1 00:00:01,020 --> 00:00:03,060 (THEME MUSIC PLAYS) 2 00:00:17,140 --> 00:00:20,020 This pill could solve all of your problems. 3 00:00:23,220 --> 00:00:25,140 CREW: We are recording. Are you good to go? 4 00:00:26,100 --> 00:00:29,580 And it may mean the end of depression as we know it. 5 00:00:29,580 --> 00:00:32,580 REPORTER: They were a new generation of antidepressants 6 00:00:32,580 --> 00:00:32,820 REPORTER: They were a new generation hailed as the latest wonder drugs. 7 00:00:32,820 --> 00:00:34,780 hailed as the latest wonder drugs. 8 00:00:34,780 --> 00:00:36,340 MARK HOROWITZ: I thought... 9 00:00:36,340 --> 00:00:38,820 ..you know, heard so much promise about these things, 10 00:00:38,820 --> 00:00:41,980 this might be the thing to fix everything. 11 00:00:41,980 --> 00:00:42,220 this might be the thing I LOVED being on Prozac. 12 00:00:42,220 --> 00:00:44,460 I LOVED being on Prozac. 13 00:00:44,460 --> 00:00:47,860 Now 1-in-7 of us is taking an antidepressant. 14 00:00:48,780 --> 00:00:51,460 Wouldn't you be tempted to take it again and again? 15 00:00:51,460 --> 00:00:54,900 But only now, decades after their launch, 16 00:00:54,900 --> 00:00:55,140 But only now, is a different story being told... 17 00:00:55,140 --> 00:00:57,380 is a different story being told... 18 00:00:57,380 --> 00:01:00,420 I was, you know, baffled by, you know, how could this be? 19 00:01:00,420 --> 00:01:00,660 I was, you know, baffled by, ..how a patient movement 20 00:01:00,660 --> 00:01:01,980 ..how a patient movement 21 00:01:01,980 --> 00:01:05,100 revealed what some drug companies had tried to ignore. 22 00:01:05,100 --> 00:01:08,420 I didn't know about any of this. I hadn't been warned. 23 00:01:08,420 --> 00:01:12,220 We felt patients on the ground had been vindicated. 24 00:01:13,180 --> 00:01:15,620 DAVID TAYLOR: In the mental-health sphere 25 00:01:15,620 --> 00:01:19,060 we're quite good at making the same mistake more than once. 26 00:01:19,060 --> 00:01:22,140 Many say they've been helped by antidepressants, 27 00:01:22,140 --> 00:01:22,380 Many say they've been helped but for those harmed by them 28 00:01:22,380 --> 00:01:24,140 but for those harmed by them 29 00:01:24,140 --> 00:01:26,540 it's been a struggle to be heard. 30 00:01:26,540 --> 00:01:30,300 I've been waiting for you to show up for 15 years. 31 00:01:30,300 --> 00:01:30,540 I've been waiting for you to show up Thank you for coming. 32 00:01:30,540 --> 00:01:32,780 Thank you for coming. 33 00:01:32,780 --> 00:01:34,660 It's amazing. 34 00:01:47,820 --> 00:01:50,180 ARCHIVE PRESENTER: Now, it's 36 minutes past the hour, 35 00:01:50,180 --> 00:01:52,700 and I'm going to show you an incredible drug. 36 00:01:53,540 --> 00:01:56,220 Imagine a drug that could make everything feel better, 37 00:01:56,220 --> 00:01:58,140 that could take away the stress of everyday life 38 00:01:58,140 --> 00:02:00,820 and transform you into somebody completely different. 39 00:02:03,420 --> 00:02:06,180 That drug was Prozac, 40 00:02:06,180 --> 00:02:06,420 one of the first That drug was Prozac, 41 00:02:06,420 --> 00:02:09,700 one of the first in a new class of antidepressants. 42 00:02:09,700 --> 00:02:12,420 Over nine million people take it here 43 00:02:12,420 --> 00:02:12,660 Over nine million people and the number is growing every day. 44 00:02:12,660 --> 00:02:15,140 and the number is growing every day. 45 00:02:17,100 --> 00:02:19,460 WENDY BURN: The first person I ever prescribed to, 46 00:02:19,460 --> 00:02:19,700 she had been depressed for years WENDY BURN: The first person I ever prescribed to, 47 00:02:19,700 --> 00:02:21,180 she had been depressed for years 48 00:02:21,180 --> 00:02:23,740 and basically would hardly leave the house. 49 00:02:23,740 --> 00:02:23,980 and basically would hardly leave the house. She phoned up a week later and said, 50 00:02:23,980 --> 00:02:26,260 She phoned up a week later and said, 51 00:02:26,260 --> 00:02:27,700 "I don't need to see you. I'm going on holiday." 52 00:02:29,580 --> 00:02:31,820 And she took her whole family to Disneyland in Paris. 53 00:02:31,820 --> 00:02:33,820 It was just amazing. 54 00:02:33,820 --> 00:02:38,580 So, they really did seem to me like miracle drugs when they came along. 55 00:02:41,140 --> 00:02:43,860 I've been on Prozac now for about six months 56 00:02:43,860 --> 00:02:45,340 and it's changed my way I think. 57 00:02:45,340 --> 00:02:48,140 I've got more confidence. I want to go out more. 58 00:02:48,140 --> 00:02:50,980 You know, it's just changed my life completely. 59 00:02:50,980 --> 00:02:53,260 All of a sudden here comes somebody that says, 60 00:02:53,260 --> 00:02:55,340 "OK, now try these on, try this Prozac on." 61 00:02:55,340 --> 00:02:58,940 And I tried it on, and for the first time in my life I went, 62 00:02:58,940 --> 00:03:02,140 "Whoa. Is this the way reality really is?" 63 00:03:02,140 --> 00:03:05,700 DAVID NUTT: Prozac had some real advantages. 64 00:03:05,700 --> 00:03:05,980 It was the first time we'd actually been able to prescribe DAVID NUTT: Prozac had some real advantages. 65 00:03:05,980 --> 00:03:08,300 It was the first time we'd actually been able to prescribe 66 00:03:08,300 --> 00:03:10,260 a medicine that didn't have side effects, 67 00:03:10,260 --> 00:03:10,540 a medicine that didn't have side effects, or at least it didn't have side effects 68 00:03:10,540 --> 00:03:12,420 or at least it didn't have side effects 69 00:03:12,420 --> 00:03:13,780 that patients complained about. 70 00:03:16,020 --> 00:03:19,820 AUDREY BAHRICK: The first thing I remember was a cover story 71 00:03:19,820 --> 00:03:23,980 where Prozac was called the 'miracle drug'. 72 00:03:31,980 --> 00:03:33,620 In the early 1990s 73 00:03:33,620 --> 00:03:36,580 Audrey Bahrick was working as a psychologist 74 00:03:36,580 --> 00:03:38,500 at the University of Iowa. 75 00:03:40,260 --> 00:03:44,780 At the time, I had just taken a leave of absence from my job 76 00:03:44,780 --> 00:03:45,060 to go with a partner to another city, At the time, I had just taken a leave of absence from my job 77 00:03:45,060 --> 00:03:48,900 to go with a partner to another city, 78 00:03:48,900 --> 00:03:50,500 and that adjustment was difficult 79 00:03:50,500 --> 00:03:50,700 and that adjustment was difficult and I decided to seek out Prozac 80 00:03:50,700 --> 00:03:54,980 and I decided to seek out Prozac 81 00:03:54,980 --> 00:03:56,820 based on what I'd read. 82 00:03:56,820 --> 00:03:59,220 There was no discussion 83 00:03:59,220 --> 00:04:00,740 about what to expect. 84 00:04:00,740 --> 00:04:05,380 Prozac gave Audrey the boost she'd hoped for. 85 00:04:05,380 --> 00:04:05,620 Prozac gave Audrey I did feel confident and energised. 86 00:04:05,620 --> 00:04:09,340 I did feel confident and energised. 87 00:04:09,340 --> 00:04:10,820 It was very novel. 88 00:04:10,820 --> 00:04:11,060 I was not a person It was very novel. 89 00:04:11,060 --> 00:04:14,220 I was not a person who had a lot of energy before that. 90 00:04:15,540 --> 00:04:18,420 I LOVED being on Prozac. 91 00:04:29,300 --> 00:04:33,620 This is me looking very happy, with a fuller head of hair, 92 00:04:33,620 --> 00:04:37,740 getting the prize for Public Communication 93 00:04:37,740 --> 00:04:40,260 because I did a few public-education events 94 00:04:40,260 --> 00:04:46,180 in which I talked in part about the benefits of antidepressants 95 00:04:46,180 --> 00:04:48,180 for treating depression and other disorders. 96 00:04:48,180 --> 00:04:48,420 for treating depression So, I was given a couple of prizes. 97 00:04:48,420 --> 00:04:50,860 So, I was given a couple of prizes. 98 00:04:50,860 --> 00:04:53,060 My mum was impressed by it. 99 00:04:56,900 --> 00:04:59,700 I went to an all-boys school 100 00:04:59,700 --> 00:05:02,380 and I was a know-it-all, 101 00:05:02,380 --> 00:05:04,100 I was a smart-arse 102 00:05:04,100 --> 00:05:04,300 and I was the shortest in the class, I was a smart-arse 103 00:05:04,300 --> 00:05:05,980 and I was the shortest in the class, 104 00:05:05,980 --> 00:05:07,940 I was the youngest 105 00:05:07,940 --> 00:05:08,140 I was the youngest and I was bullied. 106 00:05:08,140 --> 00:05:09,540 and I was bullied. 107 00:05:09,540 --> 00:05:09,780 And I think and I was bullied. 108 00:05:09,780 --> 00:05:12,180 And I think that had a big effect on me. 109 00:05:15,660 --> 00:05:19,580 Mark was diagnosed with depression when he was 21. 110 00:05:19,580 --> 00:05:22,820 He's been taking antidepressants ever since. 111 00:05:24,700 --> 00:05:27,700 My first one, I was super excited. 112 00:05:27,700 --> 00:05:31,580 You know, I almost ran to the pharmacy to fill the script. 113 00:05:31,580 --> 00:05:34,740 I remember ripping open the packet, you know, 114 00:05:34,740 --> 00:05:38,300 seeing these green and white capsules and thinking, you know, 115 00:05:38,300 --> 00:05:38,540 seeing these green and white "This is a very exciting moment." 116 00:05:38,540 --> 00:05:39,980 "This is a very exciting moment." 117 00:05:39,980 --> 00:05:42,500 I was... I couldn't wait to start them. 118 00:05:42,500 --> 00:05:45,540 I thought...you know, heard so much promise about these things. 119 00:05:45,540 --> 00:05:49,540 This might be the thing to fix everything. 120 00:05:51,020 --> 00:05:53,300 I've got a different view of them now. 121 00:05:59,220 --> 00:06:00,700 During the 1990s 122 00:06:00,700 --> 00:06:05,020 these new antidepressants became global blockbusters... 123 00:06:06,100 --> 00:06:07,300 ..driving up 124 00:06:07,300 --> 00:06:08,580 antidepressant prescriptions 125 00:06:08,580 --> 00:06:08,820 antidepressant in the UK 126 00:06:08,820 --> 00:06:09,900 in the UK 127 00:06:09,900 --> 00:06:10,140 by more in the UK 128 00:06:10,140 --> 00:06:12,460 by more than 200%. 129 00:06:17,540 --> 00:06:21,340 The drugs made billions worldwide. 130 00:06:21,340 --> 00:06:23,820 JERRY ROSENBAUM: The marketing was massive. 131 00:06:23,820 --> 00:06:26,060 There was lots of conferences 132 00:06:26,060 --> 00:06:28,460 and presentations 133 00:06:28,460 --> 00:06:32,260 and, you know, lunches and dinners. 