A Prescription For Murder

Wow! What a title! Sounds like an Agatha Christie novel or a cheap horror movie. It’s actually the title of a BBC Panorama documentary which hypothesises a link between SSRI antidepressant medication and an increased propensity to commit violent acts. 

Is there a link? Statistically yes maybe. A very tiny percentage of people taking SSRIs experience psychosis as a side effect, but statistically more people are killed as a result of trying to put on a pair of trousers. So why is there not a documentary about trouser deaths called Leg Ends Of The Fall? I believe it is because of the manner of the respective causes of death. 

Accidental deaths caused by embarrassing wardrobe malfunctions would be uncomfortable, voyeuristic subject matter. You don’t kick a man when he’s down through no fault of his own. So what’s the difference between that and someone who’s mentally ill through no fault of their own?

It’s because violent mentally ill people are juicy subject matter. A ratings winner. The subject retains a ghoulish car crash fascination. The notion that mental illness equates to violent, dangerous derangement is deeply embedded in the public’s psyche. Why else were lunatics locked in mental asylums, strapped in straitjackets, if not to prevent them from being a danger to others?

There are many variations of the escaped mental patient urban myth, with invariably innocents being slaughtered by the rampaging, almost supernatural human monster. The thing cannot be reasoned with; it is beyond reason. It is animalistic, bloodthirsty, evil. Something to be hunted and killed on sight. 

The factual reality is that mentally ill people are more likely to be a victim of violence than the general population. Only 3% of mentally ill people ever commit a criminal act of aggression. That means that 97% never commit an act of aggression. The person a mentally ill person is most likely to harm or kill is themselves. Suicide is the biggest cause of death in men aged 20-49 in the U.K. and the biggest cause of death of teenage girls worldwide. 

What then is the basis for a 21st century documentary about mentally ill killers, that lingers over gory details? According to Shelley Jofre, the BBC reporter who made the documentary, it is a public interest story. I see that it’s a story the public will be interested in, but is it in the public interest?

The Panorama programme claims that the incredibly rare side effect of SSRI medication causing psychosis, potentially leading to aggression and violence, needs to be more widely known to both the general public and to people taking SSRIs. The problem with this argument is that family doctors and prescribing psychiatrists already weigh up potential side effect risks and discuss them with patients before prescribing. And there are many possible side effects from taking SSRI medications, the most common of which include weight gain, sedation, fatigue and loss of sex drive. The average person taking an SSRI has been informed by their doctor of likely side effects, thoroughly read the leaflet that comes with the medication, probably read up some more about the risks on Wikipedia and discussed the risks with other people taking the same medication. The vast majority of mentally ill people are already very well aware of the potential and actual side effects of taking SSRI medications. 

What about the wider population? Don’t they deserve to know the danger too? If the 40,000,000 prescriptions for SSRI medications in the U.K. every year are going to trigger a nationwide bloodbath, don’t the public have a right to be warned? Therein lies the central weakness in the programme’s premise. 40,000,000 SSRI prescriptions per year already in the U.K., no mental patient slasher movie apocalypse as a result. 

I don’t deny that there are records of isolated cases where an SSRI may have contributed to a tragic incident. But is the potential danger both proven and statistically significant enough to warrant making an hour long documentary about it? What about the much more prevalent side effect of an increased risk of death by suicide among teenagers when they first start taking some, but not all, SSRI medications? That kills more people. Surely that’s more newsworthy?

The unpalatable reality is that few care about mentally ill teenagers killing themselves. It’s dull TV, compared to bloodsoaked rampaging mental patients. Real Hannibal Lecters lurking in our midst. 

This perpetuates the myth that mentally ill people are inherently violent and a well behaved one is just one waiting to explode in a killing frenzy at any moment. Drugs are supposed to suppress this huge danger, not enhance it. A dribbling, sedated, locked up mental patient is the only safe one. 

This is of course total nonsense. One in four of us will suffer a mental illness in our lifetime. The vast majority of people will be treated with a combination of medication and therapy. Out in society. Not locked up. Normal, but unwell people, not dangerous in any way. 

What are the likely outcomes of the documentary being aired?

There is a small possibility that a handful of people who are taking SSRIs and experiencing psychosis as a side effect will realise what has been wrong and seek help and advice from their doctor. This is a good thing. 

Something which is much more likely is that some mentally ill people currently benefitting from taking SSRI medications will stop taking them, to avoid the remote possibility of becoming violent. The benefits of that medication will then stop. Clinically depressed people will slide back into the abyss. People with anxiety disorders will retreat back into tormented Hell. Some of these people may well take their own lives as a result. The documentary could possibly cause more deaths, not fewer. 

Then there is the stigma issue. Some think that the term “mental health stigma” is overused. In the face of the ongoing tide of derision, fear, mistrust and demonisation of mentally ill people, I can assure you that the term could be used much more indeed. Just like black people and gay people have had to stand up and say enough is enough, mentally ill people are now standing up to be counted. 

My name is Patrick. I suffer from clinical depression, severe OCD and PTSD. I am a mentally ill person, a loving husband, a good father. I take a high dose of Prozac, an SSRI medication. It helps me to function normally. I’m not an unquestioning fanboy of Prozac. I have side effects from taking it, but I’m zero danger to anyone. Enough is enough. The unwarranted stigma against all the ordinary people just like me has to stop. This documentary will perpetuate stigma and prejudice. That is harmful and dangerous. Much more dangerous than a rare medication side effect. 

