Silence and Suicide

By Angela Bischoff.

Health Canada finally admitted it. Anti-depressants may cause anxiety, agitation and suicidal thoughts. But Health Canada’s recent warning comes too late for Tooker Gomberg.

Tooker suffered from depression, an illness that made it difficult for him to reach out. He suffered because there are few resources for those with modest incomes. He suffered because society fails to accept and deal with mental illness.

But Tooker died, I believe, because he reacted adversely to his anti-depressant medication.

Two bouts of severe depression paralyzed Tooker’s vital forces, leaving him in a bleak, desperate state. He became hopeless and anxious, suffocated by pain.

Creative people, and those who do well socially and academically, are particularly vulnerable to the spectre of mental disintegration and the fear of becoming a chronic patient.

It is known that a small percentage of people taking anti-depressant drugs suffer adverse reactions, including suicidal thoughts. Tooker began taking an antidepressant in January 2004. In the ensuing weeks his anxiety, agitation, and hopelessness spun out of control. I learned later that these are the leading predictors of suicidal behaviour.

Patients put on such drugs must be monitored for suicidal tendencies. Two weeks into his drug therapy, Tooker began to have suicidal thoughts – for the first time in his life. His doctor did not question him. Imagine taking a drug, and as your symptoms worsen, your doctor advises you to double the dosage! Just four weeks after beginning the medication and increasing the dosage twice, Tooker took his own life. He wrote that he could not bear the agony.

A public inquiry held by the US FDA (Food and Drug Administration) heard testimonials from people who had lost loved ones to suicide. On March 22, 2004, the FDA released a public health advisory stating that anti-depressants, including the drug prescribed to Tooker, may increase risk of suicide. It ordered manufacturers of ten big-selling drugs to declare this on warning labels.

Health Canada responded by setting up a scientific advisory panel. This resulted in dear-doctor letters going out to all physicians in the country linking anti-depressants with increased agitation and suicidal thoughts in some patients. On June 3rd, three months to the day after Tooker took his life, Health Canada advised the public of the deadly correlation.

Although the drug/suicide connection has been established for some time, Tooker’s psychiatrist never mentioned it. The drug fact sheet from the pharmacist included no information about suicide. The monograph inside the package contained no warning of suicidal ideation. Health Canada’s website offered no information on the topic. Any one of these interventions may have saved Tooker’s life.

Suicide is largely preventable. Yet it is epidemic, having tripled over the past 45 years. At the same time, pharmaceutical use has increased dramatically.

Around the world, between one and four percent of adults claim that they have attempted suicide at some point in their lives. Studies in 1993, 1995, and 1997 concluded that one in five high school students seriously considered suicide in the preceding 12-month period, and one in ten actually attempted it.

It is a myth that talking about suicide will induce it. The psychiatric community knows that talking saves lives. So why the media blackout? Why the lack of information? Why the taboo?

Society is under the illusion that suicide is rare. Medical professionals and government agencies are not supposed to subscribe to societal illusions. Their responsibility is to act on proven risks and statistical truths. When they fail, the public is put at risk.

Tooker died needlessly. His death is an unspeakable loss. No one else should be allowed to die this way. Given what we know today about the potential side effects of anti-depressants, there can be no excuse.

Doctors prescribing anti-depressants should be required to conduct suicide risk assessments with all patients, and warn them of the known risks. Otherwise, every prescription puts a life at risk. Isn’t that life worth a few questions?

Now that Health Canada claims that product labels and monographs will include warnings about increased risk of suicide, our regulatory agency must go further. Health Canada must research, review and publish all data on anti-depressants and suicidal behaviour; it must track the deaths and adverse reactions of children and adults on these drugs; it must hold public hearings on the effects of psychiatric drugs; and, it must encourage consumers and physicians to report adverse reactions.

The public has a right to know. Tell the truth and save lives.