134 00:06:32,260 --> 00:06:36,940 These were extraordinarily commercially successful launches. 135 00:06:40,100 --> 00:06:44,380 This new generation of drugs were called SSRIs - 136 00:06:44,380 --> 00:06:48,660 selective serotonin reuptake inhibitors. 137 00:06:48,660 --> 00:06:52,420 They were made by several companies and had an array of brand names. 138 00:06:55,140 --> 00:06:56,620 I'm David Healy. 139 00:06:56,620 --> 00:07:00,060 I'm a medical doctor, professor of psychiatry, 140 00:07:00,060 --> 00:07:02,860 and I've worked on the serotonin system one way or the other 141 00:07:02,860 --> 00:07:03,100 and I've worked on the serotonin for over 40 years. 142 00:07:03,100 --> 00:07:05,340 for over 40 years. 143 00:07:07,260 --> 00:07:11,460 SSRIs target a chemical called serotonin. 144 00:07:11,460 --> 00:07:15,060 It can affect mood, appetite, sleep and sex drive. 145 00:07:15,060 --> 00:07:19,260 Serotonin is found in the brain and throughout the body. 146 00:07:20,540 --> 00:07:23,540 Everybody thinks, because it's an antidepressant, 147 00:07:23,540 --> 00:07:26,060 that it's doing something to the brain. 148 00:07:26,060 --> 00:07:28,460 But, actual fact, it's much more likely 149 00:07:28,460 --> 00:07:28,700 But, actual fact, to be doing something to our body. 150 00:07:28,700 --> 00:07:30,940 to be doing something to our body. 151 00:07:34,420 --> 00:07:40,180 When I was taking Prozac, I was energised, I felt sharp, 152 00:07:40,180 --> 00:07:40,420 When I was taking Prozac, I was in a good mood, 153 00:07:40,420 --> 00:07:42,700 I was in a good mood, 154 00:07:42,700 --> 00:07:45,100 I had felt more confident. 155 00:07:45,100 --> 00:07:45,340 Prozac made Audrey I had felt more confident. 156 00:07:45,340 --> 00:07:48,940 Prozac made Audrey feel better in herself. 157 00:07:48,940 --> 00:07:49,180 Prozac made Audrey But something else was going on too. 158 00:07:49,180 --> 00:07:51,500 But something else was going on too. 159 00:07:51,500 --> 00:07:56,100 I was almost immediately sexually numbed. 160 00:07:56,100 --> 00:07:56,340 I was almost immediately Within a day, my genitals were numb. 161 00:07:56,340 --> 00:07:59,820 Within a day, my genitals were numb. 162 00:07:59,820 --> 00:08:02,060 I was very surprised. 163 00:08:02,060 --> 00:08:04,940 I looked at the product insert literature 164 00:08:04,940 --> 00:08:09,340 and saw that sexual side effects were very unlikely, 165 00:08:09,340 --> 00:08:13,700 and certainly I'd never heard of numb genitals. 166 00:08:13,700 --> 00:08:17,180 Prozac patient leaflets in the US at the time 167 00:08:17,180 --> 00:08:20,100 warned small numbers of people might experience 168 00:08:20,100 --> 00:08:25,300 reduced libido, sexual dysfunction and infrequent impotence, 169 00:08:25,300 --> 00:08:27,700 but no mention of numb genitals. 170 00:08:27,700 --> 00:08:31,420 And the numbing sensation wasn't just physical. 171 00:08:31,420 --> 00:08:35,500 I think my range of feelings was somewhat blunted. 172 00:08:35,500 --> 00:08:35,740 I think my range of feelings And it's kind of a mixed bag 173 00:08:35,740 --> 00:08:37,380 And it's kind of a mixed bag 174 00:08:37,380 --> 00:08:39,260 because if you're deeply depressed 175 00:08:39,260 --> 00:08:41,420 or highly anxious, 176 00:08:41,420 --> 00:08:43,660 if you can take the edge off 177 00:08:43,660 --> 00:08:45,620 those extremes, 178 00:08:45,620 --> 00:08:47,260 that can be helpful. 179 00:08:47,260 --> 00:08:48,900 Unfortunately, 180 00:08:48,900 --> 00:08:55,020 I was left with being able to feel more intensely distressed 181 00:08:55,020 --> 00:08:58,900 than intensely elated. 182 00:08:58,900 --> 00:09:03,660 It's not known how SSRIs cause sexual or emotional numbing, 183 00:09:03,660 --> 00:09:03,900 It's not known how SSRIs but the two may be linked. 184 00:09:03,900 --> 00:09:06,140 but the two may be linked. 185 00:09:06,140 --> 00:09:06,340 All antidepressants to some extent but the two may be linked. 186 00:09:06,340 --> 00:09:08,780 All antidepressants to some extent 187 00:09:08,780 --> 00:09:09,020 All antidepressants to some extent of numbing emotions, 188 00:09:09,020 --> 00:09:13,700 seem to have the property of numbing emotions, 189 00:09:13,700 --> 00:09:13,940 and in some cases of numbing emotions, 190 00:09:13,940 --> 00:09:16,180 and in some cases 191 00:09:16,180 --> 00:09:17,780 this effect seems to be associated 192 00:09:17,780 --> 00:09:20,740 with their ability to cause sexual dysfunction. 193 00:09:21,700 --> 00:09:23,340 Despite drug companies 194 00:09:23,340 --> 00:09:26,380 originally saying sexual side effects WEREN'T common, 195 00:09:26,380 --> 00:09:26,620 originally saying sexual side effects studies now suggest 196 00:09:26,620 --> 00:09:27,940 studies now suggest 197 00:09:27,940 --> 00:09:28,180 they affect at least a third of studies now suggest 198 00:09:28,180 --> 00:09:32,980 they affect at least a third of patients while they're taking SSRIs. 199 00:09:32,980 --> 00:09:35,660 AUDREY BAHRICK: I felt confident and well and energised 200 00:09:35,660 --> 00:09:35,900 AUDREY BAHRICK: I felt confident and therefore thought 201 00:09:35,900 --> 00:09:38,540 and therefore thought 202 00:09:38,540 --> 00:09:38,780 it was an acceptable temporary and therefore thought 203 00:09:38,780 --> 00:09:44,220 it was an acceptable temporary trade-off to be so sexually numbed. 204 00:09:45,500 --> 00:09:49,780 There was a particular person that I was interested in dating. 205 00:09:49,780 --> 00:09:50,020 There was a particular person I went off of the medication 206 00:09:50,020 --> 00:09:52,340 I went off of the medication 207 00:09:52,340 --> 00:09:52,580 with the expectation I went off of the medication 208 00:09:52,580 --> 00:09:58,420 with the expectation that my sexual interest and feelings 209 00:09:58,420 --> 00:09:58,660 with the expectation would resume as before. 210 00:09:58,660 --> 00:10:00,460 would resume as before. 211 00:10:00,460 --> 00:10:03,660 I was very confused when things didn't change. 212 00:10:06,060 --> 00:10:09,060 That was very, very hard on the relationship. 213 00:10:09,060 --> 00:10:14,100 And, you know, I don't blame him for wanting to move on. 214 00:10:14,100 --> 00:10:14,340 And, you know, I don't blame him I get it. 215 00:10:14,340 --> 00:10:15,820 I get it. 216 00:10:17,420 --> 00:10:19,620 I stayed fairly hopeful. 217 00:10:19,620 --> 00:10:23,420 All that time I thought being healthy, eating well 218 00:10:23,420 --> 00:10:23,660 All that time could help me resolve this. 219 00:10:23,660 --> 00:10:25,540 could help me resolve this. 220 00:10:25,540 --> 00:10:28,060 But nothing...nothing did. 221 00:10:29,180 --> 00:10:31,620 You know, I continued to hope for months 222 00:10:31,620 --> 00:10:31,860 You know, and then years. 223 00:10:31,860 --> 00:10:33,660 and then years. 224 00:10:33,660 --> 00:10:34,980 It's been... 225 00:10:36,140 --> 00:10:37,940 ..27 years. 226 00:10:42,340 --> 00:10:43,820 DAVID HEALY: We don't actually know 227 00:10:43,820 --> 00:10:45,780 why the sexual problems with these drugs 228 00:10:45,780 --> 00:10:48,300 could persist after the drugs were halted. 229 00:10:50,020 --> 00:10:53,060 In terms of what serotonin does to us, 230 00:10:53,060 --> 00:10:55,900 it's extraordinary, we understand so little. 231 00:11:08,260 --> 00:11:11,540 A few times over the years I had come off my medication 232 00:11:11,540 --> 00:11:13,420 thinking maybe I don't need it anymore. 233 00:11:13,420 --> 00:11:16,860 And all those times I'd felt bad afterwards 234 00:11:16,860 --> 00:11:18,860 and concluded that I was better on the medication. 235 00:11:20,860 --> 00:11:25,140 Mark Horowitz had been taking antidepressants for 15 years. 236 00:11:25,140 --> 00:11:27,460 He was training to be a psychiatrist 237 00:11:27,460 --> 00:11:30,500 and studying antidepressants for a PhD 238 00:11:30,500 --> 00:11:32,380 when he tried to stop again. 239 00:11:33,820 --> 00:11:37,780 It led to complete havoc in my life. 240 00:11:37,780 --> 00:11:41,820 So, I had trouble sleeping, 241 00:11:41,820 --> 00:11:42,060 I would wake up in the morning So, I had trouble sleeping, 242 00:11:42,060 --> 00:11:46,340 I would wake up in the morning in full panic, 243 00:11:46,340 --> 00:11:48,580 like I was being chased by an animal, 244 00:11:48,580 --> 00:11:50,820 like I was on the edge of a cliff. 245 00:11:50,820 --> 00:11:56,340 And that panic wouldn't abate for hours until the late evening. 246 00:11:56,340 --> 00:11:58,660 I took up running 10 kilometres a day, 247 00:11:58,660 --> 00:11:58,900 I took up running I ran until my feet bled 248 00:11:58,900 --> 00:12:00,140 I ran until my feet bled 249 00:12:00,140 --> 00:12:04,740 because it gave me a slight reprieve from that panic sensation. 250 00:12:06,900 --> 00:12:08,660 Mark knew he wasn't addicted 251 00:12:08,660 --> 00:12:12,460 but felt he was experiencing withdrawal. 252 00:12:12,460 --> 00:12:15,300 So, antidepressants are not addictive. 253 00:12:15,300 --> 00:12:18,780 Addiction is normally thought of as something extra - 254 00:12:18,780 --> 00:12:19,020 Addiction is normally craving, compulsion, 255 00:12:19,020 --> 00:12:21,740 craving, compulsion, 256 00:12:21,740 --> 00:12:24,020 a focus on the drug 257 00:12:24,020 --> 00:12:25,620 and also a euphoric high. 258 00:12:26,580 --> 00:12:29,580 When you stop a drug that you've become adapted to, 259 00:12:29,580 --> 00:12:30,860 your body and brain will miss the drug, 260 00:12:30,860 --> 00:12:32,500 and that's what causes the withdrawal symptoms. 261 00:12:32,500 --> 00:12:32,740 and that's what causes Nothing in his medical training 262 00:12:32,740 --> 00:12:35,140 Nothing in his medical training 263 00:12:35,140 --> 00:12:38,060 had prepared him for what was happening. 264 00:12:38,060 --> 00:12:40,100 As someone that was training in psychiatry, 265 00:12:40,100 --> 00:12:40,340 As someone that had taken antidepressants 266 00:12:40,340 --> 00:12:41,660 that had taken antidepressants 267 00:12:41,660 --> 00:12:44,900 and had studied antidepressants in my PhD, 268 00:12:44,900 --> 00:12:45,140 and had studied antidepressants I thought that I knew everything 269 00:12:45,140 --> 00:12:46,380 I thought that I knew everything 270 00:12:46,380 --> 00:12:46,620 there was to know I thought that I knew everything 271 00:12:46,620 --> 00:12:48,380 there was to know about antidepressants. 