"I Didn't Just Cross a Line I Tripped over an Edge": Experiences of Serious Adverse Effects with Selective Serotonin Reuptake Inhibitor Use

Evidence that selective serotonin reuptake inhibitors (SSRIs) may elicit suicidal and/or aggressive thoughts and behaviours has been circulating for nearly thirty years. Despite a growing body of knowledge around these serious adverse effects, however, they continue to be surrounded by controversy. In particular they are subject to (arguable) counter-arguments that any risks from using the drugs are outweighed by benefits and/or more attributable to a person's 'underlying disease'. Moreover assessments of risks often use rates of completed suicides as the ultimate measure. In this paper we draw on people's own accounts of their experiences of serious adverse effects associated with SSRI use. In depth semi-structured interviews were undertaken with nine people who had either used SSRIs themselves or had witnessed the use of SSRIs by a close family member. We present four themes identified across the interviews relating to adverse effects from SSRIs: experiences of akathisia, aggression and suicidality; 'out of character' behaviour; harm to relationships; and accounts of responses from the medical profession. Participants reported that the experience of adverse effects had marked impacts on general wellbeing, identities and relationships. These accounts cast doubt on notions that serious adverse effects associated with SSRI use may stem from an underlying condition and/or be outweighed by benefits from SSRI use. In addition they offer a persuasive and poignant plea to further consider non-fatal adverse effects and their consequences in assessing the risks of these drugs. ********** Selective serotonin reuptake inhibitor (SSRI) antidepressants have become the subject of considerable controversy in recent years. Not only have serious questions been raised about the efficacy of these drugs (e.g., Moncrieff & Kirsch, 2005) but evidence has long been mounting of an association between SSRIs and suicide. This evidence which has arisen from a range of sources including case reports (e.g., Teicher, Glod, & Cole, 1990), recta- and re-analyses of clinical trials (e.g., Kraus, 2006), legal cases (e.g., Healy, 2004a), epidemiological studies (e.g., Donovan et al., 2000) and primary care databases (e.g., Martinez et al., 2005)--has lead critics to urge far greater caution around the use of these drugs, particularly at the point of starting, stopping or changing dose (Healy, 2004a). According to Healy (2006) the current best estimate for the likely risk of suicide on SSRIs over placebo is 2.6 (p. 93). Links between SSRIs and a number of other serious adverse (and withdrawal) effects--such as aggression, akathisia, mania and the wider realm of suicidality--have also been postulated (e.g., Breggin, 2003; Glenmullen, 2000; Healy, 2004a; Medawar, Herxheimer, Bell & Jofre, 2002; Whitaker, 2005), although the research evidence is less well established (see for instance Healy, Herxheimer, & Menkes, 2006, regarding the links between SSRIs and violence). Although pharmaceutical regulatory bodies in the United States, the United Kingdom, Europe, Canada, Australia and New Zealand have responded to this evidence of serious potential adverse effects by issuing warnings about the risks associated with SSRIs (e.g., ADRAC, 2004; EMEA, 2005; FDA, 2005; Health Canada, 2004; Medsafe, 2004; MHRA, 2003), proponents of the drugs nevertheless continue to argue that their benefits outweigh the risks. For instance, it has been claimed that SSRIs are associated with a decrease in the rate of suicide at the population level (e.g., Khan, Khan, Leventhal, & Brown, 2001), although more recently others have countered that there is no evidence for any causal relationship between increasing use of SSRIs and declining rates of suicide (e.g., Safer & Zito, 2007). As well as this debate about whether SSRIs 'on balance' may help more people than they hurt, the currency in which such cost-benefit analyses are calculated is often restricted to measures of completed suicide. …

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