rules of evidence and adversary system. Its primary concern is with the welfare of the child, rather than with guilt or innocence.

Under the law, and following the ancient doctrine (Parens-Patriaie), the court as the agent of the state, has the right and the responsibility to intervene in cases of child need, including those where violation of the law is involved or likely to be involved.

Juvenile delinquency is that behaviour on the part of children which, may under the law, subject those children to the juvenile court.

The legal status of ’juvenile delinquent’ is important in defining, but does not fully encompass, the ’social’ role of the juvenile delinquent; that is, a youngster who has been taken into custody by the police, or committed to an institution, or otherwise disposed of by the court, and is thereafter likely to be ‘defined as a delinquent’ by many people including his/her parents and community.

For the purposes of scientific enquiry, delinquency may be defined as behaviour that is specified by law as grounds for an adjudication of delinquency, and delinquents, as those young people who engage in such behaviour.

Concern is great in some countries including Ireland over the involvement of juveniles in crimes of violence, in the general disregard for social order, as in the case of property destruction, mass rioting, and the use of alcohol and narcotics.

Within cities, juvenile delinquency tends to be concentrated in areas characterised by extreme physical deterioration, poverty, and social-disorganisation. These areas have become known as ‘delinquent areas’ because they have been found to be characterised by high delinquency rates and high rates of *recidivism over time. (* Authors note; falling back into bad behaviour).

Delinquency rates in the more technologically and economically advanced countries appear to be the highest in the world. Studies clearly identified detailed aspects of family relationships that seem important, and found that among youths from areas of low socio-economic status, delinquents differed from non-delinquents in the extent of parental-rejection and in the inconsistency of punishment and discipline, which was meted out in a harsher manner with families of the delinquents. The studies systematically compared delinquent youths with their non-delinquent siblings. The most important difference between them was that over 90% of the delinquents, as compared to 13% of their non-delinquent siblings, had unhappy home lives and felt discontented with their life circumstances.

The nature of the unhappiness differed; some felt rejected by parents; others felt inadequate or inferior; others were jealous of siblings; still others were affected by a more deep-seated mental-conflict,- but whatever the nature of the conflict or unhappiness, delinquency was seen as a solution.

It brought attention to those who suffered from parental neglect, provided support from peers for those who felt inadequate, and brought on punishment to those who sought to reduce feelings of guilt. More aggressive, delinquent boys had poor relationships with their peers, while the boys with more healthy family relationships had stronger peer relations as well. Unfortunate, unhappy family circumstances lead to personal psychological problems of adjustment for many of the youths, which in some way in turn, is solved by the commission of delinquent acts.

Studies indicated;

Those important causes of delinquency were found to be residing not alone in the youth’s family, but in the cultural context of his home and neighbourhood. In such areas boys ’natural history’ was to participate in delinquent careers. No specific psychological block seemed necessary; patterns of delinquency and criminal action were all around him, joining in those patterns would be natural for all except those restrained by close family life or by ties to conventional community institutions, such as, school, church, sporting and other recreation clubs and suchlike.The key concept; for understanding why youths became delinquent, was association with other youths already delinquent. The theory of ’differential association’ asserts that youths become delinquent to the extent that they participate in settings where delinquent ideas or techniques are viewed favourably;

The earlier, the more frequently, the more intensely, and the longer the duration of the youths association in such settings, the greater the probability of their becoming delinquents, as ideas are focused on what is learned and who it is learned from.