272 00:12:48,380 --> 00:12:51,180 And what I quickly worked out is that I knew almost nothing, 273 00:12:51,180 --> 00:12:55,340 and if I had no understanding, then the public surely had even less. 274 00:12:55,340 --> 00:12:55,580 and if I had no understanding, then From the beginning the SSRIs 275 00:12:55,580 --> 00:12:57,780 From the beginning the SSRIs 276 00:12:57,780 --> 00:12:59,540 were marketed with the message 277 00:12:59,540 --> 00:13:01,660 that they were not addictive, 278 00:13:01,660 --> 00:13:04,100 like the benzodiazepines, 279 00:13:04,100 --> 00:13:06,300 and that they were relatively safe. 280 00:13:07,140 --> 00:13:10,100 Professor David Taylor is chief pharmacist 281 00:13:10,100 --> 00:13:13,620 at one of the UK's leading mental-health hospitals - 282 00:13:13,620 --> 00:13:15,900 The Maudsley in South London. 283 00:13:17,300 --> 00:13:19,980 DAVID TAYLOR: When we started with SSRIs 284 00:13:19,980 --> 00:13:23,700 we had an idea that they were effective 285 00:13:23,700 --> 00:13:26,060 and we were aware 286 00:13:26,060 --> 00:13:27,540 that they caused 287 00:13:27,540 --> 00:13:29,340 short-term side effects. 288 00:13:30,940 --> 00:13:33,220 Hello. Medication Helpline. 289 00:13:33,220 --> 00:13:35,700 The Maudsley ran a helpline in the '90s 290 00:13:35,700 --> 00:13:38,340 for people taking psychiatric drugs. 291 00:13:38,340 --> 00:13:38,580 It was striking for people taking psychiatric drugs. 292 00:13:38,580 --> 00:13:41,940 It was striking that we got so many calls 293 00:13:41,940 --> 00:13:44,900 from people who were having quite severe problems 294 00:13:44,900 --> 00:13:45,140 from people who were having stopping antidepressants 295 00:13:45,140 --> 00:13:46,420 stopping antidepressants 296 00:13:46,420 --> 00:13:52,540 and that those problems seem to go on for weeks or months. 297 00:13:52,540 --> 00:13:55,340 I remember we debated whether or not 298 00:13:55,340 --> 00:13:57,420 we thought that it was possible 299 00:13:57,420 --> 00:14:00,180 for those withdrawal effects to last that long 300 00:14:00,180 --> 00:14:05,020 or it was the case that there was some kind of psychosomatic disorder. 301 00:14:06,500 --> 00:14:08,260 Before the drugs were launched 302 00:14:08,260 --> 00:14:11,700 they were tested by manufacturers in clinical trials 303 00:14:11,700 --> 00:14:11,940 they were tested by manufacturers to assess safety and effectiveness. 304 00:14:11,940 --> 00:14:14,820 to assess safety and effectiveness. 305 00:14:14,820 --> 00:14:15,060 In early trials, withdrawal symptoms to assess safety and effectiveness. 306 00:14:15,060 --> 00:14:19,060 In early trials, withdrawal symptoms weren't closely studied. 307 00:14:19,060 --> 00:14:19,300 In early trials, withdrawal symptoms To my knowledge, 308 00:14:19,300 --> 00:14:20,860 To my knowledge, 309 00:14:20,860 --> 00:14:23,900 this wasn't looked at particularly carefully 310 00:14:23,900 --> 00:14:25,220 in the trials that were done. 311 00:14:25,220 --> 00:14:27,700 You only need to do studies for six weeks, 312 00:14:27,700 --> 00:14:30,180 so, we might not have seen withdrawal 313 00:14:30,180 --> 00:14:30,420 so, we might not after that short duration of use. 314 00:14:30,420 --> 00:14:32,660 after that short duration of use. 315 00:14:32,660 --> 00:14:33,940 For many drugs, 316 00:14:33,940 --> 00:14:35,460 the longer you take them 317 00:14:35,460 --> 00:14:39,780 the more likely you are to experience withdrawal when stopping. 318 00:14:39,780 --> 00:14:40,020 the more likely you are to experience Medicines are licensed 319 00:14:40,020 --> 00:14:43,340 Medicines are licensed 320 00:14:43,340 --> 00:14:43,580 before long-term studies Medicines are licensed 321 00:14:43,580 --> 00:14:46,060 before long-term studies have been done. 322 00:14:46,060 --> 00:14:46,300 before long-term studies And, again, this is about balancing 323 00:14:46,300 --> 00:14:48,540 And, again, this is about balancing 324 00:14:48,540 --> 00:14:51,620 the need to get effective medicines to patients 325 00:14:51,620 --> 00:14:55,140 and the risk of discovering something 326 00:14:55,140 --> 00:14:57,420 after we've licensed those medicines. 327 00:14:57,420 --> 00:15:01,140 There are very few trials that have lasted longer than six months 328 00:15:01,140 --> 00:15:04,660 and almost none that have lasted longer than a year. 329 00:15:04,660 --> 00:15:06,500 So, really, we can say 330 00:15:06,500 --> 00:15:08,260 that everyone who takes these drugs 331 00:15:08,260 --> 00:15:09,740 for more than a few weeks 332 00:15:09,740 --> 00:15:13,220 is taking part in a huge, unregulated experiment 333 00:15:13,220 --> 00:15:17,860 to find out what the long-term consequences of doing this are. 334 00:15:20,020 --> 00:15:24,300 Panorama has discovered, as evidence of withdrawal symptoms grew, 335 00:15:24,300 --> 00:15:28,980 one pharmaceutical company wanted to keep what it knew to itself. 336 00:15:30,180 --> 00:15:32,660 Your take on a few of these documents... 337 00:15:32,660 --> 00:15:32,900 Your take James Davies is a psychologist 338 00:15:32,900 --> 00:15:34,500 James Davies is a psychologist 339 00:15:34,500 --> 00:15:37,620 and campaigner on psychiatric drug harms. 340 00:15:37,620 --> 00:15:41,220 He's looking at a confidential Pfizer memo from 1996. 341 00:15:41,220 --> 00:15:45,140 In it staff discuss what the company will tell regulators in Norway 342 00:15:45,140 --> 00:15:45,380 In it staff discuss what the company about its drug sertraline. 343 00:15:45,380 --> 00:15:47,580 about its drug sertraline. 344 00:15:47,580 --> 00:15:49,300 It says... (READS) 345 00:15:58,700 --> 00:16:03,420 So, some of the withdrawal reactions they are listing here, 346 00:16:03,420 --> 00:16:08,300 we've got sensory disturbances, sweating, nausea, insomnia, 347 00:16:08,300 --> 00:16:12,300 tremors, agitation, anxiety. 348 00:16:13,260 --> 00:16:15,660 It's quite clear from this document 349 00:16:15,660 --> 00:16:20,980 they know that these effects exist, 350 00:16:20,980 --> 00:16:25,420 that they are hugely problematic. 351 00:16:25,420 --> 00:16:30,420 But this isn't translating often into the information 352 00:16:30,420 --> 00:16:33,380 that patients on the ground were getting, 353 00:16:33,380 --> 00:16:33,620 that patients on the ground presumably because it would affect 354 00:16:33,620 --> 00:16:35,420 presumably because it would affect 355 00:16:35,420 --> 00:16:35,660 the economic profile presumably because it would affect 356 00:16:35,660 --> 00:16:39,980 the economic profile of these medications. 357 00:16:41,260 --> 00:16:46,060 Pfizer says it's been "monitoring and reporting all adverse event data" 358 00:16:46,060 --> 00:16:47,620 to the licensing authorities 359 00:16:47,620 --> 00:16:51,020 "in line with its legal and regulatory obligations 360 00:16:51,020 --> 00:16:54,500 "and updated sertraline labelling as required." 361 00:16:54,500 --> 00:16:54,740 The MHRA, the UK's drug regulator, as required." 362 00:16:54,740 --> 00:16:57,580 The MHRA, the UK's drug regulator, 363 00:16:57,580 --> 00:16:57,820 The MHRA, the UK's drug regulator, to "conduct retrospective analyses 364 00:16:57,820 --> 00:17:03,180 says in 2003 it asked manufacturers to "conduct retrospective analyses 365 00:17:03,180 --> 00:17:03,420 "of their clinical trial data." to "conduct retrospective analyses 366 00:17:03,420 --> 00:17:05,380 "of their clinical trial data." 367 00:17:05,380 --> 00:17:08,820 It says it "led to more detailed information" on withdrawal 368 00:17:08,820 --> 00:17:09,060 being added to SSRI labelling. information" on withdrawal 369 00:17:09,060 --> 00:17:11,460 being added to SSRI labelling. 370 00:17:11,460 --> 00:17:11,660 being added to SSRI labelling. (SIREN WAILS) 371 00:17:11,660 --> 00:17:14,820 (SIREN WAILS) 372 00:17:17,300 --> 00:17:19,500 I'm Jerry Rosenbaum. 373 00:17:19,500 --> 00:17:22,380 I'm a professor of psychiatry at Harvard Medical School. 374 00:17:22,380 --> 00:17:24,260 During the early 1990s 375 00:17:24,260 --> 00:17:27,260 doctors at one of America's most prestigious hospitals 376 00:17:27,260 --> 00:17:30,300 also began noticing withdrawal symptoms. 377 00:17:30,300 --> 00:17:30,580 We had some pretty dramatic cases in our clinic also began noticing withdrawal symptoms. 378 00:17:30,580 --> 00:17:32,900 We had some pretty dramatic cases in our clinic 379 00:17:32,900 --> 00:17:35,180 of people with emergency-room visits. 380 00:17:35,180 --> 00:17:35,460 of people with emergency-room visits. We saw people have these symptoms. It was pretty clear. 381 00:17:35,460 --> 00:17:38,420 We saw people have these symptoms. It was pretty clear. 382 00:17:38,420 --> 00:17:41,940 I think at the time we thought it was rare. 383 00:17:41,940 --> 00:17:43,180 One of the professor's team 384 00:17:43,180 --> 00:17:45,380 was working on an industry-funded trial 385 00:17:45,380 --> 00:17:49,780 for a new antidepressant that also targeted serotonin. 386 00:17:49,780 --> 00:17:51,220 He did something, I guess, 387 00:17:51,220 --> 00:17:53,900 the drug company didn't necessarily approve of, 388 00:17:53,900 --> 00:17:54,140 the drug company which is, after the study was over, 389 00:17:54,140 --> 00:17:55,820 which is, after the study was over, 390 00:17:55,820 --> 00:17:58,300 he followed the patients as they discontinued 391 00:17:58,300 --> 00:17:59,540 and published a paper 392 00:17:59,540 --> 00:18:01,820 about the symptoms that emerged during that period. 393 00:18:04,060 --> 00:18:05,540 They published data 394 00:18:05,540 --> 00:18:05,780 showing 78% of those who'd taken the drug for eight weeks They published data 395 00:18:05,780 --> 00:18:09,260 showing 78% of those who'd taken the drug for eight weeks 396 00:18:09,260 --> 00:18:13,820 had some withdrawal symptoms within three days of stopping. 397 00:18:13,820 --> 00:18:17,100 Professor Rosenbaum went on to publish a study 398 00:18:17,100 --> 00:18:19,020 of three other antidepressants. 