Paxil is forever – can you quit? – addiction and withdrawal

This is part two of a 2002 article about Paxil marketing and withdrawal by Beth Hawkins.

Listen to enough people who can’t seem to stop taking Paxil and you start to notice a common thread: When they first ask a doctor about their withdrawal, they all too often hear that whatever they are experiencing, it has nothing to do with Paxil. They are routinely told that any “discontinuation effects” should clear up in a few days. When they are still ill a week, two weeks, or sometimes months later, they may be told that the symptoms signal a return of their depression.

About a year ago, Randi Morrison (not her real name) drove herself to the emergency room. The diarrhea and upset stomach that had been dogging her for weeks just kept getting worse and worse. She’d lost a lot of weight and started having crying jags. Her family was panicked. At the ER, it didn’t occur to her to tell anyone that she’d been weaning herself slowly off Paxil for weeks. And it didn’t occur to the hospital staff that after eight years of taking the drug, she might be addicted. “They first said I had an eating disorder,” Morrison recalls. “The [doctor] asked me if I had a ‘fond liking’ of laxatives. Then she asked me how much methamphetamine I had done that day. No one ever asked me what medication I was on, what else was going on. I think they just drew conclusions.”

When it finally occurred to Morrison, a Brooklyn Park resident, to mention that she had become ill when she began decreasing her Paxil dosage, “they said, ‘then obviously you need to be on this medication.’ And me not knowing it was the medication causing it, I agreed. I felt kind of lethargic for a couple of days, but my stomach problems went away and I stopped–mostly–crying.”

Morrison tried again to quit Paxil in the winter, with the help of her psychiatrist. Again, she spent a couple of months tapering off the drug. But this time the effects were worse than before. “By the time I took the last pill, I was okay for a day or two,” she recounts. “On day three, I was incredibly tired. I had to call in sick to work. I mostly just slept that day. But as the week went on it just turned into a fucking nightmare. One minute I was bawling, the next I was enraged.”

“I remember wanting to stab my mom with a fork,” she continues. “I went to staring at a blank wall and laughing. I had tremors. I would be really hot and shaky at some times, and I was sweating tons and tons of this rancid, metallic sweat. I got these electrical zaps if I turned my head, or even just from eye movement.

“I called the doctor and was told to go back on it and then try tapering off again. I hung up on him. I called pharmacists and they said there was no proof that this stuff even occurred. So I hung up on them.”

A hairdresser with a hefty client list, Morrison quit going to work. “It’s incredibly hard work to make people feel pretty when you feel like shit,” she says. “It was like getting off crack, for chrissakes.”

Tales like Morrison’s don’t make Kevin Turnquist so much as blink. “If you spend an hour online, you’ll know as much about this as the majority of general practitioners,” he says. Indeed, more than 25 percent of psychiatrists and nearly 75 percent of other physicians are unaware that patients might have trouble discontinuing the drug, according to the Harvard Mental Health Letter.

One of the differences between Paxil and its pharmaceutical cousins is its half-life, the length of time the drug takes to leave a person’s system. Whereas Prozac lingers in the body for two to four days, Paxil wears off in about 20 hours. And a short half-life is one characteristic that can make a drug habit-forming. “The brain likes things to change very gradually,” explains Turnquist.

In 1993, five months after Paxil went on the market in the United States, a study presented at the American Psychiatric Association’s annual meeting found that up to 42 percent of individuals suffered withdrawal symptoms when they stopped taking the drug. At the same time, Great Britain’s counterpart to the FDA, the Committee on the Safety of Medicines, reported 78 cases of Paxil withdrawal.

In fact, since 1994 some 16 studies found “withdrawal syndrome” in up to half of individuals attempting to quit taking SSRIs; all the studies noted that the problem was the worst with Paxil. In an Australian study, Paxil caused withdrawal three times as often as Zoloft and four times as often as Prozac. (The second-highest rate of withdrawal is reported with another SSRI with a short half-life, Luvox.)

A Canadian study found that a number of women who took Paxil during the last trimester of their pregnancies gave birth to babies that went through withdrawal. Many of the researchers concluded that the withdrawal symptoms could be mistaken as physical illness or a relapse into depression. Warnings about the withdrawal symptoms were placed on Paxil’s label in several European nations.

Yet, even as the research was suggesting that SmithKline should both change Paxil’s label and work to educate doctors about its withdrawal symptoms, the drug company seemed to be more interested in damage control. For example, in 1997, a report on more than 13,000 British patients’ experience with SSRIs concluded that Paxil was far more likely to cause withdrawal than its competitors. According to a class-action lawsuit filed against SmithKline, the company reacted by ordering its sales representatives to tell U.S. physicians that the damning study had found no difference between Paxil’s withdrawal rates and those of other antidepressants.

