Widow of bridge suicide victim urges MD body to do more — (The Chronicle Herald)

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The Chronicle Herald

By JOHN GILLIS Health Reporter (jgillis@herald.ca)

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.
Below is a statement by Tooker’s wife:
YOUR DRUGS MAY BE YOUR PROBLEM
Speaking Tour with Angela Bischoff

Did Drugs Play a Role?

“The great gift of the human species is our minds. Our minds have two great aspects: we can imagine, and we can alter our environment… We must find ways to spice up our imaginations, and tap into our yearning for clean air and a livable city… We can evolve our city into a healthy place for people and nature, not asphalt and poison. We can do it. If we will it.” Tooker Gomberg, Sept. 13, 1999

Angela Bischoff is Tooker Gomberg’s surviving spouse. For 17 years the two of them traveled the world, educating and advocating on environmental and justice issues. Since Tooker’s passing Angela has been researching, writing and speaking about the dangers of anti-depressant drugs. See: www.greenspiration.org

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I lost my best friend

I’m a suicide survivor. My soul-mate of 17 years, Tooker Gomberg, suicided March 3, 2004. My life was turned upside down — I lost my best friend and the world lost a warrior.

The pain around suicide is unfathomable, and indescribable, for those left behind, but especially for the person driven to take his/her own life. Unless you’ve been there, you just can’t know this darkest torture of the soul. I saw Tooker’s anguish, an anguish so deep and riveting that he saw no choice other than to end the suffering through death.

What could possibly drive him to such despair?

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The world lost a warrior

Tooker Gomberg, internationally renowned environmental-, peace- and justice-activist, gave up the ghost at age 48. He was in an excellent relationship for 17 years; he had skills and friends; he was kind, humorous, courageous, a fighter, a leader, an environmental and social justice advocate; and he had fame and respect around the world.

His first depression hit in 2001-2 following the FTAA police clamp-down and horrific mass poisoning (tear gas, etc.) in Quebec City. Tooker was discouraged and exhausted, and his depression zapped the spark out of him for nine months. He tried many holistic alternatives to pharmaceutical drugs before turning to an SSRI antidepressant drug. Nothing seemed to help, but in time, he climbed out of his despair.

When his second depression hit a year later after moving to a new city and unemployed, he sought help through counseling and pharmaceutical drugs, partly because he was desperate, but also because that was the only option the health care system would pay for. Psychiatrists are covered, and the drugs they prescribe are covered, but doctors of Naturopathic medicine aren’t, nor are Cognitive Behavioral Therapists, or massage therapists, or acupuncturists, etc.

Tooker’s doctor prescribed Remeron, an antidepressant drug in a class of its own, but sometimes referred to as an SNRI. His anxiety and agitation went through the roof – clearly an adverse reaction – however his psychiatrist didn’t perceive it as such, and encouraged him to stick with the program, increasing the dosage to the maximum. After just five weeks on the drug, Tooker’s agitation sent him over the railing of the MacDonald Bridge in Halifax.

He wrote in his suicide note that he was anxious, felt like a zombie, and couldn’t think.

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Let’s look at the facts

Three weeks after Tooker passed, the US Food and Drug Administration (FDA) publicly associated antidepressant drugs with worsened depression and suicidal ideation. I was dumbfounded, and immediately immersed myself in this field, reading everything I could on what had been written to corroborate this bold assertion. It became obvious to me that Tooker was most definitely affected adversely by the drug he was on.

I’m no expert. I’m not a scientist. I’m a survivor who was motivated to peek behind the corporate curtain and study what the independent experts were saying about the connection between antidepressant drugs and suicide. And what I learned astounded me.

I read the writings of two experts: Dr. David Healy from England, and Dr. Peter Breggin from the US, both distinguished physicians of high academic standing and international credibility. Much of what they published in their books came from years in the courts as medical experts, pouring over company data made available through court injunctions, previously unavailable to the public, such as unreported clinical trial data, internal memos, etc.

What I learned is that typically one in four patients feels worse when beginning any antidepressant drug and ‘drops out’ or quits use of the drug within the first month, and almost half quit within three months. That is to say that while antidepressant drugs may help some people, they are not reliable, not even close.

That might not be such a problem if drug companies were straight up about this, but that wouldn’t be good for sales. On the contrary doctors are instructed, through industry propaganda, to ‘reduce’ patient drop out by ‘managing’ the side effects and encouraging patients to stick with the program rather than encouraging physicians to listen to patients’ individual sensitivities.

Perhaps if Tooker’s doctor had been better informed about the adverse reaction of agitation, Tooker would be alive today. Instead, his doctor repeatedly upped the dosage and prescribed a tranquilizer to calm his agitation.

Agitation is a very common side effect of antidepressant drugs, primarily during the early stages of treatment or shortly after a change in dosage (up or down). Extreme agitation is known as akathisia, an internal unrest, turmoil, or torture.

In clinical trials for SSRIs (the most commonly prescribed family of antidepressants), this reaction has been well-recognized and documented since the early ’80s. Prozac’s own clinical trials, prior to its launch in 1988 and post-launch, recorded rates of agitation and akathisia from between 5 and 25%.

Conservatively speaking then, one in 20 patients becomes agitated on antidepressant drugs — 5% is a significant adverse reaction that doctors need to be informed about and need to warn patients about, but they generally don’t. The concern is that agitation is a very potent predictor of suicide and violence.

By extrapolating from clinical trial data and multiplying by numbers of users, Dr. David Healy claims that one in 500 users of antidepressant drugs will complete suicide because of the drug. That’s 100,000 tragic and unnecessary deaths.

Clearly, drug companies have a lot to lose if this information becomes well understood since there are 40-50 million people world wide on antidepressant drugs, and the number is growing — there was an 80% increase in antidepressant prescriptions in Canada from 1999 – 2004.

In February 2005, an incredible study authored by Dr. Dean Fergusson was published in the British Medical Journal. Dr. Fergusson is a scientist with the Ottawa Health Research Institute, and teaches in the Dept. of Medicine at the University of Ottawa. His meta-analysis reviewed data on 90,000 patients from some 700 clinical trials. His team found that patients are twice as likely to attempt suicide on antidepressants as on sugar pills. This result confirmed other study results of 2000 and 2001.

Huh? Patients are put on antidepressant drugs to lower suicide risk, not double it!

Just how effective are antidepressants in relieving symptoms of depression? Incredibly, there is little evidence that antidepressant drugs actually produce benefits. We know that they may help some people in the short term, but over the long term we find a worsening of depression or anxiety compared to placebo-treated patients.