399 00:18:19,020 --> 00:18:21,620 For two of them - sertraline and paroxetine - 400 00:18:21,620 --> 00:18:24,260 more than half of patients who had taken the drugs 401 00:18:24,260 --> 00:18:26,780 for between four months and two years 402 00:18:26,780 --> 00:18:30,460 experienced withdrawal symptoms when they stopped. 403 00:18:30,460 --> 00:18:30,700 experienced withdrawal symptoms The interesting thing is, 404 00:18:30,700 --> 00:18:31,940 The interesting thing is, 405 00:18:31,940 --> 00:18:32,140 The interesting thing is, like all of psychiatry, 406 00:18:32,140 --> 00:18:34,380 like all of psychiatry, 407 00:18:34,380 --> 00:18:35,820 there was tremendous variation. 408 00:18:35,820 --> 00:18:36,060 I mean, there was a small group there was tremendous variation. 409 00:18:36,060 --> 00:18:38,500 I mean, there was a small group of people who had terrible effects 410 00:18:38,500 --> 00:18:41,020 and a larger group of people who didn't notice it. 411 00:18:41,020 --> 00:18:43,980 You know, it's something that doctors needed to be aware of 412 00:18:43,980 --> 00:18:46,820 because some of the cases that we saw 413 00:18:46,820 --> 00:18:50,180 were of people who were told there's no problem stopping these medicines. 414 00:18:50,180 --> 00:18:52,500 Highlighting evidence of withdrawal symptoms 415 00:18:52,500 --> 00:18:56,060 didn't go down well with the wider medical profession. 416 00:18:56,060 --> 00:18:57,300 It wasn't a message that, 417 00:18:57,300 --> 00:19:02,140 despite our, you know, position in this august institution, 418 00:19:02,140 --> 00:19:02,380 despite our, you know, got out very well. 419 00:19:02,380 --> 00:19:03,980 got out very well. 420 00:19:04,940 --> 00:19:10,060 I also personally got some negative feedback from colleagues 421 00:19:10,060 --> 00:19:10,300 I also personally got some about focusing on that issue, 422 00:19:10,300 --> 00:19:12,140 about focusing on that issue, 423 00:19:12,140 --> 00:19:16,420 saying that I was an adverse force for the field, 424 00:19:16,420 --> 00:19:19,220 that we worked so hard to get antidepressants, 425 00:19:19,220 --> 00:19:20,500 you know, acceptable. 426 00:19:22,380 --> 00:19:26,500 Pfizer no longer holds the license for sertraline. 427 00:19:26,500 --> 00:19:29,820 GlaxoSmithKline still makes paroxetine. 428 00:19:29,820 --> 00:19:33,620 They both say patients shouldn't stop treatment abruptly. 429 00:19:33,620 --> 00:19:33,860 They both say patients Any decision to stop 430 00:19:33,860 --> 00:19:35,700 Any decision to stop 431 00:19:35,700 --> 00:19:39,540 should always be taken in close consultation with your doctor. 432 00:19:40,500 --> 00:19:42,700 With limited research available, 433 00:19:42,700 --> 00:19:46,460 doctors were learning about antidepressants through experience. 434 00:19:46,460 --> 00:19:50,540 For The Maudsley's Professor Taylor, it was his own. 435 00:19:50,540 --> 00:19:53,620 He'd been taking antidepressants himself. 436 00:19:55,300 --> 00:20:00,660 I stopped taking antidepressants more than 20 years ago now, 437 00:20:00,660 --> 00:20:06,100 and I had in mind mild, transient and short-lived. 438 00:20:06,100 --> 00:20:08,380 And it was anything but. 439 00:20:08,380 --> 00:20:10,940 It was really quite an unpleasant experience, 440 00:20:10,940 --> 00:20:13,140 and that's probably an understatement. 441 00:20:13,140 --> 00:20:14,740 I was quite shocked by it. 442 00:20:14,740 --> 00:20:17,540 I gained from the experience 443 00:20:17,540 --> 00:20:22,420 and was better able to appreciate what other people were telling me. 444 00:20:24,820 --> 00:20:26,860 In the mental-health sphere 445 00:20:26,860 --> 00:20:31,380 we're quite good at making the same mistake more than once. 446 00:20:32,340 --> 00:20:36,620 And I suspect people felt that we wouldn't let that happen again, 447 00:20:36,620 --> 00:20:39,420 we wouldn't allow an introduction of a group of drugs 448 00:20:39,420 --> 00:20:39,660 we wouldn't allow which seemed to work really well 449 00:20:39,660 --> 00:20:41,900 which seemed to work really well 450 00:20:41,900 --> 00:20:46,460 but then later find that it was difficult for people to stop them. 451 00:20:46,460 --> 00:20:51,020 But that is pretty much what's happened with SSRIs. 452 00:20:51,020 --> 00:20:56,060 Withdrawal symptoms can be similar to those of depression and anxiety. 453 00:20:56,060 --> 00:20:56,300 Withdrawal symptoms can be similar They're sometimes mistaken 454 00:20:56,300 --> 00:20:57,540 They're sometimes mistaken 455 00:20:57,540 --> 00:21:01,660 for a return of the condition the drugs were prescribed to treat. 456 00:21:01,660 --> 00:21:06,260 Change in mood, change in sleep, anxiety, panic. 457 00:21:06,260 --> 00:21:06,500 Change in mood, change in sleep, Those kinds of symptoms 458 00:21:06,500 --> 00:21:08,740 Those kinds of symptoms 459 00:21:08,740 --> 00:21:10,060 are quite common. 460 00:21:10,060 --> 00:21:12,500 There are also physical symptoms, 461 00:21:12,500 --> 00:21:15,740 so, dizziness, 462 00:21:15,740 --> 00:21:18,260 changes in digestion, 463 00:21:18,260 --> 00:21:21,900 strange physical symptoms, which people call 'brain zaps'. 464 00:21:21,900 --> 00:21:22,140 strange physical symptoms, Because of this overlap 465 00:21:22,140 --> 00:21:23,580 Because of this overlap 466 00:21:23,580 --> 00:21:25,620 it's often quite difficult to know 467 00:21:25,620 --> 00:21:27,820 in the early stages of coming off an antidepressant 468 00:21:27,820 --> 00:21:31,100 whether a person is simply getting withdrawal symptoms 469 00:21:31,100 --> 00:21:31,340 whether a person is simply or they're becoming depressed. 470 00:21:31,340 --> 00:21:32,860 or they're becoming depressed. 471 00:21:32,860 --> 00:21:33,100 WENDY BURN: People are staying or they're becoming depressed. 472 00:21:33,100 --> 00:21:34,740 WENDY BURN: People are staying on antidepressants 473 00:21:34,740 --> 00:21:34,980 WENDY BURN: People are staying for longer and longer. 474 00:21:34,980 --> 00:21:36,220 for longer and longer. 475 00:21:36,220 --> 00:21:36,460 And we don't really have long-term studies that support that. for longer and longer. 476 00:21:36,460 --> 00:21:40,340 And we don't really have long-term studies that support that. 477 00:21:40,340 --> 00:21:42,180 And, you know, the drugs DO have side effects. 478 00:21:42,180 --> 00:21:42,420 And, you know, the drugs DO have side effects. You shouldn't just stay on them 479 00:21:42,420 --> 00:21:43,660 You shouldn't just stay on them 480 00:21:43,660 --> 00:21:46,380 without ever thinking about coming off them. 481 00:21:46,380 --> 00:21:48,820 I would suggest that anyone who's on an antidepressant 482 00:21:48,820 --> 00:21:51,220 should have their treatment reviewed every six months. 483 00:21:51,220 --> 00:21:52,900 And you must never stop an antidepressant 484 00:21:52,900 --> 00:21:54,540 without discussing it with your doctor. 485 00:21:57,300 --> 00:21:58,780 VIDEO PRESENTER: Imagine a world 486 00:21:58,780 --> 00:22:00,260 where every word ever written 487 00:22:00,260 --> 00:22:02,740 could be viewed instantly in your home 488 00:22:02,740 --> 00:22:04,980 via an information superhighway. 489 00:22:04,980 --> 00:22:06,780 By the early 2000s 490 00:22:06,780 --> 00:22:08,980 the Internet began connecting people 491 00:22:08,980 --> 00:22:12,540 who were experiencing problems with their drugs. 492 00:22:12,540 --> 00:22:15,020 ADELE FRAMER: I already knew about using the web. 493 00:22:15,020 --> 00:22:18,140 I was an early adopter of the Internet. 494 00:22:18,140 --> 00:22:22,060 Adele Framer was working as a software consultant 495 00:22:22,060 --> 00:22:26,700 before she says antidepressant withdrawal forced her to quit. 496 00:22:26,700 --> 00:22:29,940 Her doctors thought she was relapsing. 497 00:22:29,940 --> 00:22:30,220 It was clear to me that I was not having a relapse Her doctors thought she was relapsing. 498 00:22:30,220 --> 00:22:35,060 It was clear to me that I was not having a relapse 499 00:22:35,060 --> 00:22:35,340 It was clear to me that I was not having a relapse because I'd never experienced those symptoms before. 500 00:22:35,340 --> 00:22:37,380 because I'd never experienced those symptoms before. 501 00:22:37,380 --> 00:22:37,620 because I'd never experienced They were really strange. 502 00:22:37,620 --> 00:22:39,500 They were really strange. 503 00:22:40,700 --> 00:22:45,940 Adele set up a support group called Surviving Antidepressants. 504 00:22:45,940 --> 00:22:47,860 Almost everybody who comes to my site 505 00:22:47,860 --> 00:22:48,100 Almost everybody has been told that they've relapsed. 506 00:22:48,100 --> 00:22:50,060 has been told that they've relapsed. 507 00:22:50,060 --> 00:22:50,300 They've been told has been told that they've relapsed. 508 00:22:50,300 --> 00:22:52,140 They've been told that their withdrawal symptoms 509 00:22:52,140 --> 00:22:54,700 are depression or anxiety or whatever. 510 00:22:54,700 --> 00:22:54,940 are depression or anxiety This is a very universal experience. 511 00:22:54,940 --> 00:22:58,460 This is a very universal experience. 512 00:22:59,420 --> 00:23:01,260 AUDREY BAHRICK: The Internet changed everything 513 00:23:01,260 --> 00:23:06,300 for people who were experiencing psychiatric drug harms 514 00:23:06,300 --> 00:23:06,540 for people who were experiencing that were undocumented. 515 00:23:06,540 --> 00:23:08,780 that were undocumented. 516 00:23:08,780 --> 00:23:10,260 We found each other. 517 00:23:15,340 --> 00:23:18,420 All along I believed I couldn't be alone, 518 00:23:18,420 --> 00:23:21,340 but I never had any evidence that I wasn't alone. 519 00:23:22,540 --> 00:23:25,060 It was a very lonely journey 520 00:23:25,060 --> 00:23:30,500 and it became progressively more isolating. 521 00:23:30,500 --> 00:23:33,020 Mostly I wanted to just be believed. 522 00:23:33,020 --> 00:23:37,260 And in one of my routine searches on the Internet, 523 00:23:37,260 --> 00:23:37,500 And in one of my routine searches I found, oh, my gosh, 524 00:23:37,500 --> 00:23:39,740 I found, oh, my gosh, 525 00:23:39,740 --> 00:23:42,460 someone had started a support group 526 00:23:42,460 --> 00:23:47,420 for people who had enduring sexual dysfunction after stopping SSRIs. 