The company may, in fact, have known about the withdrawal symptoms much earlier, according to the suit. One hundred and eight patients who dropped out of a clinical trial of the drug told the manufacturer that they had experienced withdrawal. When it reported on the trial to the FDA, the suit alleges, the drug company reclassified these patients as having relapsed. (Typically the FDA uses only the data submitted by a pharmaceutical company when considering whether to approve a new drug.)

The watchdog organization Public Citizen has warned that the FDA is increasingly dependent on the pharmaceutical industry for funding. In 1992, under pressure from AIDS activists and drug companies, Congress passed the Prescription Drug User Fee Act, which allows manufacturers to pay the agency to review products more quickly. The move has cut the average length of time it takes to bring a new drug to market from 30 months to 15. At the same time, however, there’s been an increase in the number of drugs the agency has had to take off the market, according to the Washington, D.C.-based nonprofit.

In May, Congress increased the share of the agency’s funding that comes from drug companies. The provision was neatly hidden in a rider to the $3 billion Bioterrorism Preparedness Act. Sen. Ted Kennedy, author of the rider and head of the Senate Health, Education, Labor, and Pensions Committee, failed to hold a hearing on the controversial law. The pharmaceutical concerns did have to make one small concession: Recognizing that the FDA was ill-equipped to track drugs once they had hit the market, Congress ordered that some of the fees be used to monitor new drugs.

The wing of the agency that tracks adverse drug effects operates with a shoestring budget of $15 million and a staff of 72 and depends on voluntary and unreliable reporting by doctors, according to a May 2000 article in Washington Monthly. By comparison, the portion of the FDA that approves and monitors new drugs has some 1,300 employees and a budget of roughly $290 million.

It’s a far cry from the systems other countries have in place to monitor the safety of new and popular drugs. “What the Brits and the Aussies do is ask healthcare professionals to pay particular attention to possible adverse effects of both new drugs and those that are widely distributed or they are interested in,” says Larry Sasich, a research pharmacist with Public Citizen’s Health Research Group. “And they give healthcare professionals a lot more information, via a newsletter, for instance….Of course, gathering data is certainly easier in countries with national healthcare systems, because prescriptions can be tracked.”

Last December, nine years after Paxil came on the market, the FDA ordered GlaxoSmithKline to begin warning consumers that they might have trouble discontinuing Paxil. Ever PR-savvy, the company rewrote the label to note that the drug sometimes causes “discontinuation effects.” Even as it was drafting the warning, GlaxoSmithKline argued that Paxil isn’t addictive. In the company’s view, in order for a substance to be deemed addictive it must cause withdrawal symptoms that produce “drug-seeking behavior.” And who ever heard of someone jonesing badly enough to steal Paxil from their neighborhood drugstore?

Nonetheless, on August 16 Mariana Pfaelzer, the federal judge hearing Murphy’s and Morrison’s case, ordered GlaxoSmithKline to stop advertising Paxil as non-habit-forming.

“We are very disappointed in the ruling,” said David Stout, president of U.S. Pharmaceuticals at the company. “The U.S. Food and Drug Administration–and not the courts–has the expertise and responsibility for reviewing and regulating pharmaceutical ads.” The company had submitted the ad in question to the agency for review, he noted, and heard no objections.

“GSK is strongly behind the safety and efficacy of Paxil,” he continued. “Physicians’ organizations like the American Psychiatric Association have stated that antidepressants are not habit-forming. It is also important to note that the court has made no finding that Paxil is addictive or induces dependency.”

The company contacted the FDA, and two days later the agency demanded that the judge lift the ban, arguing that the court had no authority to order GlaxoSmithKline to pull the ads. The agency wanted to reserve that power for itself. Last week, Judge Pfaelzer reversed herself and allowed the company to continue airing the ads.

In 1994, Jessica Porter (not her real name) went to see her nurse practitioner for a checkup. She had lost a lot of weight, and on being quizzed by the nurse she admitted that she was depressed and anxious. “I was in a somewhat desperate space,” she recalls. “I was really unhappy and I felt like I was wasting a lot of my life.”

The nurse suggested she try Paxil. Porter was quick to agree. “I had sort of had it in the back of my mind,” she says. “I just never felt like I was sad enough to seek out therapy.” The nurse gave her a prescription for a supply of 20-milligram tablets and a pill cutter. Porter was to start out taking 10 milligrams and work her way up to 20. If she had a particularly hard time, she could increase her own dose to 30 milligrams. “It had a decent effect,” she says. “It put a floor underneath me. With the drug I still had down times and anxious times, but they were never as bad.”