Delinquency grows,

as a society becomes industrialised and urbanised. In England for example, the best studies indicate that, burglaries committed by delinquents climbed almost 200% between 1938 and 1961; sex offences by about 300% and violent crime by an astounding 2,200%. The United States, that classical arena for crime, exhibit’s a similar trend; juvenile crimes have gone up since 1940 by about 93%; according to the statistics of officially recognized crimes, many juvenile offences remain undetected or, if recorded, go unpublished. Studies have shown that, virtually every child in certain urban areas has participated in a wide range of delinquent activities, even though only 10% or 15% of the youthful population are recognised by the courts as delinquents. Using official definitions of delinquency, it appears that as a society progresses materially, crime increasingly becomes the prerogative of youth. Thus, in the USA during the 1950s crimes committed by boys under the age of 18 years, increased six times as rapidly as crimes committed by adults, by 1961 American children accounted for 8% of the arrests for murder, 20% for rapes, 51% of burglaries and 62% of auto thefts. As many as one-fifth of American boys between the ages of 10 and 17 years, have appeared before courts or have been arrested by police. Every affluent nation faces a similar problem. Juvenile crime has grown immoderately during the past fifty years and has outdistanced the rate of many types of adult crime.To understand this phenomenon requires some understanding of the relationships of culture, social structure, and early environmental experiences, as they combine to produce psychological types prone to delinquency.

Research on the intelligence of delinquents, found that 50% were feeble-minded, but more recent research however, tended not to support the earlier studies, and suggested that delinquents differ from non-delinquents only by approximately eight points on standard intelligence tests (an inconsequential difference). While the general intelligence of delinquents does not differ significantly from that of non-delinquents, there may be specific cognitive functions where differences exist.

Delinquents usually score higher on performance tasks than on those which require verbal skill; this characteristic seems, however, to be a reflection of the lower socio-economic status of delinquents, rather than specifically of their criminal activities. Studies in 1941/1943 noted that, a high proportion of delinquent’s under-react to painful stimuli. Other studies in 1957, found that delinquents exhibit more sings of physical immaturities or developmental anomalies than do non-delinquents. Other studies have reported that delinquents have more indications of neurological disorders (emotional and mental illness, with symptoms such as, unreasonable anxiety), than does the normal population. It could be that the higher rate of physical disorders is simply the result of environmental deprivation, or it may be that, in some cases, a physiological malfunction plays a role in the cause of producing delinquency. In 1953, studies found that, many delinquents are emotionally disturbed, but equally important, that certain types of emotional disorder are negatively correlated with delinquency.


The suicide rate in Ireland, is currently 13.5 per 100,000 of the population about 460/500 per-year, and being more common among men than women. Men less than 35 years of age and the elderly of both sexes are the most vulnerable groups. Those who are single, widowed or separated also have an increased risk. It has been shown that the most powerful association is with psychiatric illness and up to 95% per-cent of victims has a psychiatric disorder.

Depressive illness is the disorder most associated with suicide, and those depressed patients who are in the early stages of recovery following discharge from hospital or who have just achieved an antidepressant response, such that motivation has improved, but hopelessness is still present, are particularly at risk. This is by way of contrast with alcohol abuse, the second most common disorder found among suicide victims, when the period of the greatest risk is in the late stages of alcoholism and is often linked to the termination of a relationship.

Those with schizophrenia are also at risk, especially young, chronically ill patients. Although the suicide is often committed during a period of wellbeing and may be unexpectedly violent. Some suggest that in these circumstances, it is related to insight about the illness. Up to 15% of those with severe untreated depressive illness, 15% of alcoholics and 15% to 20% of schizophrenics commit suicide, and suicide generally peaks during the spring and summer of the year. In Ireland, studies of the number of accidental or undetermined deaths, the categories to which suicides are incorrectly recorded and would have been assigned, have not diminished in parallel with the changes in the suicide rate.

It is apparent that the increase in the suicide rate is a true increase, and is in common with the upward trend across Europe. One possibility, given the connection between psychiatric illness and suicide, is that the former is rising and elevating the rate of the latter.

Opinion now is that these changes are reflective of the social changes in Europe and changes in the family and personal ways of life. Due to the powerful association between psychiatric illness and suicide, it might seem that the potential for prevention of suicide exists with the vigorous treatment of these disorders. One of the problems faced by psychiatrists is that compliance with treatment is poor and up to 60% per-cent of patients does not take their medication in the dosage or for the duration prescribed. In addition, retrospective studies of suicide victims confirm their low consultation rates. Predictions of suicide in high-risk groups in studies have shown that for every 100 cases where suicide was predicted, the forecast was wrong 97 times.

