* Names and identifying details have been changed.
For 16-year-old Angela Reich*, 2002 was a year of hell.
First, the Palo Alto teenager was diagnosed with a rare form
of highly aggressive cancer. Then she went through months of
debilitating chemotherapy that made her nauseous, caused her
hair to fall out and kept her in bed for much of her last year
of high school. She handled it all with unflappable poise and
good humor until it seemed she was out of the woods. But the
worst began when she started taking the antidepressant Paxil.
"Angela had been just pushing through and pushing through,"
says her mother, Sara.* "She mustered all her strength and
courage to face the chemo and to be sick all the time." By the
end of the summer, with the most intense part of her treatment
behind her, she was worn out and discouraged. "She started to
feel overwhelmed and depressed."
She began seeing a therapist and talked openly about her
feelings. But after a few weeks her depression had not lifted,
and Angela asked about going on antidepressants.
It took six weeks for the Reich's insurance company to
approve a psychiatrist, and by then Angela was in a deep funk.
"She was not wanting to get out of bed in the morning," Reich
recalls. "She couldn't do her homework. She said it felt
terrible to live like this, but then she would say, 'I don't
want to die, I don't want to hurt myself.' I remember sitting
across from her at the kitchen table and tears pouring from
her eyes and her saying 'This is so hard.' "
The psychiatrist prescribed Paxil, a selective serotonin
reuptake inhibitor (SSRI) similar to its famous predecessor,
Prozac. On a dose of 5, then 10, then 15 milligrams a day,
Angela soon started feeling better. Five weeks after she began
taking the medication, Angela and her mother met with the
psychiatrist, who suggested another boost in dosage. "He said
she's doing well now; she could be doing even better on 20
milligrams," Reich remembers. She was hesitant, but Angela
wanted her old life back and thought it made sense to try. The
next day, she started on the higher dose.
Restless Legs, Sleepless Nights
Within days, Reich says, her daughter was acting strangely.
The first change was Angela couldn't keep her leg still.
"She'd be sitting in a chair and her knee would be jerking up
and down." She became irritable and had more trouble sleeping.
Her parents would ask about her restless, jerking leg and she
would snap at them to leave her alone.
When Reich left on a business trip, Angela called her three
or four times a day and begged her to come home early. When
she returned, Angela "burst in my room and hugged me," Reich
says. "She kept saying, 'Mommy, I'm so glad you're home.' She
was scared, like she couldn't cope. She said she dreaded going
to bed because she had so much trouble sleeping. She'd lay
there thinking and her thoughts got darker and became
unbearable."
That night, Reich shared her daughter's bed but Angela
slept little and was still wound up in the morning. When her
mother tried to get her ready for a piano lesson, she said she
wasn't going. "She looked funny and had a weird smile on her
face," Reich remembers. "I knew something was wrong. I looked
around the room and saw some pill bottles. I asked if she took
any pills and she said 'Yes.' "
Under questioning, Angela told her mother she had taken
four tablets of the sleeping pill Ativan. Then Angela ran to
the bathroom, locked the door, and started going through pill
bottles. Her father, Jim, smashed the door open and snatched a
bottle of Benadryl from her hands. She ran to her purse,
seized a bottle of Tylenol and began shoving pills in her
mouth. Her mother grabbed her, pinned her arms, and marched
her to the car, as Angela's younger brother watched.
Reich drove straight to a nearby hospital. One block from
the house, Angela turned to her mother. "She said 'Mom, I
don't know why I did that. It was like something took me
over.' And I said 'I know, it wasn't like you. But I will keep
you safe.' "
At the emergency room, the staff administered charcoal to
absorb the drugs, then transferred Angela to a psychiatric
hospital. The next day, the hospital psychiatrist called
Reich. "He told me it was a drug-induced suicide attempt," she
said, related to the increased dosage of Paxil.
Neither Angela, Sara nor her husband, Jim, an internal
medicine doctor, knew Paxil might carry a risk of triggering
suicidal thoughts or actions. Aside from a generic statement
that depressed people are more likely to attempt suicide,
there is no mention of such a risk in Paxil's prescribing
information.