Porter stayed on Paxil for three years before she started having stomach problems. By that time, the nurse she had been seeing had left her practice, and Porter didn’t feel like she could call the psychiatrist who had renewed her prescription during brief annual visits. So she just quit taking the pills on her own. After a couple of days, she began to feel electrical shocks in her head. “Every time I turned I would have these zaps,” she says. “It felt like I had blacked out for a few seconds.

“I was feeling really bad, and feeling really anxious about feeling bad,” she says. “I was thinking, ‘This is me. This is what I’m like without any drug. How can I live like this?'” She called the psychiatrist and was told to go back on the drug and begin tapering off five milligrams at a time.
After she took her last pill, however, the symptoms returned. “I sought out a therapist, but I was having so much trouble with crying that she said, ‘We need to get you on something and then we can talk.'” She went back to the psychiatrist, who put her on Prozac. The doctor assured her she’d be able to stop taking the new medication if she wanted to quit.

Porter has grown used to the idea that she’ll take an antidepressant for the rest of her life. “Still, I always have the feeling that I ought to be able to do this myself,” she confesses. “My issue about it is sort of feeling guilty about it. Like, I have a good life. I have this, I have that, I should be able to get through this.”

Porter does have one major cause for remorse, however. A onetime poet, she has stopped writing and she’s sure it’s because of the antidepressants. She can’t articulate why she can’t create while she’s on medication, but she has accepted it as an inevitable side effect.

If Kevin Turnquist were to meet her, this part of her story would probably trouble him the most. He has a theory that a lack of novel experience–good and bad–puts unhealthy stress on the human brain. “Mundane jobs, boring routines, and the absence of real struggles for survival may all prove to contribute to depression’s increasing place in society,” Turnquist wrote recently in The Humanist. “We cannot discount the possibility that the activities that seem to add diversity to our modern existence don’t provide the sort of stimulation that healthy brains thrive on.”

The latest research indicates that there is a connection between the size of the piece of the brain involved in the formation of memories, the hippocampus, and depression. “One study suggests that the hippocampus may shrink by an average of 19 percent in depression,” Turnquist reports. “Other research has found that SSRI antidepressants and shock treatment, among other factors, restore the hippocampus to more normal volume. This increase in the size of the hippocampus is now considered to be a possible mechanism by which these treatments promote recovery from depressive illness.”

In Turnquist’s experience, many of the people who have a hard time quitting SSRIs are young women. Many didn’t respond well to the drug in the first place. “What you never see are studies about the characteristics of the people who have trouble getting off of this medication,” he says. “My guess is that these are people with chronic, low-grade depression. A lot of them have had awful childhoods. Some have been abused. One of the effects of an abusive childhood is a smaller or misshapen hippocampus.

“The drug companies work like crazy to keep them out of their studies,” he continues. “When you look at the entrance requirements for these trials, they don’t want people who are suicidal, they don’t want people with long-term depression. They want people with nice, circumscribed depressions. They don’t want people who are going to sue them.”

Nor is GlaxoSmithKline likely to pony up to fund research into Turnquist’s theory. After all, a prescription to do something new and stimulating–to exercise, travel, or turn off the TV–isn’t going to do anything for the price of the company’s stock.

Paxil is forever – can you quit? – marketing secrets

This interesting article from 2002 is a snapshot of Paxil marketing by Beth Hawkins.

Part two of the article (which is all about addiction to and withdrawal from Paxil) will follow:

In a year of tumbling stock prices, accounting scandals, and shaky consumer spending, the British pharmaceutical giant GlaxoSmithKline has had remarkably good news to report so far. More than eight million prescriptions have been written for Advair, its asthma medication, in the year and a half it has been on the market; Trizivir has become the most frequently prescribed drug for new HIV patients; and despite competition from a new generic version, the antibiotic Augmentin is still selling well.

But it is the antidepressant drug Paxil that seems to be GlaxoSmithKline’s unstoppable star. During the first half of this year, the drug’s sales were up 18 percent in the United States. Every day an estimated 3,000 to 5,000 Americans begin taking Paxil. In 2001 alone, 25 million new scripts were written for the drug. Paxil’s strong sales–$2.1 billion last year–are often cited by Wall Street analysts as one reason GlaxoSmithKline’s stock remains an attractive prospect in an otherwise gloomy market.

Indeed, during the past 15 years the antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, have revolutionized mental health care. And for tens of millions of Americans, Paxil and its pharmaceutical cousins–Prozac, Zoloft, Celexa, and Luvox–have proven a godsend. They boast far fewer side effects than their predecessors and it’s virtually impossible to take a lethal quantity of the new pills. Most people know someone who has been on one of the drugs for years.