Increasing social disintegration, evidenced by increased divorce rates and the diminishing importance of religious and moral values, the loosening of social cohesion contributes to personal alienation, and in addition, stressful circumstances and events seem to interact with other personality variables as well as with personal and familial psychopathology to lead to suicide-ality. Around half of prison suicides (in Ireland) occur within three months of prisoners being remanded in custody. Underreporting of suicides is accepted to be widespread in many countries, including Ireland.

The extent of the concealment depends on the way that we record and certify deaths. “More than 90% of people who die by suicide have an undiagnosed or untreated psychiatric disorder”. Professor John Mann, professor of psychiatry at Columbia “University, New York, added “the failure to identify these problems was a major obstacle to reducing suicide”.

Suicide, risk factors:

Major depressive disorders is the single biggest risk-factor for attempted and completed suicide, with the risk heightened even further by comorbit-anxiety, substance abuse or conduct disorder. Bipolar affective disorder also conveys increased risk for completed and attempted suicide.

There is an average of seven years since the onset of the disorder and completed suicide in adolescents, so repeated suicide attempts are common.

Youths who attempt suicide, feel hopeless, are impulsive and have poor problem-solving and social skills. Children with other illnesses may also face an increased risk of suicidal behaviour. For example, children with epilepsy have a higher suicide rate, which mat be related to the side-effects of the drug (Phenobarbtac), used to treat epilepsy.

Family history and environment are also risk factors for suicide, the relatives of both suicide attempters and completers, have high prevalences of affective disorders, substance abuse, assault-ive behaviour, suicide and attempted suicide. The family environments of suicide attempters and completers have described as *discordant-with greater exposure to family violence, including physical and sexual abuse, both have also been disposed to suicidal behaviour. (* Authors note: Not harmonious).

Studies of friends and siblings of suicide victims, show that, they do not tend to imitate the act, suggesting that increased risk is related more too distant exposure for example, media publicity about fictional or true suicides has been shown consistently to increase the risk of suicide and suicidal behaviour. Repeated suicide attempts are common, but rates vary. Follow-up studies, ranging from one to twelve years, found a re-attempt rate amongst adolescents of between 6% and 15% per year, with the greatest risk within the first three months after the initial attempt.

Factors associated with a higher re-attempt rate include, chronic and severe *psychopathology, hostility and aggression, non-compliance with treatment, poor levels of social-adaption, family *discord, abuse or neglect and parent *psychopathology.

(* Authors note: psychopathology; substance abuse and depression coexisting or combined, at the same time, within the same person).*discord: Disagreement and quarrelling).

The dark side of the ‘happy pills’. June 2004.

Some 300,000 Irish people are taking anti-depressants, and an estimated 80% of anti-depressants prescribed in the country are SSRIs (Selective Serotonin Re-uptake Inhibitors), they include drugs like Seroxat, Prozac, and Cipramil. But there’s a dark side to the so called ‘happy pills’ that have taken Ireland by storm.

As evidence of their dangers becomes increasingly compelling, there is a huge ground-swell of concern among medical experts, that not only do SSRIs not work for many people, but they can be a prescription for suicide, self-mutilation and even murder. The medical experts say, the distressing and sometimes fatal side-effects and withdrawl symptoms of SSRIs are a ’chemical time-bomb’ ignored by doctors and flatly denied by pharmaceutical companies. Irish doctors are in the firing line from their colleagues for unwisely and dangerously over- prescribing SSRIs. The case against SSRIs has been building with relentless force. The US Food and Drugs Administration says that from 1997 to 2002, the six most popular SSRIs were suspected of triggering, 3,309 incidents of suicide, attempted suicide or hostile, violent behaviour in America. Suicidal or aggressive behaviour was reported in children who took the drug, more than twice as often as among adults who did.

 Delinquent drift;

is a state of limbo for some adolescents in which there is no strong attachments to either conventional or criminal lifestyles. The concept attributes delinquency to a general weakening of the moral ties of society, rather than to a conscious criminal drive or strong determination by other social forces. Delinquents ‘neutralize’ or exempt themselves from the moral constraints of law or social norms and for this reason act without strong feelings of responsibility, guilt or remorse.

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