England Acts, United States Follows
The risk Paxil may pose to children and teenagers burst
into the news this summer, when British regulators issued a
warning urging doctors not to prescribe the drug to children.
They were acting on new data presented to United States and
British authorities showing that among 1,100 children enrolled
in clinical trials of Paxil, those taking the drug were nearly
three times as likely to consider or attempt suicide as
children taking placebos. "There is an increase in the rate of
self-harm and potentially suicidal behavior in this age
group," said a statement from the British Medicines and
Healthcare Products Regulatory Agency (MHRA). "It has become
clear that the benefits (of Paxil) in children for the
treatment of depressive illness do not outweigh these risks."
Nine days later, the FDA issued a similar warning and
announced that it would conduct a detailed review of pediatric
trials of Paxil, a review soon broadened to include seven
other antidepressants, including top sellers Prozac, Zoloft
and Effexor. In August, Wyeth Pharmaceuticals warned doctors
that its drug, Effexor, triggered hostile behavior or suicidal
thinking in children at twice the rate as the sugar pills
taken as placebos.
Then, last month, the MHRA announced that it was urging
doctors to stop prescribing a group of six antidepressants,
including Paxil, Zoloft and Effexor because they caused an
increase in suicidal thoughts and actions. "These products
should not be prescribed as new therapy for patients under 18
years of age with depressive illness," wrote Gordon Duff,
chairman of the MHRA's Committee on Safety of Medicines, in a
"Dear colleague" letter to British physicians.
Prozac, the only SSRI approved for use in depressed
children, was not included in the new warning. The British
review did not find a significant increase in the risk of
suicide-related events among children taking the drug.
The British and American warnings were a stunning
turnaround that left thousands of parents whose children are
using the drugs wondering whether their children were at risk.
But it was also long-sought vindication for a small group of
researchers, family members and lawyers who have been arguing
for years that antidepressants cause some people to become
violently unhinged. They say they've been frustrated in
getting this word out to the public, in large part because of
the FDA's unwillingness to confront and control the
drugmakers.
The FDA's warning about a possible suicide risk from Paxil
left Sara and Jim Reich feeling furious, betrayed, and ready
to sue. "Had I known there was a threefold increased risk of
suicide among kids taking Paxil, I would not have allowed my
daughter to go on that drug," said Jim. In fact, Jim has
prescribed the drug himself and is outraged that the
Physician's Desk Reference, or PDR - the drug bible for
doctors, based on FDA-approved prescribing information - says
nothing about Paxil's suicide risk.
The British and American warnings also raised some
troubling questions: How did drugs that have been widely
promoted as nearly risk-free, and that are commonly prescribed
by pediatricians and child psychiatrists, come to be seen as
potentially dangerous? What should parents whose children are
taking them do about it? And just how effective are these
drugs that can sometimes cause such serious problems?
An Uncontrolled Experiment
Since 1987, when Prozac became the first SSRI on the
market, America's love affair with antidepressants has worked
its way down the age ladder. Between 1987 and 1996, the use of
antidepressants and other psychotropic medications by children
and adolescents tripled, with most of that increase occurring
after 1991, according to a recent study in the Archives of
Pediatric and Adolescent Medicine. By 1996, the study found, 6
percent of American children and teenagers were taking
psychotropic medications, one-third of which were
antidepressants.
Biological solutions to behavioral problems were becoming
increasingly acceptable, even fashionable. "I think there's
been a revolution in the way people think about behavior,"
says Lawrence Diller, a behavioral pediatrician in Walnut
Creek. "The idea that children's behavior is the product
primarily of their genetics and biochemistry was promoted by
American psychiatry and hijacked by the drug industry. It's
simply become more acceptable to see behavior as a reflection
of an imbalance in chemistry rather than an imbalance in
life."