527 00:23:49,620 --> 00:23:51,500 Audrey began publishing 528 00:23:51,500 --> 00:23:51,740 some of the first ever Audrey began publishing 529 00:23:51,740 --> 00:23:55,460 some of the first ever academic papers on her condition. 530 00:23:55,460 --> 00:23:55,700 some of the first ever It's become known as PSSD - 531 00:23:55,700 --> 00:23:58,060 It's become known as PSSD - 532 00:23:58,060 --> 00:24:01,100 post-SSRI sexual dysfunction. 533 00:24:02,060 --> 00:24:03,740 A large part of my motivation 534 00:24:03,740 --> 00:24:07,340 was to put out some papers into the world 535 00:24:07,340 --> 00:24:11,020 that could be downloaded and brought to their physician 536 00:24:11,020 --> 00:24:11,260 that could be downloaded or brought to their prescriber. 537 00:24:11,260 --> 00:24:12,580 or brought to their prescriber. 538 00:24:12,580 --> 00:24:12,820 I don't want anybody to ever have to or brought to their prescriber. 539 00:24:12,820 --> 00:24:16,900 I don't want anybody to ever have to go through what I've gone through. 540 00:24:29,140 --> 00:24:34,260 So, this is me writing in 2019. 541 00:24:34,260 --> 00:24:35,660 "Hello. 542 00:24:35,660 --> 00:24:37,460 "I feel so depressed and depersonalised 543 00:24:37,460 --> 00:24:37,700 "I feel so depressed "and fatigued at times. 544 00:24:37,700 --> 00:24:38,940 "and fatigued at times. 545 00:24:38,940 --> 00:24:40,820 "I'm not sure what to do with myself. 546 00:24:40,820 --> 00:24:41,860 "If it IS withdrawal, 547 00:24:41,860 --> 00:24:43,900 "then I really hope that it can't last too much longer 548 00:24:43,900 --> 00:24:46,220 "because it is sapping my will to keep going." 549 00:24:52,020 --> 00:24:54,500 It just reminds me of how upsetting it was. 550 00:24:54,500 --> 00:24:57,780 I'm a bit.... I'm in a better place than I was then, 551 00:24:57,780 --> 00:24:58,020 I'm a bit.... I'm in a better place but it was a very hard process. 552 00:24:58,020 --> 00:24:59,460 but it was a very hard process. 553 00:24:59,460 --> 00:25:01,220 It's a bit upsetting to read it. 554 00:25:02,180 --> 00:25:03,460 At the time 555 00:25:03,460 --> 00:25:05,380 UK guidelines advised 556 00:25:05,380 --> 00:25:05,620 steadily reducing or tapering UK guidelines advised 557 00:25:05,620 --> 00:25:08,180 steadily reducing or tapering an antidepressant dose 558 00:25:08,180 --> 00:25:08,420 steadily reducing or tapering over four weeks. 559 00:25:08,420 --> 00:25:09,700 over four weeks. 560 00:25:10,660 --> 00:25:15,860 They said withdrawal would be generally mild and short-lived. 561 00:25:15,860 --> 00:25:20,740 Mark had already tried to stop his antidepressant, but couldn't, 562 00:25:20,740 --> 00:25:20,980 Mark had already tried to stop so, he looked for advice online 563 00:25:20,980 --> 00:25:22,580 so, he looked for advice online 564 00:25:22,580 --> 00:25:24,620 and found Adele's site. 565 00:25:24,620 --> 00:25:27,020 Online I was getting advice 566 00:25:27,020 --> 00:25:31,420 from retired engineers and firemen and housewives. 567 00:25:31,420 --> 00:25:31,660 from retired engineers and firemen It was clear who the experts were. 568 00:25:31,660 --> 00:25:33,620 It was clear who the experts were. 569 00:25:33,620 --> 00:25:36,100 People said it took months to come off. 570 00:25:36,100 --> 00:25:38,060 It took more than a year for some of them 571 00:25:38,060 --> 00:25:40,300 and it took several years for quite a few of them. 572 00:25:40,300 --> 00:25:41,940 I could see that a lot of people were coming down 573 00:25:41,940 --> 00:25:46,100 by very small amounts of their drug as they got down to lower doses, 574 00:25:46,100 --> 00:25:47,900 by smaller and smaller amounts. 575 00:25:47,900 --> 00:25:49,780 And the reason they were doing that 576 00:25:49,780 --> 00:25:51,260 is because they felt 577 00:25:51,260 --> 00:25:53,060 that their withdrawal symptoms 578 00:25:53,060 --> 00:25:53,300 became more pronounced that their withdrawal symptoms 579 00:25:53,300 --> 00:25:55,860 became more pronounced at lower doses, 580 00:25:55,860 --> 00:25:58,060 which was...you might think is a bit surprising, 581 00:25:58,060 --> 00:25:59,740 you might think you're on less of the drug, 582 00:25:59,740 --> 00:25:59,980 you might think it should be easier to come off. 583 00:25:59,980 --> 00:26:01,580 it should be easier to come off. 584 00:26:01,580 --> 00:26:03,020 But I heard it again and again, 585 00:26:03,020 --> 00:26:05,060 people saying it's these small doses 586 00:26:05,060 --> 00:26:07,220 that are particularly hard to come off. 587 00:26:07,220 --> 00:26:10,940 Many drugs don't come in such small doses, 588 00:26:10,940 --> 00:26:14,740 so, some people who are struggling found creative solutions. 589 00:26:14,740 --> 00:26:17,260 They were grinding up tablets with nail files 590 00:26:17,260 --> 00:26:20,460 and measuring them with jeweller's scales. 591 00:26:20,460 --> 00:26:21,940 They were making liquids 592 00:26:21,940 --> 00:26:23,780 by crushing them and making liquids 593 00:26:23,780 --> 00:26:25,660 and using syringes to measure them out. 594 00:26:25,660 --> 00:26:28,980 They were opening up capsules to count beads. 595 00:26:29,980 --> 00:26:32,020 As I followed their guidelines and slowly came off, 596 00:26:32,020 --> 00:26:35,100 it was a lot easier than when I came off more quickly. 597 00:26:35,100 --> 00:26:37,900 Tiredness, memory trouble, concentration issues 598 00:26:37,900 --> 00:26:39,140 started to improve, 599 00:26:39,140 --> 00:26:43,060 which was, I should say, you know, a huge gift to me. 600 00:26:43,060 --> 00:26:47,620 Mark then teamed up with The Maudsley's Professor David Taylor. 601 00:26:47,620 --> 00:26:52,060 Together they wrote the first paper on how to ease withdrawal symptoms 602 00:26:52,060 --> 00:26:54,620 by tapering the dose very slowly. 603 00:26:54,620 --> 00:26:58,700 It was published 30 years after the launch of Prozac. 604 00:26:58,700 --> 00:27:02,980 The way I see it is half the field is empty in psychiatry. 605 00:27:02,980 --> 00:27:05,220 All the papers, all the textbooks, all the research 606 00:27:05,220 --> 00:27:07,460 is about how to start the drugs, 607 00:27:07,460 --> 00:27:09,700 and there's almost no research and guidelines 608 00:27:09,700 --> 00:27:11,100 on how to stop the drugs. 609 00:27:11,100 --> 00:27:11,340 To me, it's the same as allowing on how to stop the drugs. 610 00:27:11,340 --> 00:27:14,540 To me, it's the same as allowing cars to be sold without brakes. 611 00:27:14,540 --> 00:27:17,100 We should know how to start the car and how to stop it. 612 00:27:26,420 --> 00:27:27,980 I remember very clearly 613 00:27:27,980 --> 00:27:28,220 when I first went into I remember very clearly 614 00:27:28,220 --> 00:27:31,300 when I first went into severe withdrawal 615 00:27:31,300 --> 00:27:34,540 looking it up on the Internet 616 00:27:34,540 --> 00:27:34,780 looking it up and I was absolutely horrified 617 00:27:34,780 --> 00:27:37,180 and I was absolutely horrified 618 00:27:37,180 --> 00:27:41,980 because I saw that so many people were suffering the same thing. 619 00:27:41,980 --> 00:27:44,780 And I didn't know about any of this. I hadn't been warned. 620 00:27:44,780 --> 00:27:49,340 Luke Montagu took Prozac for more than a decade. 621 00:27:49,340 --> 00:27:54,860 When I stopped the Prozac and I had these severe withdrawal reactions 622 00:27:54,860 --> 00:27:57,260 I thought that that was evidence that I was really ill 623 00:27:57,260 --> 00:28:01,500 and that I needed the drug in order to survive. 624 00:28:01,500 --> 00:28:04,380 I used to think of myself as being held together 625 00:28:04,380 --> 00:28:04,620 I used to think of myself by pieces of chemical string. 626 00:28:04,620 --> 00:28:06,660 by pieces of chemical string. 627 00:28:06,660 --> 00:28:06,900 I remember thinking about that by pieces of chemical string. 628 00:28:06,900 --> 00:28:08,900 I remember thinking about that at the time. 629 00:28:08,900 --> 00:28:12,380 And we just didn't know that it was withdrawal. 630 00:28:12,380 --> 00:28:15,780 And, of course, that then led to the misdiagnosis 631 00:28:15,780 --> 00:28:20,500 of more things that were wrong with me for which more drugs were added. 632 00:28:21,460 --> 00:28:24,500 By now he was on another antidepressant. 633 00:28:24,500 --> 00:28:27,980 When Luke tried to stop taking all the drugs a few years later 634 00:28:27,980 --> 00:28:33,220 he says the withdrawal was so bad he couldn't leave home for three years. 635 00:28:33,220 --> 00:28:36,980 I could at least read online and I could go to websites, 636 00:28:36,980 --> 00:28:40,540 and it was really the volume of people online 637 00:28:40,540 --> 00:28:43,580 suffering in the same way, with the same story, 638 00:28:43,580 --> 00:28:45,220 being left on them long-term, 639 00:28:45,220 --> 00:28:48,260 coming off them, suffering horrendous withdrawal, 640 00:28:48,260 --> 00:28:51,900 and then, critically, having that withdrawal denied, 641 00:28:51,900 --> 00:28:55,420 having the harms denied by the doctors. 642 00:28:55,420 --> 00:28:58,100 And that was my story. Exactly that had happened to me. 643 00:28:58,100 --> 00:28:58,340 And that was my story. And that made me think 644 00:28:58,340 --> 00:28:59,580 And that made me think 645 00:28:59,580 --> 00:29:04,780 that, really, there was a profound problem with the system 646 00:29:04,780 --> 00:29:07,100 and that if I was going to recover 647 00:29:07,100 --> 00:29:10,420 I was going to try and do something about that. 648 00:29:11,620 --> 00:29:15,500 Luke contacted the psychologist James Davies. 649 00:29:15,500 --> 00:29:18,980 He and I got together and we thought, "What can we do to help?" 650 00:29:18,980 --> 00:29:21,860 The critical thing was to get to the experts, 651 00:29:21,860 --> 00:29:24,380 because, ultimately, if things were going to change, 652 00:29:24,380 --> 00:29:26,940 we needed to change the opinion of experts. 653 00:29:26,940 --> 00:29:27,220 There was something that always perplexed us, we needed to change the opinion of experts. 