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I think I have OCD…

One of the scariest things a person who has developed OCD (Obsessive Compulsive Disorder) can think is “I think I have OCD”. Given the nature of the condition, that is REALLY saying something. 

The average amount of time between onset of OCD and a person getting officially diagnosed is 12 years. That’s a very long time to spend in mental torture. Why do people wait so long?

There are several reasons: 

  • OCD is the bully which convinces you it is your friend. As with victims of domestic abuse, it takes guts to get help and escape the manipulative, harmful abuser. (As an abuse survivor myself, I don’t make this comparison lightly).  
  • The nature of many OCD intrusive thoughts means that sufferers are afraid that they maybe really are bad people who could hurt others, despite never ever having done so before. The shame associated with OCD is a huge obstacle to seeking help. 
  • OCD is widely misunderstood as a funny, common quirk of human nature, to do with enjoying cleaning, liking symmetry and arranging sweets/candy by colour. Sounds harmless, positive even. It’s not. What’s happening inside the mind of someone with actual OCD is neither harmless, nor positive. Because of this, many people with OCD fear that they have some other mental malfunction: psychosis, psychopathy, schizophrenia. Not that quirky, harmless thing everybody calls OCD. 
  • The fear of mental health stigma is real and sadly still somewhat justified. People worry about how we will be perceived by family, friends or at work. And people with OCD are World class worriers. 
  • Sometimes the obsessional focusses themselves can be a barrier. Because of my contamination fears, I had to wait outside my doctor’s surgery and he came out and got me when it was my turn to see him. 

OK, so you think you might have OCD. What should you do?

I would recommend finding out a little more about the condition first. Here are links to an OCD-UK web page about OCD:

About OCD – click here

And a link to the Wikipedia page about OCD:

Wikipedia on OCD – click here

These give an idea of the basics of the condition. If what is described seems familiar to what you’re experiencing; intrusive thoughts which get stuck in your head, focussed obsessions which cause anxiety or fear, lots of time spent doing a particular activity maybe repeatedly, avoiding doing certain things out of fear and anxiety, hyper-responsibility, shame, guilt, panic, self loathing, then you may well be suffering from OCD. 

The best thing you can do is go and see your family doctor. They are general practitioners, but will have some experience of patients with OCD. 

One exception. If you are in crisis and feeling actively suicidal, go to a local police station or A&E/ER and ask to be referred to a crisis team, or dial the emergency services and say the same. 

Below is a link to a printable sheet to take along to an initial family doctor appointment: 

Doctor OCD icebreaker – click here

When I went to my doctor first, I had written down what I considered to be my “OCD things”. Thoughts, obsessions, fears, worries, behaviours, avoidance behaviours. This was useful to have, as my doctor was initially doubtful of my self diagnosis. Once he had glanced through the three pages of writing, he conceded that yes, it did indeed look like I had quite severe OCD. 

If you feel that your doctor isn’t taking your concerns seriously, you have the right to ask to see someone else. Don’t be discouraged or put off. You have done the most difficult thing already. You have a right to appropriate treatment. 

Don’t be overly worried about this doctor’s visit. I know, it’s daft for one worrier to be suggesting to another worrier not to worry, but trust me, I’ve been there. It will be initially difficult for you, but the doctor will be sympathetic. This is the first step towards recovery. You will feel some of the huge burden of responsibility lift a little from your shoulders. 

The doctor will most likely prescribe a medication to help you. This may be an anti-depressant or a combination of medications. I have always been incredibly wary of taking any kind of medication for anything. I was extra afraid of taking “happy pills” which would change who I was and turn me into an addict. My fears were unfounded. I took the medication very reluctantly, but I took it as instructed. I didn’t become euphoric, but I did become less unhappy and my mood also stabilised. This gave me a solid foundation upon which to start building a recovery. It really helped. 

Hopefully the doctor will also refer you for specialist therapeutic treatment too. If after the first couple of months on medication you haven’t been referred for therapy, it is worth asking your doctor the reasons why not. Whilst medication certainly helps most people, it is not a cure in itself and not an ideal long term solution on its own. 

The main therapy used today to overcome OCD is called Cognitive Behavioural Therapy (CBT). If you’re in the UK, your GP will refer you to an NHS mental health service, which will further assess your condition and most likely offer you a course of one-to-one CBT sessions. The waiting list for NHS CBT for OCD (so many initials!) can be quite long, but it’s worth the wait.

If you are seeking a private CBT specialist, make sure they are properly qualified and very experienced in successfully treating people with OCD. You want to get what you’re paying for and to trust that you’re getting appropriate and effective treatment. 

If and when you get to do CBT, do it properly. It’s challenging and you’ll be doing most of the hard work, but it works for most who commit to doing it properly. It has worked very well for me. I am still in recovery, but I’m starting to live life without the bully called OCD controlling me every waking second. 

The book Break Free From OCD was an invaluable help to me before, during and after CBT. It helped me understand OCD better and explained the how and why of CBT treatment. 

Break Free From OCD book – click here 

You can recover too. You just need to take that first brave step on the road to recovery, as others have done already. You are not alone. You can do it. OCD can be overcome. Good luck.