The phenomenal growth in antidepressants prescribed to
children leaves many doctors and therapists uneasy. Diller,
who has written about his misgivings in two books ("Running on
Ritalin" and "Should I Medicate My Child?"), cautiously
prescribes antidepressants to some children, but says the new
data about a possible link to suicide is making both him and
some parents think twice. "It hasn't caused me to stop using
SSRIs, particularly in teenagers, but I think it's another
reminder that our information is incomplete."
To understand how we got here, it's important to know a bit
about the drug- approval process. When a drug company applies
to the FDA for approval to sell a medication, it must
demonstrate that the drug is safe and effective for a
particular population, such as adults, and a specific
condition, such as depression. Once the drug has been cleared
by the FDA and is on the market, doctors are free to prescribe
it to anyone for any reason. "Off-label" prescribing, is quite
common; the only real restriction is that drug companies
cannot market drugs to unapproved groups. From 1987, when
Prozac was first approved for adults, until early last year,
when Prozac became the first SSRI approved for use in
depressed children 7 and older, all antidepressants used by
depressed children were prescribed off-label.
The widespread use of antidepressants by children, critics
say, amounts to an uncontrolled national experiment. The
prescribing physicians are often pediatricians or family
doctors with little or no training in psychopharmacology. The
drugs are frequently given in the absence of therapy or other
interventions. The subjects of the experiment - children - are
too young to give meaningful consent. There is little
understanding of the long- term effect these medications have
on the architecture of children's developing brains. And the
evidence that the drugs are effective is less than impressive.
When Prozac was approved for depressed children last year,
it was on the strength of two controlled trials. One,
published in 1997 in the Archives of General Psychiatry, found
that after eight weeks, 56 percent of kids taking Prozac
showed some improvement, according to the clinicians who
evaluated them, compared with 33 percent of the kids in the
placebo group. But 69 percent of the kids taking Prozac still
had significant symptoms of depression. Clinical trials of
Paxil, Zoloft and Effexor found those drugs to be no more
effective than placebos in treating depressed children.
Perhaps the most notable finding from clinical trials of
antidepressants is how many children respond well to placebos
- as many as 59 percent in some studies. This high placebo
response rate is a common finding in pediatric drug trials, in
which children are generally seen once or twice a week by
clinicians, says David Healy, an internationally known
psychopharmacologist from the University of Wales College of
Medicine who has emerged as a prominent critic of drug company
practices. "This suggests that simple support can help
children in many cases," Healy says.
SSRIs: Cleaner and Safer?
In the years since 1987, SSRIs have developed a reputation
for being largely free of serious side effects, vastly
improved over the older generation of so-called tricyclic
antidepressants. In some respects, this is true: Distressed
patients who attempt to kill themselves by overdosing are
unlikely to succeed; they can usually tolerate the pills. And
patients taking tricyclics are more likely to suffer from
constipation, urinary retention, blurred vision and dry mouth.
But SSRIs cause sexual problems at fairly high rates, as
well as insominia, nausea, dizziness and other side effects.
Studies also have not found them to be more effective than the
older pills at relieving symptoms of depression. "The SSRIs
have sold themselves very heavily as safe and clean drugs
compared to the old antidepressants," says Healy. "Well, it's
not clear that they're safer, and it's not clear that they
cause fewer side effects."
One side effect of SSRIs, recognized for at least 15 years,
is a sensation called akathisia, a restless agitation that
ranges from jitteriness to a sensation described by some
people as "jumping out of their skin." Healy believes
akathisia is the principal trigger for impulsive violence in
some people taking SSRIs. "They became anxious, agitated,
terrified, unable to sleep at night and restless," he says -
the symptoms that plagued Angela Reich.