654 00:29:27,220 --> 00:29:31,020 There was something that always perplexed us, 655 00:29:31,020 --> 00:29:31,260 There was something and it was this massive disjunct 656 00:29:31,260 --> 00:29:33,500 and it was this massive disjunct 657 00:29:33,500 --> 00:29:33,740 and it was this massive disjunct between what the guidelines were saying, 658 00:29:33,740 --> 00:29:36,020 between what the guidelines were saying, 659 00:29:36,020 --> 00:29:37,940 that antidepressant withdrawal 660 00:29:37,940 --> 00:29:42,700 is usually mild, self-limiting, resolving over a week, 661 00:29:42,700 --> 00:29:45,820 and what we were encountering online. 662 00:29:46,780 --> 00:29:50,060 James and Luke wrote a letter to The Times newspaper 663 00:29:50,060 --> 00:29:55,500 saying antidepressant withdrawal can be disabling for many patients. 664 00:29:55,500 --> 00:29:55,740 saying antidepressant withdrawal It was 2018 665 00:29:55,740 --> 00:29:57,140 It was 2018 666 00:29:57,140 --> 00:29:58,940 and it started a public debate 667 00:29:58,940 --> 00:29:59,180 with the then-president of and it started a public debate 668 00:29:59,180 --> 00:30:03,140 with the then-president of the Royal College of Psychiatrists. 669 00:30:04,100 --> 00:30:05,620 WENDY BURN: I replied 670 00:30:05,620 --> 00:30:06,980 saying that antidepressants DID work 671 00:30:06,980 --> 00:30:07,180 and also talking about withdrawal saying that antidepressants DID work 672 00:30:07,180 --> 00:30:08,980 and also talking about withdrawal 673 00:30:08,980 --> 00:30:11,900 and saying that withdrawal wasn't really a problem. 674 00:30:11,900 --> 00:30:12,180 and saying that withdrawal wasn't really a problem. I didn't really expect anything to come of that. 675 00:30:12,180 --> 00:30:13,980 I didn't really expect anything to come of that. 676 00:30:13,980 --> 00:30:15,420 It was really quite a kind of, you know, 677 00:30:15,420 --> 00:30:19,380 casual send a letter to The Times, which when you're president, you do. 678 00:30:19,380 --> 00:30:19,620 casual send a letter to The Times, You do quite a lot. 679 00:30:19,620 --> 00:30:20,940 You do quite a lot. 680 00:30:20,940 --> 00:30:25,140 But people got really upset and really angry. 681 00:30:25,140 --> 00:30:28,420 I think Wendy found herself in a really difficult position 682 00:30:28,420 --> 00:30:28,660 I think Wendy found herself because, on the one hand, 683 00:30:28,660 --> 00:30:30,140 because, on the one hand, 684 00:30:30,140 --> 00:30:33,340 she had a lot of her members, a lot of psychiatrists, 685 00:30:33,340 --> 00:30:33,580 she had a lot of her members, who had promoted this story 686 00:30:33,580 --> 00:30:36,620 who had promoted this story 687 00:30:36,620 --> 00:30:36,860 that antidepressant withdrawal who had promoted this story 688 00:30:36,860 --> 00:30:40,460 that antidepressant withdrawal was mild and short-lived, 689 00:30:40,460 --> 00:30:40,700 that antidepressant withdrawal and then, at the same time, 690 00:30:40,700 --> 00:30:42,380 and then, at the same time, 691 00:30:42,380 --> 00:30:46,980 she had all of these patients and campaign groups 692 00:30:46,980 --> 00:30:49,380 coming to her and saying, "This isn't true at all." 693 00:30:49,380 --> 00:30:52,940 I was realising that the college had got it wrong. 694 00:30:52,940 --> 00:30:57,140 So, then we had to work out how to put things right. 695 00:30:58,740 --> 00:31:03,220 She asked two experts who'd both experienced withdrawal themselves 696 00:31:03,220 --> 00:31:03,460 She asked two experts who'd both to help. 697 00:31:03,460 --> 00:31:04,820 to help. 698 00:31:04,820 --> 00:31:06,740 We had a lot of input from different people, 699 00:31:06,740 --> 00:31:06,980 We had a lot of input but two of the big influence 700 00:31:06,980 --> 00:31:08,500 but two of the big influence 701 00:31:08,500 --> 00:31:08,740 were Professor David Taylor but two of the big influence 702 00:31:08,740 --> 00:31:12,220 were Professor David Taylor and Dr Mark Horowitz. 703 00:31:12,220 --> 00:31:16,780 They produced a patient information leaflet on withdrawal 704 00:31:16,780 --> 00:31:19,380 and how to taper the dose. 705 00:31:19,380 --> 00:31:21,780 We thought, if patients are getting withdrawal symptoms, 706 00:31:21,780 --> 00:31:22,980 they can show it to their doctor and say, 707 00:31:22,980 --> 00:31:24,460 "Look, the Royal College of Psychiatrists 708 00:31:24,460 --> 00:31:24,700 "Look, the Royal College "says that withdrawal is a thing 709 00:31:24,700 --> 00:31:25,940 "says that withdrawal is a thing 710 00:31:25,940 --> 00:31:26,180 "and this is how "says that withdrawal is a thing 711 00:31:26,180 --> 00:31:28,660 "and this is how you might experience it." 712 00:31:28,660 --> 00:31:28,900 "and this is how For us, it was a significant U-turn. 713 00:31:28,900 --> 00:31:31,300 For us, it was a significant U-turn. 714 00:31:31,300 --> 00:31:33,180 This was the first time 715 00:31:33,180 --> 00:31:36,540 a major psychiatric organisation 716 00:31:36,540 --> 00:31:36,780 like the Royal College a major psychiatric organisation 717 00:31:36,780 --> 00:31:38,660 like the Royal College of Psychiatrists 718 00:31:38,660 --> 00:31:38,900 like the Royal College had stepped up and acknowledged 719 00:31:38,900 --> 00:31:40,460 had stepped up and acknowledged 720 00:31:40,460 --> 00:31:42,740 a problem that had been there for a long time. 721 00:31:42,740 --> 00:31:46,740 We felt patients on the ground had been vindicated. 722 00:31:48,100 --> 00:31:53,940 I think now people accept that a small minority of people 723 00:31:53,940 --> 00:31:54,220 will have significant difficulty in stopping antidepressants I think now people accept that a small minority of people 724 00:31:54,220 --> 00:31:57,900 will have significant difficulty in stopping antidepressants 725 00:31:57,900 --> 00:31:58,140 will have significant difficulty and they'll get withdrawal symptoms, 726 00:31:58,140 --> 00:32:00,020 and they'll get withdrawal symptoms, 727 00:32:00,020 --> 00:32:00,220 and they'll get withdrawal symptoms, which are severe 728 00:32:00,220 --> 00:32:02,460 which are severe 729 00:32:02,460 --> 00:32:04,820 inasmuch as that they are difficult to tolerate 730 00:32:04,820 --> 00:32:08,700 and they can go on for a very long time. 731 00:32:08,700 --> 00:32:12,180 Professor Burn is no longer president of the Royal College. 732 00:32:12,180 --> 00:32:14,300 She's still a practising psychiatrist 733 00:32:14,300 --> 00:32:14,540 She's still and personally regrets 734 00:32:14,540 --> 00:32:15,780 and personally regrets 735 00:32:15,780 --> 00:32:20,300 that severe and long-lasting withdrawal wasn't recognised sooner. 736 00:32:20,300 --> 00:32:24,260 I can't really explain why it took...why it took so long, 737 00:32:24,260 --> 00:32:27,380 perhaps partly because of the overlap 738 00:32:27,380 --> 00:32:27,620 perhaps partly between relapse and withdrawal. 739 00:32:27,620 --> 00:32:29,420 between relapse and withdrawal. 740 00:32:29,420 --> 00:32:31,980 I don't know. I can't really explain it. 741 00:32:31,980 --> 00:32:36,260 Do you feel like there's an apology that should be made? 742 00:32:36,260 --> 00:32:37,180 I guess, yes. 743 00:32:37,180 --> 00:32:39,180 If there's anybody watching who's gone through withdrawal 744 00:32:39,180 --> 00:32:39,420 If there's anybody watching and it wasn't recognised, 745 00:32:39,420 --> 00:32:40,740 and it wasn't recognised, 746 00:32:40,740 --> 00:32:43,140 then I'm very sorry. 747 00:32:45,140 --> 00:32:46,820 In the US 748 00:32:46,820 --> 00:32:48,420 Audrey had been trying for years 749 00:32:48,420 --> 00:32:53,140 to get recognition for the serious sexual side effects of SSRIs. 750 00:32:53,140 --> 00:32:59,460 I vigorously reached out to dozens of health journalists. 751 00:32:59,460 --> 00:33:04,500 Every major newspaper in a big city I wrote to them. 752 00:33:04,500 --> 00:33:07,300 All those efforts resulted in just a couple nibbles 753 00:33:07,300 --> 00:33:07,540 All those efforts but no follow-through. 754 00:33:07,540 --> 00:33:11,180 but no follow-through. 755 00:33:11,180 --> 00:33:13,980 It appeared no-one wanted to listen. 756 00:33:13,980 --> 00:33:15,580 You know, you'd think to yourself, 757 00:33:15,580 --> 00:33:15,820 "Sex - the media will be interested You know, you'd think to yourself, 758 00:33:15,820 --> 00:33:18,580 "Sex - the media will be interested in sex." 759 00:33:18,580 --> 00:33:18,820 It was just the opposite. "Sex - the media will be interested in sex." 760 00:33:18,820 --> 00:33:20,220 It was just the opposite. 761 00:33:20,220 --> 00:33:21,700 You know, you mentioned sex, 762 00:33:21,700 --> 00:33:23,420 and the media shut down. 763 00:33:24,860 --> 00:33:26,220 By 2019 764 00:33:26,220 --> 00:33:28,660 there were 93.6 million 765 00:33:28,660 --> 00:33:29,980 prescriptions in the UK 766 00:33:29,980 --> 00:33:32,700 for all types of antidepressants. 767 00:33:32,700 --> 00:33:34,380 The number had almost doubled 768 00:33:34,380 --> 00:33:34,620 The number had in a decade. 769 00:33:34,620 --> 00:33:35,980 in a decade. 770 00:33:35,980 --> 00:33:36,220 in a decade. Now even rarer SSRI side effects were being more widely discussed. 771 00:33:36,220 --> 00:33:40,980 Now even rarer SSRI side effects were being more widely discussed. 772 00:33:42,540 --> 00:33:46,460 People suffering with post-SSRI sexual dysfunction 773 00:33:46,460 --> 00:33:50,420 also began to find each other and raise awareness. 774 00:33:52,580 --> 00:33:54,340 The UK's medicines regulator 775 00:33:54,340 --> 00:33:55,780 has been receiving reports 776 00:33:55,780 --> 00:34:00,180 of persistent sexual side effects since 1991. 777 00:34:00,180 --> 00:34:02,420 Two internal reviews later concluded 778 00:34:02,420 --> 00:34:06,500 there was insufficient data to issue any warnings. 779 00:34:06,500 --> 00:34:10,260 We don't know much about the prevalence of PSSD. 780 00:34:10,260 --> 00:34:13,340 There haven't been any systematic surveys. 