Day 919

Prozacation

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In 2004 the U.S. Food and Drug Administration issued a black-box warning against the use of all antidepressants in individuals up to 24 years old due to concerns about the increased risk of suicidal thoughts and behavior.

Depression often presents differently in children and adults. The very condition that the antidepressants are supposed to treat is made worse by their use in the young because their brains are still developing.

A meta-analysis of 34 RCTs published by Oxford University in the Lancet in August 2016 says that only one drug among all antidepressants is statistically better than placebo and that is Fluoxetine or Prozac. The lead author, Dr Andrea Cipriani claims no influence of the pharmaceutical industry on these findings.

Prozac has made hundreds of court appearances and billions of dollars have been paid out in compensation lawsuits.

‘The idea that it’s been a major step forward for Prozac to select serotonin only is just hypothesis,’ says Malcolm Lader, professor of clinical psychopharmacology at the Institute of Psychiatry. ‘There’s no science behind it.’ Some SSRI users have reported agitation and an inability to keep still, a preoccupation with violent, self-destructive fantasies and a feeling that ‘death would be welcome’. In Germany, Prozac was initially refused a licence after trials resulted in 16 attempted suicides, two of which were successful.

For mild depression, talking therapies are recommended. Young people with moderate to severe depression are often believed to need medication. They need frequent and close monitoring. However, there are huge variations in practice. It is easier to write out a prescription at a brief consultation rather than delve deep into details. As for the usefulness and safety of antidepressants, the jury is still out.

Saagar was on Citalopram for a few weeks before he died. The GP investigator said he should have been on Prozac but she didn’t write it down in her report. The representative of the Psychiatric hospital was a Clinical Psychologist. She said she could not comment on medications. The mud is watery. 

Ref:

Lancet August 2016: http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)30385-3/fulltext

Prozac and lawsuits:
http://thesandersfirm.com/dangerous-drugs/ssri-antidepressant-lawsuits/

History of Prozac:
https://www.theguardian.com/society/2007/may/13/socialcare.medicineandhealth

Day 918

Biggest cause of avoidable deaths in children and young people – Suicide and self-inflicted injuries

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The Office of National Statistics published a report in 2015 saying that the  single cause with the highest number of avoidable deaths in children and young people was suicide and self-inflicted injuries (14% or 206 deaths of all avoidable deaths in this age group).

Of the top five causes of avoidable deaths among children and young people, suicide and self- inflicted injuries was the only cause to see an increase since 2014 by 13% or 24 deaths.

Avoidable mortality accounted for 3 out of 10 deaths of children and young people (aged 0 to 19 years), nearly the same as in 2014. Males accounted for almost two-thirds (63%) of avoidable deaths in children and young people.

The other top causes each saw a decline since 2014, with accidental injuries, which was the leading cause in 2014, experiencing the largest decline of 8% or 15 deaths.

 

Key Points for London

  • The rate of avoidable mortality in London has increased to 210.4 deaths per 100,000 population from 204.6 in 2014. This is significantly lower than for England (222.9).
  • The South East, East of England and South West Regions have lower rates of avoidable mortality than London. The highest rate is in the North East (266.4).
  • As in all other regions, avoidable mortality rates in London are higher for males (274.0 deaths per 100,000 population) than for females (152.9). Rates have increased for males (from 259.9 in 2014) and slightly reduced for females (154.3 in 2014).
  • Ref: https://www.gov.uk/government/statistics/avoidable-mortality-in-england-and-wales-2015

 

Day 909

Most life assurance providers exclude suicide within first year of the policy.

A benefit scheme run by Utility Warehouse is called Bill Protector. It’s for Utility Warehouse customers, and basically between £2-9 per month added onto your premium. This gives cover for your bills should you lose your income due to illness, injury or redundancy. There is also an accidental death cover.

The illness cover excludes mental health. The basis of this is because it’s ‘hard to prove’. The attitude of the underwriters seems to be that people could go to their GP and simply say ‘I’m depressed’ when they’re not and be signed off work. This is in part due to an industry-wide attempt to combat insurance ‘fraud’.

It is interesting that mental health was covered until July 2016 and then they decided to write it out.

What annoys me most is that this is sold to customers as cover for bills in the event of illness, and then when they call to make a claim, they’re essentially told that their mental health difficulties don’t qualify as an illness – it’s the same old issue of perceptions and attitudes towards mental health. I think if there are going to be any restrictions like this, it should be made abundantly clear.

We as a society treat mental and physical health just the same. Don’t we?

Ref:

Utility Warehouse: www.utilitywarehouse.co.uk
Bill Protector:  https://www.utilitywarehouse.co.uk/services/billprotector
Key Facts: https://s3-eu-west-1.amazonaws.com/pdf.utilitywarehouse.co.uk/Bill%20Protector_KeyFacts_1July2016.pdf

 

Day 906

Last September I started writing a case study on patient safety for an academic paper. For every sentence, it required evidence. Unfortunately, the level of evidence for some of the material is not high because of the nature of the subject. Secondly, research in mental illness is poorly funded in the UK.

I am reminded of a young friend who is looking for a job but she can’t find one as they require her to have experience which she cannot gain unless she has a job. A classic chicken and egg situation.

So, the deadline has been extended time and again and finally we are going to have another attempt at submitting it before the end of this month. The lowest level of evidence to be found is Level 5 – ‘Case series or studies with no control’.