There have long been signs that SSRIs sometimes cause these
reactions, which drug manufacturers have tried mightily, and
largely successfully, to keep out of the public eye and off
the labels. This issue first arose a couple years after Prozac
went on the market, amid a raft of media reports about grisly
acts of murder and suicide. The most notorious event took
place in 1989, when Joseph Wesbecker went on a shooting
frenzy, killing nine fellow workers of a Louisville, Ky.,
printing plant before turning his gun on himself. Wesbecker,
who had a history of mental problems, was taking Prozac. No
one could prove Prozac caused his rampage, but by early 1991,
some 350 suicides of Prozac patients had been reported to the
FDA, according to one former FDA official. Those reports,
which occurred outside the context of scientific clinical
trials, were dismissed as anecdotal and sensational by company
officials.
Harder to dismiss, though, was a study published by Harvard
researcher Martin Teicher and two colleagues in the American
Journal of Psychiatry in 1990 about six patients who developed
"violent suicidal preoccupation" after taking Prozac for two
to seven weeks. "It was also remarkable how violent these
thoughts were," the authors reported. "Two patients
fantasized, for the first time, about killing themselves with
a gun," they wrote, while one placed a loaded gun to her head,
another had to be restrained to prevent self- mutilation, and
another fantasized about killing himself in a gas explosion.
None of the patients was suicidal when they started taking
Prozac, the researchers reported, and their fixation with
violence and death abated when they stopped.
Similar symptoms were noted the next year in a paper in the
American Journal of Child and Adolescent Psychiatry about six
children ages 10 to 17 who developed "intense self-injurious
ideation or behavior" while taking Prozac. After three weeks
on the drug, one 14-year-old girl, who had been depressed but
never suicidal, began cutting and otherwise injuring herself.
She told hospital staff, "I'm just waiting for the opportunity
to kill myself, " and chanted, "Kill, kill, kill; die, die
die; pain, pain, pain," according to the paper. The Yale
University authors noted the complexity of reaching any
conclusion about the cause of these events since the children
all had lengthy histories of psychiatric difficulties that put
them at risk for suicide. They also noted that many children
taking Prozac become agitated, restless, and disinhibited and
developed insomnia to boot.
A 1998 paper by Roger Lane, a scientist at Pfizer, the
maker of Zoloft, stated that "all SSRIs have the rare
potential to cause akathisia." In its most extreme form, Lane
wrote, patients may feel that "death is a welcome result."
Lane also warned that akathisia can sometimes be mistaken
for worsening depression, prompting some doctors to increase
the dosage - and the danger. Healy agrees. "[Doctors] have
been educated to think that SSRIs take four, five, six weeks
to work," he says. "But they can cause problems long before
that."
In response to the Teicher paper and the growing media
furor connecting Prozac to acts of violence and suicide, the
FDA in September 1991 convened an extraordinary special
hearing of its Psychopharmacological Drugs Advisory Committee.
Speakers told of family members who committed suicide or
homicide while on Prozac and begged agency officials to ban or
restrict the drug. But representatives of Eli Lilly, maker of
the blockbuster drug, backed by FDA and academic researchers,
argued that suicide is an inherent risk among depressed
patients. The Lilly officials presented figures from the
company's clinical trials database suggesting that people on
Prozac were at no greater risk of suicide than people taking
placebos.
Committee members voted unanimously in Lilly's favor, and
Prozac remained on the market. No warning that the drug might
induce violent or suicidal urges in some people was added to
its label.
'Cooking the Books'
The Prozac suicide controversy, and the huge number of
suicide reports that were streaming into the agency,
reverberated inside the FDA, where two other SSRIs, Paxil and
Zoloft, were being considered for approval. The FDA medical
officer charged with reviewing Paxil's safety and efficacy
data was Martin Brecher, now an executive with the British
pharmaceutical company Astra Zeneca. "The reports of
successful suicide were coming in in bunches," he said in a
recent deposition. "It was extraordinary, especially in
comparison to other annual reports where, you know, you had 20
reports of a cold and maybe two reports of some liver enzyme
elevations and here you are with 20 deaths in a report."