781 00:34:13,340 --> 00:34:13,580 There haven't been We don't know how common it is. 782 00:34:13,580 --> 00:34:15,380 We don't know how common it is. 783 00:34:15,380 --> 00:34:20,300 But what I would say is that, even if it's quite uncommon, 784 00:34:20,300 --> 00:34:23,660 antidepressants are being used so commonly now 785 00:34:23,660 --> 00:34:27,940 that that would still amount to a substantial number of people. 786 00:34:30,180 --> 00:34:31,700 It's absolutely horrendous. 787 00:34:31,700 --> 00:34:31,940 It flipped whatever plans and future It's absolutely horrendous. 788 00:34:31,940 --> 00:34:37,180 It flipped whatever plans and future I had for my life upside down. 789 00:34:37,180 --> 00:34:41,340 Like, I almost laugh at the fact that I used to think I was suffering 790 00:34:41,340 --> 00:34:41,580 Like, I almost laugh at the fact that I used to think I was suffering until I got this. 791 00:34:41,580 --> 00:34:42,540 until I got this. 792 00:34:42,540 --> 00:34:42,740 I require medical attention, until I got this. 793 00:34:42,740 --> 00:34:44,540 I require medical attention, 794 00:34:44,540 --> 00:34:44,780 but there is no medical assistance I require medical attention, 795 00:34:44,780 --> 00:34:47,460 but there is no medical assistance to be found for this condition 796 00:34:47,460 --> 00:34:47,740 but there is no medical assistance as it is underreported and understudied. 797 00:34:47,740 --> 00:34:49,780 as it is underreported and understudied. 798 00:34:49,780 --> 00:34:52,860 An acknowledgement that sexual side effects can persist 799 00:34:52,860 --> 00:34:54,100 after stopping the drugs 800 00:34:54,100 --> 00:34:59,100 was finally added to SSRI patient leaflets in 2019. 801 00:34:59,100 --> 00:34:59,380 I just feel like I've been completely done over to SSRI patient leaflets in 2019. 802 00:34:59,380 --> 00:35:01,660 I just feel like I've been completely done over 803 00:35:01,660 --> 00:35:03,300 by the medical community. 804 00:35:03,300 --> 00:35:03,500 by the medical community. They've updated their packaging, 805 00:35:03,500 --> 00:35:04,900 They've updated their packaging, 806 00:35:04,900 --> 00:35:06,500 but it still doesn't reflect 807 00:35:06,500 --> 00:35:10,580 the fact that you can be permanently chemically castrated. 808 00:35:10,580 --> 00:35:15,060 To this day we've got doctors simply not believing people 809 00:35:15,060 --> 00:35:16,940 when they say that this can happen. 810 00:35:16,940 --> 00:35:20,500 You know, so, that's still the experience of a lot of people. 811 00:35:20,500 --> 00:35:20,740 You know, so, that's still It adds to the awful problem. 812 00:35:20,740 --> 00:35:22,500 It adds to the awful problem. 813 00:35:22,500 --> 00:35:26,180 This isn't saying that you won't recover. 814 00:35:26,180 --> 00:35:29,140 We need to hang on to the hope of recovery 815 00:35:29,140 --> 00:35:31,340 and the fact that there is more research happening. 816 00:35:31,340 --> 00:35:35,340 So, this hope is hopefully getting stronger. 817 00:35:35,340 --> 00:35:35,620 All I can do is just hope So, this hope is hopefully getting stronger. 818 00:35:35,620 --> 00:35:40,460 All I can do is just hope that my body knows what to do 819 00:35:40,460 --> 00:35:40,700 All I can do is just hope and it can go back 820 00:35:40,700 --> 00:35:42,420 and it can go back 821 00:35:42,420 --> 00:35:47,380 to the way that it used to be before I took this medication. 822 00:35:50,780 --> 00:35:52,420 In 2021 823 00:35:52,420 --> 00:35:55,100 the number of antidepressant prescriptions in the UK 824 00:35:55,100 --> 00:35:55,380 reached 100 million. the number of antidepressant prescriptions in the UK 825 00:35:55,380 --> 00:35:57,940 reached 100 million. 826 00:35:59,660 --> 00:36:01,700 With 1-in-7 of us taking them, 827 00:36:01,700 --> 00:36:06,700 understanding the benefits and the risks is more important than ever. 828 00:36:08,580 --> 00:36:13,220 They've actually saved the lives of many hundreds of thousands of people 829 00:36:13,220 --> 00:36:13,460 and they've allowed people to cope They've actually saved the lives of many hundreds of thousands of people 830 00:36:13,460 --> 00:36:14,620 and they've allowed people to cope 831 00:36:14,620 --> 00:36:18,540 with what is becoming a more and more stressful society. 832 00:36:18,540 --> 00:36:22,220 And it might be a lot worse without them. 833 00:36:23,580 --> 00:36:25,260 While many doctors report 834 00:36:25,260 --> 00:36:27,940 their patients often improve on antidepressants, 835 00:36:27,940 --> 00:36:28,180 their patients over the last 15 years 836 00:36:28,180 --> 00:36:29,740 over the last 15 years 837 00:36:29,740 --> 00:36:29,980 how well they work has been over the last 15 years 838 00:36:29,980 --> 00:36:34,260 how well they work has been increasingly called into question. 839 00:36:36,420 --> 00:36:37,700 My name is Erick Turner. 840 00:36:37,700 --> 00:36:40,100 I'm a former FDA reviewer 841 00:36:40,100 --> 00:36:42,060 and before that 842 00:36:42,060 --> 00:36:45,860 a research fellow at National Institute of Mental Health. 843 00:36:45,860 --> 00:36:49,100 When Erick Turner joined the US regulator, 844 00:36:49,100 --> 00:36:49,340 When Erick Turner the Food And Drug Administration, 845 00:36:49,340 --> 00:36:51,380 the Food And Drug Administration, 846 00:36:51,380 --> 00:36:51,620 he'd been prescribing antidepressants the Food And Drug Administration, 847 00:36:51,620 --> 00:36:54,700 he'd been prescribing antidepressants as a psychiatrist. 848 00:36:54,700 --> 00:36:58,380 He'd also researched them as an academic. 849 00:36:58,380 --> 00:36:58,620 When I came to the FDA He'd also researched them as an academic. 850 00:36:58,620 --> 00:37:00,060 When I came to the FDA 851 00:37:00,060 --> 00:37:03,460 it was the spring of 1998. 852 00:37:04,420 --> 00:37:07,860 I thought I knew all about how well drugs work. 853 00:37:07,860 --> 00:37:12,340 And once I got there I found out that I didn't. 854 00:37:12,340 --> 00:37:13,780 I didn't know much of anything. 855 00:37:16,140 --> 00:37:17,820 Working at the FDA, 856 00:37:17,820 --> 00:37:21,260 Dr Turner got to see confidential drug-company data 857 00:37:21,260 --> 00:37:23,500 from their clinical trials. 858 00:37:23,500 --> 00:37:26,500 Those trials measured antidepressants effectiveness 859 00:37:26,500 --> 00:37:31,380 by comparing the drug with a dummy pill, or placebo. 860 00:37:31,380 --> 00:37:35,340 Right away I saw a number of negative studies 861 00:37:35,340 --> 00:37:36,740 where the drug didn't beat placebo, 862 00:37:36,740 --> 00:37:41,740 and I was, you know, baffled by, you know, how could this be? 863 00:37:41,740 --> 00:37:41,980 and I was, you know, baffled It was a shock to me 864 00:37:41,980 --> 00:37:43,220 It was a shock to me 865 00:37:43,220 --> 00:37:43,460 because, looking at journal articles It was a shock to me 866 00:37:43,460 --> 00:37:47,740 because, looking at journal articles and psychiatry journals, 867 00:37:47,740 --> 00:37:51,180 it appeared that the drugs always were superior to placebo, 868 00:37:51,180 --> 00:37:54,060 and I had no reason to think otherwise. 869 00:37:54,060 --> 00:37:54,300 and I had no reason To gain approval from regulators 870 00:37:54,300 --> 00:37:56,260 To gain approval from regulators 871 00:37:56,260 --> 00:37:56,500 companies usually need to show To gain approval from regulators 872 00:37:56,500 --> 00:37:59,780 companies usually need to show at least two successful trials 873 00:37:59,780 --> 00:38:03,140 where their drug beat placebo by a significant margin. 874 00:38:03,140 --> 00:38:03,380 where their drug beat placebo What Erick was seeing 875 00:38:03,380 --> 00:38:04,620 What Erick was seeing 876 00:38:04,620 --> 00:38:08,340 was how many attempts companies needed to achieve that. 877 00:38:08,340 --> 00:38:11,380 And then I spoke with my boss about this. 878 00:38:11,380 --> 00:38:11,620 And then I spoke with my boss I said, "What's going on here? 879 00:38:11,620 --> 00:38:12,900 I said, "What's going on here? 880 00:38:12,900 --> 00:38:14,940 "What's with all these negative studies?" 881 00:38:14,940 --> 00:38:15,180 "What's with And he kind of chuckled, 882 00:38:15,180 --> 00:38:16,940 And he kind of chuckled, 883 00:38:16,940 --> 00:38:17,180 "Oh, yeah. And he kind of chuckled, 884 00:38:17,180 --> 00:38:19,460 "Oh, yeah. Basically, it happens all the time. 885 00:38:19,460 --> 00:38:23,380 "Yeah, about 40% of the time these studies will fail." 886 00:38:23,380 --> 00:38:23,620 "Yeah, about 40% of the time And... 887 00:38:23,620 --> 00:38:24,820 And... 888 00:38:25,780 --> 00:38:28,740 Yeah, I didn't see the humour in that. 889 00:38:28,740 --> 00:38:31,660 Erick Turner began scrutinising studies 890 00:38:31,660 --> 00:38:31,900 Erick Turner published by the drug companies 891 00:38:31,900 --> 00:38:33,140 published by the drug companies 892 00:38:33,140 --> 00:38:33,380 and their trial data published by the drug companies 893 00:38:33,380 --> 00:38:36,620 and their trial data only the FDA got to see. 894 00:38:36,620 --> 00:38:36,860 and their trial data If you look at the FDA data 895 00:38:36,860 --> 00:38:39,220 If you look at the FDA data 896 00:38:39,220 --> 00:38:40,860 you find out that the fact is 897 00:38:40,860 --> 00:38:44,140 that it's roughly half the trials are negative, 898 00:38:44,140 --> 00:38:45,420 it did not beat placebo, 899 00:38:45,420 --> 00:38:47,820 and only half were positive. 900 00:38:49,420 --> 00:38:52,900 In 2008 he published the first evidence 901 00:38:52,900 --> 00:38:56,060 of how many antidepressant trials were unsuccessful. 902 00:38:56,060 --> 00:38:59,020 He found the effectiveness of a range of antidepressants 903 00:38:59,020 --> 00:38:59,260 He found the effectiveness had been overstated 904 00:38:59,260 --> 00:39:00,580 had been overstated 905 00:39:00,580 --> 00:39:00,780 by between 11% and 69%. had been overstated 906 00:39:00,780 --> 00:39:03,980 by between 11% and 69%. 907 00:39:05,060 --> 00:39:07,900 If you exaggerate the benefits, 908 00:39:07,900 --> 00:39:10,220 make the drug look more effective than it really is 909 00:39:10,220 --> 00:39:11,940 by suppressing negative studies, 910 00:39:11,940 --> 00:39:15,820 then that's going to alter the risk-benefit ratio right there. 