Here is one that I am going to use to support my statement: “Almost everyone who is suicidal is ambivalent. They don’t necessarily want to die. They just want the pain to end.” Hopefully it will be accepted. 

Kevin Hines is one of less than 1% of people to survive a jump from the Golden Gate bridge in a suicidal attempt. He is now a mental health advocate and works actively towards suicide prevention.

“The millisecond my hands left that rail, I thought, ‘what have I just done? I don’t want to die, God please save me’, and then I hit the water,” he said.
“You fall four seconds, you hit the water and get vacuum sucked down 70 or 80 ft – when I opened my eyes I was alive. “All I desperately wanted to do was survive – suicide experts call this being ‘shocked into reality’.”

Ref:

Kevin Hines:
http://www.bbc.co.uk/news/uk-northern-ireland-29995470

Youtube clip:
https://www.youtube.com/watch?v=WcSUs9iZv-g

Website: http://www.kevinhinesstory.com/bio/

Day 899

 More Vietnam veterans have died by suicide than were killed in Vietnam. According to the Veterans Administration, one veteran dies by suicide every hour in the USA. 

‘The survivor is a disturber of peace. He is a bearer of ”unspeakable” things. About these he aims to speak, and in so doing he undermines, without intending to, the validity of existing norms. He is a genuine transgressor, and here he is made to feel real guilt. The world to which he appeals does not admit him, and since he has looked to this world as the source of moral order, he begins to doubt himself. And that is not the end, for now his guilt is doubled by betrayal– of himself, of his task, of his vow to the dead. The final guilt is not to bear witness. The survivor’s worst torment is not to be able to speak.’ – Terrence Des Pres in ‘The Survivor’.

”If the thing they were fighting for was important enough to die for then it was also important enough for them to be thinking about it in the last minutes of their lives. That stood to reason. Life is awfully important so if you’ve given it away you’d ought to think with all your mind in the last moments of your life about the thing you traded it for. So, did all those kids die thinking of democracy and freedom and liberty and honor and the safety of the home and the stars and strips forever? You’re goddamn right they didn’t.” – Dalton Trumbo in ‘Johnny got his gun.’.
Viktor E. Frankl said, ” Suffering ceases to be suffering when it has meaning.” 
Meaningless violence gives birth to more meaningless violence. There are no winners. All sides loose. 

Day 888

Dying from Inequality – Samaritans commissioned eight leading social scientists to review and extend the existing body of knowledge on socioeconomic disadvantage, ie. being poor, addressing three key questions:

  • Why is there a connection between socioeconomic disadvantage and suicidal behaviour?
  • What is it about socioeconomic disadvantage that increases the risk of suicidal behaviour?
  • What can be done about it?

A few excerpts:

Neighbourhoods that are the most deprived have worse health than those that are less deprived and this association follows a gradient: for each increase in deprivation, there is a decrease in health. Additional support for those living in deprived areas is needed to reduce geographical inequalities in health and the risk of suicidal behaviour.

Economic uncertainty, unemployment, a decline in income relative to local wages, unmanageable debt, the threat or fear of home repossessions, job insecurity and business downsizing may all increase the risk of suicidal behaviour, especially for individuals who experience socioeconomic disadvantage.

Unmanageable debt is an important risk factor for suicidal behaviour. Financial advice and support for those at risk of having unmanageable debt can help reduce the risk of mental health problems and suicidal behaviour.

Suicidal behaviour and mental health problems, such as mild-to-moderate anxiety and depression, could be reduced through labour market policy design, such as higher spending on active labour market programmes and unemployment benefits.

People living with socioeconomic disadvantage and inequalities are more likely to experience negative events during their life, such as job loss, financial difficulties, poor housing, and relationship breakdown. This can lead to negative emotions and increase the likelihood of suicidal behaviour.

Ref:

Dying from Inequality: http://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans%20Dying%20from%20inequality%20report%20-%20summary.pdf

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Day 886

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“More people are being detained by police under the Mental Health Act as Psychiatric services struggle to cope” says Jacqui Wise in the cover story of the British Medical Journal of 18th March 2017.

Statistics tell us that deaths in custody are up by 21%.
Self-inflicted deaths are up by 13%.
In the female estate, the number has doubled from 4 to 8 in this 12 month period.
Self-harm incidents up by 26%.
Individuals self-harming up 23%
Assaults up by 34%.
Assaults on staff up 43%.
Natural cause deaths up 17%, explained by the ageing population.
5 apparent homicides, down from 7 in the same period of the previous year

Could there be a co-relation between the facts stated in the first and the second paragraph?

“The police to an extent have always been used as an emergency mental health service” says Michael Brown, a police inspector. He adds that police receive little formal training in managing patients with mental health problems. “A highly agitated person may be experiencing Serotonin Syndrome due to the mismanagement of their antidepressant medications. The signs are subtle and most police officers won’t be able to pick up on that. We need to have a proper debate about the role of the police in this area.”

Ref:

Safety in Custody Statistics 2016: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/562897/safety-in-custody-bulletin.pdf#page=6
Blog about Mental health and the Criminal Justice system:
https://mentalhealthcop.wordpress.com/
Serotonin Syndrome:
https://patient.info/doctor/serotonin-syndrome