Because Paxil and Zoloft were members of the same chemical
class as Prozac, the FDA asked officials at SmithKline Beecham
(the predecessor to GlaxoSmithKline) and Pfizer, Zoloft's
maker, to submit reviews on the drugs' effect on suicidal
behavior of patients. Brecher called Thomas Donnelly, a
SmithKline Beecham executive, and asked him to prepare such a
report. In an internal company memo uncovered in a lawsuit,
Donnelly described his conversation with Brecher, noting that
the FDA "does not see it as a real issue but rather as a
public relations problem."
What happened next is controversial. Critics charge that
the company manipulated data to diminish the apparent suicide
risk among Paxil users and submitted it to the agency. One of
the harshest critics is an unlikely plaintiff's attorney in
San Rafael, a self described conservative Republican and
retired Navy officer named Don Farber.
Farber, who has spent the better part of the past five
years suing Glaxo- SmithKline and other drug companies, is one
of a handful of lawyers handling such cases. His first case
involved a San Jose man, Reynaldo Lacuzong, who, in 1996,
drowned his two children and himself in a bathtub three days
after he began taking Paxil. After the suit was filed,
GlaxoSmithKline and the surviving Lacuzong family resolved the
case with an undisclosed settlement.
The same thing has happened in dozens of other cases of
alleged SSRI- induced suicide or violence; few cases ever go
to jury. In June 2001, however, a case did. Three years
earlier, Donald Schell, a 60-year-old Wyoming man, killed his
wife, daughter and granddaughter three hours after taking two
tablets of Paxil given to him as samples by his internist.
Surviving family members sued GlaxoSmithKline, and the jury
awarded them $6.4 million for the wrongful deaths of their
relatives.
"[The company] knew there was a small group at risk and Don
Schell was one of those vulnerable people," the family's
attorney, Andy Vickery told the jury. Farber makes the same
argument: Drug companies have an obligation to warn doctors
and patients that these drugs can pose a threat to some
people.
"If there was a warning that said 'Caution: this drug may
cause suicide in some people,' then doctors are going to know
about it," Farber says.
Instead of warning people, Farber charges, Glaxo-SmithKline
tried to hide the true numbers. "They cooked the books," says
Farber during a recent interview. "They cheated on the
results. And the FDA is part of this."
Farber says the company manipulated the figures. Documents
obtained by The Chronicle show that in its initial application
to the FDA, the company reported that out of 2,963 adults
taking Paxil during clinical trials in the United States or
other countries, seven patients killed themselves and 42
attempted suicide. But in a review submitted in April 1991, in
response to Brecher's request, the seven suicides had dropped
to five and the 42 attempts had gone down to 40.
At the same time, the number of attempted suicides by
patients taking placebos doubled from three to six in the
later review. The 1991 review also acknowledges that two
suicides and two suicide attempts charged to placebo occurred
during a one-week "washout" period that came before the start
of the study. During that period, subjects were taken off any
drugs they had been using to get the drugs out of their
system. Experts say it is inappropriate to count events during
the run-in period as placebo events.
Company officials admit there were errors made in reports
filed with the FDA, but deny any attempt to mislead. "There
were unfortunately some inconsistencies in how the data on
suicide attempts was presented to FDA," says GSK spokeswoman
Mary Anne Rhyne. "When we became aware of this, we went back
and looked at the clinical trial data again. GSK did not
intentionally submit any erroneous or misleading information
to FDA. The suicide data submitted to FDA explicitly
identified when events occurred during the placebo run-in
period. FDA had all this information right from the
beginning."
Farber contends that these small shifts in numbers make a
big difference in suicide rates. He claims that a close look
at the data reveals that only one placebo patient out of 554
attempted suicide, while 49 patients out of 2,963 taking the
drug committed or attempted suicide - a ninefold difference.
Rhyne disputes this analysis. "The randomized,
placebo-controlled data shows no statistically significant
differences in suicides or suicide attempts between Paxil and
placebo," she says.
Drug Firms and the FDA: Too Close?
For its review of all pediatric trials of antidepressants,
the FDA is reanalyzing the data to determine whether reports
of suicidal ideation among children were categorized properly.