911 00:39:15,820 --> 00:39:16,060 then that's going to alter By that time 912 00:39:16,060 --> 00:39:17,380 By that time 913 00:39:17,380 --> 00:39:21,180 clinicians have been prescribing Prozac and Zoloft and Paxil 914 00:39:21,180 --> 00:39:22,020 for many years, 915 00:39:22,020 --> 00:39:24,620 and they probably were quite comfortable with them 916 00:39:24,620 --> 00:39:27,940 and felt that they knew what they needed to know about these drugs. 917 00:39:34,300 --> 00:39:35,780 In 2018 918 00:39:35,780 --> 00:39:37,620 a leading academic and his team 919 00:39:37,620 --> 00:39:41,780 published a review that had taken six years to complete. 920 00:39:41,780 --> 00:39:43,700 Their aim - to settle the debate 921 00:39:43,700 --> 00:39:46,500 over the effectiveness of antidepressants. 922 00:39:47,820 --> 00:39:50,020 ANDREA CIPRIANI: Part of the controversy 923 00:39:50,020 --> 00:39:52,540 is the influence of industry 924 00:39:52,540 --> 00:39:54,220 in this area, 925 00:39:54,220 --> 00:39:57,340 because in the past 926 00:39:57,340 --> 00:40:00,180 we know that there was a push 927 00:40:00,180 --> 00:40:02,060 for prescribing drugs 928 00:40:02,060 --> 00:40:04,980 and trying to market these drugs 929 00:40:04,980 --> 00:40:07,980 as a quick fix, an easy solution. 930 00:40:07,980 --> 00:40:10,220 And they are definitely not. 931 00:40:10,220 --> 00:40:11,260 ARCHIVE REPORTER: Scientists think 932 00:40:11,260 --> 00:40:11,500 they have finally answered the question ARCHIVE REPORTER: Scientists think 933 00:40:11,500 --> 00:40:12,740 they have finally answered the question 934 00:40:12,740 --> 00:40:12,980 they have finally answered in a huge study. 935 00:40:12,980 --> 00:40:14,060 in a huge study. 936 00:40:14,060 --> 00:40:14,300 They analysed in a huge study. 937 00:40:14,300 --> 00:40:17,020 They analysed more than 500 clinical trials, 938 00:40:17,020 --> 00:40:20,420 including previously unpublished data held by drug companies. 939 00:40:20,420 --> 00:40:20,700 including previously unpublished data held by drug companies. This was the largest studies ever carried out in mental health. 940 00:40:20,700 --> 00:40:25,700 This was the largest studies ever carried out in mental health. 941 00:40:26,660 --> 00:40:29,020 Professor Cipriani's analysis of trials 942 00:40:29,020 --> 00:40:29,260 involving people with depression analysis of trials 943 00:40:29,260 --> 00:40:30,860 involving people with depression 944 00:40:30,860 --> 00:40:33,700 showed, on average, more improved substantially 945 00:40:33,700 --> 00:40:33,940 with an antidepressant than placebo. more improved substantially 946 00:40:33,940 --> 00:40:36,540 with an antidepressant than placebo. 947 00:40:36,540 --> 00:40:36,780 with an antidepressant than placebo. We know that antidepressants are better than placebo, 948 00:40:36,780 --> 00:40:41,220 We know that antidepressants are better than placebo, 949 00:40:41,220 --> 00:40:44,660 but the difference is about 15% from placebo. 950 00:40:44,660 --> 00:40:47,340 So, it's not a huge, dramatic difference. 951 00:40:48,300 --> 00:40:50,140 Around 40% of patients 952 00:40:50,140 --> 00:40:52,020 improved on placebo, 953 00:40:52,020 --> 00:40:54,860 around 55% improved on the drug, 954 00:40:54,860 --> 00:40:56,780 giving a 15% difference 955 00:40:56,780 --> 00:40:58,700 between the two. 956 00:40:58,700 --> 00:41:00,660 The difference between placebo 957 00:41:00,660 --> 00:41:02,060 and active treatment 958 00:41:02,060 --> 00:41:02,300 can be the difference and active treatment 959 00:41:02,300 --> 00:41:03,740 can be the difference between life or death 960 00:41:03,740 --> 00:41:07,420 if it happens to be that it gets you above being suicidal. 961 00:41:07,420 --> 00:41:07,660 if it happens to be that it gets you We have to look at the benefit-risk. 962 00:41:07,660 --> 00:41:09,940 We have to look at the benefit-risk. 963 00:41:09,940 --> 00:41:13,180 The benefit-risk for SSRI is actually... 964 00:41:13,180 --> 00:41:15,540 ..you know, really rather remarkable, I think. 965 00:41:16,500 --> 00:41:18,340 ANDREA CIPRIANI: It's an average effect, 966 00:41:18,340 --> 00:41:22,380 but it doesn't reflect what is the reality, 967 00:41:22,380 --> 00:41:25,140 which is some people don't respond at all 968 00:41:25,140 --> 00:41:29,220 and other people respond a lot to the medication. 969 00:41:29,220 --> 00:41:34,140 This is why we need to get rid of the one-size-fits-all approach. 970 00:41:36,300 --> 00:41:40,180 The companies behind the most widely used SSRIs in the UK 971 00:41:40,180 --> 00:41:44,140 say that many clinical trials and studies by independent researchers 972 00:41:44,140 --> 00:41:44,380 say that many clinical trials and show their drugs are effective, 973 00:41:44,380 --> 00:41:46,140 show their drugs are effective, 974 00:41:46,140 --> 00:41:46,380 that they've been taken show their drugs are effective, 975 00:41:46,380 --> 00:41:48,620 that they've been taken by millions worldwide 976 00:41:48,620 --> 00:41:52,500 for potentially devastating and sometimes life-threatening conditions 977 00:41:52,500 --> 00:41:55,820 and that they've helped patients globally. 978 00:41:55,820 --> 00:42:00,820 They say, as with all medicines, SSRIs have potential side effects, 979 00:42:00,820 --> 00:42:03,780 which are clearly stated in the prescribing information. 980 00:42:03,780 --> 00:42:06,460 And they say their drugs are considered to be safe 981 00:42:06,460 --> 00:42:06,700 And they say their drugs with a positive benefit-risk ratio 982 00:42:06,700 --> 00:42:09,020 with a positive benefit-risk ratio 983 00:42:09,020 --> 00:42:13,300 by doctors, patients and regulators around the world. 984 00:42:20,780 --> 00:42:24,220 Mark's now been reducing his dose for five years. 985 00:42:24,220 --> 00:42:28,340 He's hoping to stop completely in the next few months. 986 00:42:28,340 --> 00:42:29,540 MARK HOROWITZ: The history of psychiatry 987 00:42:29,540 --> 00:42:32,060 is of drugs being put onto the market, 988 00:42:32,060 --> 00:42:32,300 is of drugs being told that they're effective, 989 00:42:32,300 --> 00:42:35,260 being told that they're effective, 990 00:42:35,260 --> 00:42:37,740 there's minimal side effects and they're easy to stop, 991 00:42:37,740 --> 00:42:41,020 and, again and again, that it's turned out 992 00:42:41,020 --> 00:42:43,660 that years later that none of those things are true. 993 00:42:43,660 --> 00:42:48,260 DAVID TAYLOR: What matters are the regulatory conditions, 994 00:42:48,260 --> 00:42:48,500 DAVID TAYLOR: What matters and at the moment, to my knowledge, 995 00:42:48,500 --> 00:42:52,500 and at the moment, to my knowledge, 996 00:42:52,500 --> 00:42:54,700 there isn't a regulatory demand 997 00:42:54,700 --> 00:43:00,020 that new drugs are tested in terms of their long, very long-term use 998 00:43:00,020 --> 00:43:04,220 and the likely long-term effects of withdrawing. 999 00:43:05,580 --> 00:43:07,540 Millions of people around the world 1000 00:43:07,540 --> 00:43:11,140 continue to take SSRI antidepressants. 1001 00:43:11,140 --> 00:43:14,780 For many, the benefits still outweigh the risks. 1002 00:43:14,780 --> 00:43:18,580 I believe very firmly, as does the college, 1003 00:43:18,580 --> 00:43:18,820 I believe very firmly, that antidepressants are helpful. 1004 00:43:18,820 --> 00:43:21,060 that antidepressants are helpful. 1005 00:43:21,060 --> 00:43:23,940 And I've seen throughout my long and extensive career, 1006 00:43:23,940 --> 00:43:26,820 I have seen people benefit from antidepressants 1007 00:43:26,820 --> 00:43:29,060 and I see lives being saved by them. 1008 00:43:30,780 --> 00:43:37,220 So, I think, you know, the SSRIs will be history at some point. 1009 00:43:37,220 --> 00:43:39,220 I think they were more helpful than not. 1010 00:43:39,220 --> 00:43:41,540 But, you know, not everybody was helped, for sure. 1011 00:43:41,540 --> 00:43:41,780 But, you know, Lots of people weren't. 1012 00:43:41,780 --> 00:43:43,140 Lots of people weren't. 1013 00:43:43,140 --> 00:43:44,860 It's more than 30 years 1014 00:43:44,860 --> 00:43:47,660 since the wonder drugs of a generation 1015 00:43:47,660 --> 00:43:51,500 promised safe, effective treatment for depression. 1016 00:43:51,500 --> 00:43:55,340 But the story has turned out to be much more complicated. 1017 00:43:57,900 --> 00:44:00,220 And for those who've been harmed by them, 1018 00:44:00,220 --> 00:44:03,060 it's been a long, hard fight to be heard. 1019 00:44:03,060 --> 00:44:03,300 it's been a long, hard fight OK, good boy. Yeah. 1020 00:44:03,300 --> 00:44:05,540 OK, good boy. Yeah. 1021 00:44:05,540 --> 00:44:07,420 Let's go home, buddy. Let's go home. 1022 00:44:07,420 --> 00:44:07,660 So, you've asked what I think Let's go home, buddy. Let's go home. 1023 00:44:07,660 --> 00:44:10,340 So, you've asked what I think my life might have been like 1024 00:44:10,340 --> 00:44:10,580 So, you've asked what I think if this hadn't happened. 1025 00:44:10,580 --> 00:44:12,820 if this hadn't happened. 1026 00:44:12,820 --> 00:44:14,740 It's a really painful question. 1027 00:44:14,740 --> 00:44:16,860 It's really hard to contemplate. 1028 00:44:19,540 --> 00:44:21,940 It's left an indelible mark on my life. 1029 00:44:21,940 --> 00:44:22,180 It's left an indelible mark It's been huge. 1030 00:44:22,180 --> 00:44:23,980 It's been huge. 1031 00:44:24,940 --> 00:44:27,700 But nobody's life is predictable. 1032 00:44:31,340 --> 00:44:34,300 I've retired now and... 1033 00:44:34,300 --> 00:44:35,860 ..threw out a lot of my files. 1034 00:44:35,860 --> 00:44:38,060 I thought I might have been done. 1035 00:44:39,020 --> 00:44:42,100 And how does it feel kind of sitting here and talking about it now? 1036 00:44:43,060 --> 00:44:47,380 I've been waiting for you to show up for 15 years. 1037 00:44:47,380 --> 00:44:47,620 I've been waiting for you to show up Thank you for coming. 1038 00:44:47,620 --> 00:44:49,340 Thank you for coming. 1039 00:44:49,340 --> 00:44:51,140 It's amazing. 1040 00:44:52,820 --> 00:44:54,820 Captions by Red Bee Media 1041 00:44:54,820 --> 00:44:57,020 Copyright Australian Broadcasting Corporation