J. Gillis, Chronicle Herald, Halifax, NS, April, 26, 2006
A decision last week by the College of Physicians and Surgeons of Nova Scotia is only a small step toward educating doctors about the risks of prescribing antidepressants, says the widow of activist and suicide victim Tooker Gomberg.
Mr. Gomberg jumped from the Angus L. Macdonald Bridge in March 2004, five weeks after going on the antidepressant Remeron and only hours after a visit to his psychiatrist.
His wife Angela Bischoff said the college’s decision Thursday counselling the psychiatrist to do regular suicide assessments of depressed patients, obtain previous medical records if necessary and inform patients’ partners of any suicide concerns doesn’t address a widespread lack of knowledge about risks associated with the much prescribed drugs.
“It vindicates my assessment that the doctor was indeed negligent,” she said last week. “I’m looking for much more systemic results and I’m not satisfied with this being systemic at all.”
Ms. Bischoff declined to identify the psychiatrist out of compassion. The college’s decision is not considered a reprimand and hasn’t been publicly released.
Ms. Bischoff believes the doctor simply wasn’t aware of a connection between antidepressants and increased suicidal thoughts.
“If he wasn’t even aware of the side effects, how can we expect (general practitioners) to know it?”
Her complaint asked the college to educate Nova Scotia physicians on the dangers of antidepressants and create a standard practice for suicide assessments.
By coincidence, a few weeks after Mr. Gomberg’s death, Health Canada warned that safety trials of selective serotonin reuptake inhibitors like Remeron were unreliable and that adverse reactions including severe agitation and self-harm were seen in some studies.
Ms. Bischoff said her husband began talking about suicide three weeks after starting the drug and by five weeks he was on a maximum dose.
“Tooker’s agitation went through the roof and still the doctor never talked to him once about thoughts of self-harm.”
The agitation was serious enough that the psychiatrist prescribed tranquillizers to counter it. Yet the investigation found his records showed he never assessed Mr. Gomberg’s suicide risk.
Ms. Bischoff was commenting from Ontario in the midst of a nationwide speaking tour.
Dr. Cameron Little, registrar of the College of Physicians and Surgeons, couldn’t comment on Ms. Bischoff’s complaint but said the association between antidepressants and suicide is usually linked to adolescents and is not clear-cut.
Good medical care involves knowing current information about drugs and the college encourages doctors to stay up to date, Dr. Little said.
A position paper from the Canadian Psychiatric Association says there are benefits to using antidepressants in adults and little evidence to support an increased suicide risk. In children, however, it says antidepressants should not be used as a first-choice treatment, with one exception.
A Halifax psychiatrist said there’s still debate on whether antidepressants are effective at all compared to placebos or psychotherapy.
“There’s very little to no data that medications are any better than counselling treatments for depression,” said Dr. Allan Abbass. “Why should people end up on these medications? Have they had a trial of something that’s non-toxic and effective?”
One reason the drugs are widely prescribed is heavy advertising from drug companies, he said.
Another is that the cost benefits of counselling, like the intensive psychotherapy program provided by Dr. Abbass and his colleagues at the Capital district health authority’s Centre for Emotions and Health, aren’t seen by those paying for the therapy.
While in Halifax on her Healthy Mind, Body, Planet tour earlier this month, Ms. Bischoff met with Nova Scotia’s chief medical examiner and officials from the Justice Department to ask for a fatality inquiry into Mr. Gomberg’s death and the role played by antidepressants.
Mr. Gomberg’s body has not been found; that prevents the medical examiner from conducting an inquiry.
Ms. Bischoff believed Justice Minister Murray Scott had discretion to call an inquiry without a body, but department spokeswoman Cathy MacIsaac said he does not have that leeway.
Ms. Bischoff, who now lives in Toronto, said being in Halifax was difficult but her activism on the issue helps her deal with the loss of her husband.