Critics are concerned that this reanalysis may minimize the
apparent suicide risk to the benefit of drug companies, and
contend that the agency has a long history of protecting the
industry. They point to company memos, uncovered through legal
actions, that reveal a sense of confidence within the
companies that the FDA was on their side. Memos from Eli Lilly
executives described one FDA official, Paul Leber, as "our
defender" and cautioned that faxes should not be sent to him
unless he knew they were coming so he could receive them
personally.
Other memos suggest Lilly officials went to great lengths
to conceal any hints that Prozac might trigger suicide.
Consider this line from a 1990 memo to Lilly executive Leigh
Thompson written by Claude Bouchy, a Lilly official in
Germany, in response to a request to change the description of
an event from "suicidal ideation" to "depression." Bouchy
writes: "Hans [a fellow Lilly employee] has medical problems
with these directions and I have great concerns about it. I do
not think I could explain to the BGA [the German FDA], a
judge, to a reporter, or even to my family why we would do
this, especially on the sensitive issue of suicide and
suicidal ideation."
Critics charge that the pro-industry stance of FDA
officials prevented a more thorough examination of the role
antidepressants may play in triggering suicide and violence in
some users. They also charge that many American psychiatric
researchers have been compromised in their ability to look
objectively at this issue because they are so dependent on
funding from pharmaceutical companies.
The FDA's Thomas Laughren rejects the notion that his
agency is protecting drugmakers. "The goal here is to get to
the truth," he says. For the review of pediatric trials of
antidepressants now under way, the agency is bringing in a
panel of experts as judges. "We're taking all the cases and
having them reclassified blindly," he says. "They'll be
looking at all the information that is relative to the
question of suicidality and they will not know the drug
assignment."
As the agency reviews the data, experts will debate a core
question: how to reconcile reports of antidepressants
triggering suicidal behavior with other studies that suggest
that these drugs reduce suicide rates. A paper published in
the October Archives of General Psychiatry found that regions
of the country where the use of antidepressants by children
increased the most also tended to have the greatest drop in
suicide rates.
Could antidepressants lower the suicide risk in some people
while raising it in others? "It's entirely possible that both
things are true," says Mark Olfson, a professor of clinical
psychiatry at Columbia University and lead author of the
Archives paper.
David Healy says the drugs simply have different effects on
different people. "My hunch is that, just as with adults,
there is a group of children who are suited to the pills and
do very well on them and an equally large group of kids who
are not." Among those who don't do well, Healy says, are some
who get much worse.
One thing most experts seem to agree on is that patients,
especially children, should be monitored closely for side
effects from the day they start taking the drugs. "They may be
more anxious or have unusual thoughts they've never had
before," Healy says. "They may think about harming others or
themselves." Healy also suggests asking children if they've
had strange dreams, nightmares or thoughts since they started
taking the drug. "The other thing to look out for," he says,
"is the opposite effect: Kids who become absolutely fearless,
they just don't feel anxious at all."
Tragedy Strikes
On Feb. 2, nearly 13 years after the 1991 Prozac hearings,
an FDA advisory committee will once again hold a hearing about
the risk of suicide by people taking antidepressants, this
time focusing on the risk to children and teenagers. The
meeting will come too late to help 17-year old Julie Woodward
of North Wales, Pa.
In July, Julie began attending a two-week group therapy
program at nearby Horsham Clinic. A break-up with a boyfriend
and conflicts with her parents had left her feeling withdrawn
and in a struggle to maintain good grades. One condition of
attending the program was taking antidepressants, Tom Woodward
says. He and his wife didn't really like the idea, but were
told they were "essential to treatment" and "very benign."
On day three of the program, Julie began taking 50
milligrams of Zoloft, and that night came the first signs of
unusual behavior. Julie and her mother had a small dispute,
and Julie roughly shoved her mother, an out-of-character act,
Woodward says.
During the next few days, Julie became more edgy and
withdrawn. On the evening of day six, she told her parents she
wanted to stay home alone. But when they looked for her later
that night, they couldn't find her. The next day, her father
found her body hanging in the garage. One week after starting
on Zoloft, she had taken her life.
When the FDA hearing comes, Tom and Kathy Woodward plan to
testify, as do Jennifer Tierney and her daughter, Jame, of
Kernerville, N.C. The Tierneys' story exemplifies another part
of the antidepressant story: withdrawal.
All SSRIs have been reported to cause withdrawal problems
in some patients who stop taking them. Paxil and Effexor,
however, seem especially likely to trigger withdrawal
symptoms, probably because they exit a user's body more
rapidly. "Paxil has been linked to more reports of withdrawal
symptoms than any other drug in clinical history," says Karen
Barth, an attorney with Baum- Hedlund, a Los Angeles firm that
is representing some 3,000 people who have suffered withdrawal
problems on Paxil.
Jame Tierney was 14 when she was prescribed Effexor to ease
migraines she'd been suffering from for years. She started
with Effexor and other drugs, but gradually went off the
others. She enjoyed eight good months of reduced headache
pain. Then the migraines worsened and her neurologist doubled
the dose. Within two weeks, her personality began to change.
"She became the most angry, combative, raging child you've
ever seen," says her mother. "I'd never seen her like this and
I had no idea why."
Jame was also unhappy and depressed. "I was hopeless, and I
thought suicide was the only way out," she recalls. "I had
violent thoughts and tendencies that I'd never felt before."
She contemplated killing herself and made one attempt to cut
her wrists.
She remained on 150 milligrams and in a raging misery for a
full year, functioning at school but isolating herself in her
room. Then her mother learned Effexor wasn't a headache drug
but an antidepressant, unapproved for children, which can
sometimes cause serious side effects. Over the objections of
the neurologist, Jame tried to taper off the drug. Her
personality quickly returned to normal, but she suffered
terrible withdrawal symptoms - constant vomiting, headaches,
muscle aches and disequilibrium that kept her out of school
for months. Finally, on advice from a California doctor, she
began taking vitamin and enzyme supplements. After six months,
the withdrawal symptoms ended and her headaches are now a rare
event. Her bout with depression, which she experienced only on
Effexor, also came to an end.
While Jame was weaning herself from Effexor, Angela Reich
was trying to get off Paxil. Her dose was cut to 15 milligrams
a day while she got through the next round of chemo. She
lowered her dosage - to 12.5 mgs, then 10, then 7.5, 5, and
2.5 over four weeks. Finally, on Jan. 24, she took no Paxil.
That's when the side effects began.
"She couldn't sit up, she had trouble walking, and she was
dizzy," Sara recalls. "She couldn't walk straight, and she had
this zapping, this electrical feeling in her arms."
The restless akathisia was gone, but Angela was
uncomfortable, depressed, and irritable - "really irritable,"
her mother says. One night, Angela nearly flipped out. She ran
into the living room, screaming, and started grabbing books
off the shelves and heaving them. "She tore them up and said
she hated them, she hated us and she hated the people around
her," Sara says. "Then she grabbed for some knives." Her
father restrained her and held her until she calmed down. But
the whole family was shaken. "I started to feel like 'Oh my
God, my kid has gone insane,' " Sara says.
Somehow Angela and her family got through the next month,
and she gradually started to feel normal. She went off to
college in September and is doing well, her parents say. Best
of all, as this article was going to press, she got another
negative biopsy report on her cancer.
Angela didn't want to talk about her Paxil experiences with
a reporter - "It's just too painful," her mother explained.
But she did want to join the lawsuit that Baum-Hedlund is
pursuing against GlaxoSmithKline. "She wants to prevent anyone
else from going through this kind of nightmare. She wants to
save other people from suffering like she suffered."
Berkeley-based writer Rob Waters' articles have appeared
in Health, Parenting, and the Los Angeles Times. He is the
co-author of "From Boys to Men: A Woman's Guide to the Health
of Husbands, Partners, Sons, Fathers, and Brothers," which
will be released in April.