The SSRIs have been a boon to the pharmaceutical industry, too, becoming the third most commonly prescribed type of drug, with sales of more than $13 billion a year worldwide. A bonus: Many patients use SSRIs for years, which takes some of the sting out of the cost of bringing a new prescription drug to market.

For years Eli Lilly’s Prozac was the most widely prescribed SSRI. Pfizer’s Zoloft has likewise taken a turn as the top seller. But it’s Paxil that has shone as a marketer’s dream. When the drug was introduced in 1992, the market seemed so saturated with antidepressants that it was hard to imagine Paxil would ever catch up. A decade later, it’s poised to become the world’s best-selling SSRI. GlaxoSmithKline has steadily and energetically added to the list of disorders Paxil can be used to treat, and spent billions of dollars to make sure the buying public knows where to turn in case anxiety or melancholy sets in.

Unfortunately GlaxoSmithKline leaves out one little detail: For thousands of people, it seems that Paxil could well be addictive.
The chemical serotonin is present throughout the human body. Among other places, it exists in blood, in the mucous membranes of the gastrointestinal system, and in certain kinds of tumors. Serotonin plays a vital role in regulating sleep, appetite, sensory perception, body temperature, pain, and mood.

In the brain, serotonin acts as a neurotransmitter, a chemical messenger that facilitates communication between two nerve cells. Serotonin molecules are released from a “sender” cell into the space between nerve cells known as the synapse. From there, they are scooped back up by a “receiver” cell.

When physicians describe depression as an illness resulting from a chemical imbalance in the brain, one of the possibilities they speak of is an interruption in the supply of serotonin in the synapses. Perhaps too little of the chemical is being manufactured, for instance, or too little of its chemical precursors–the molecules used to make the neurotransmitter. Sometimes there aren’t enough receptor sites, and sometimes serotonin is taken back up before it can get to those sites.

Research into serotonin’s role in mood disorders has been going on for decades. Physicians have long known that in many instances, depression is caused by a lack of another chemical important to brain function, norepinephrine. Perhaps, they posited, a lack of serotonin somehow caused or allowed a dip in norepinephrine. If that were the case, the manipulation of serotonin levels would indirectly raise norepinephrine.

Before Prozac came on the U.S. market in 1988, depression was often treated with a class of drugs known as tricyclic antidepressants. These drugs were quite effective at manipulating both serotonin and norepinephrine but caused a wide range of bothersome side effects.
“In the old days, the pre-Prozac days of tricyclic antidepressants, you were told to treat endogenous depressions for six to 12 months and then to taper off,” explains Kevin Turnquist, a psychiatrist with the Hennepin County Mental Health Initiative. “In most cases, it worked well for those people; in fact, the tricyclics worked slightly better. The problem was the side effects. A week’s dose was lethal.”

As a consequence, tricyclics were not widely prescribed. The advent of Prozac, Paxil, and the other selective serotonin reuptake inhibitors changed that. Although each is a slightly different chemical cocktail, the SSRIs all work in roughly the same way: They slow the action of brain cells that take serotonin out of the synapses, raising the amount of the chemical circulating in the brain. And they do it with relatively few side effects. “Plus,” notes Turnquist, “you could just give one dose, start a patient on 20 milligrams and let them stay on it. It’s much easier and safer for the doctor to prescribe.”

To gild the lily, the pharmaceutical industry touted the SSRIs as non-habit-forming. “Paxil is not a controlled substance,” explains GlaxoSmithKline’s promotional literature. “Paxil belongs to a class of medications called SSRIs, which have not been shown to be associated with addiction.” The claim is repeated in all of the ads for Paxil, and in the drug information GlaxoSmithKline gives to doctors.

Kevin Murphy found all of this information comforting when he and his wife struggled with the decision to put their 11-year-old daughter Kelly on medication. She’d been having panic attacks for a while and had tried several kinds of therapy. Nothing worked, so the Murphys, who live in Lino Lakes, swallowed their concerns and took Kelly to see a psychiatrist. “He prescribed a couple of medications that didn’t do anything,” Kevin Murphy recalls. “He switched her over to Paxil, and Paxil worked pretty quickly.

“We had talked to the doctor and said what we’d really like to do is have her on it for a year and then take her off of it in the hope that her body would have unlearned the panic response,” he continues. “As we drew near the end of that year, her doctor said very casually that it’s always a good idea to taper off of this very gradually. She was already cracking a 10-milligram tablet in half, then she started cracking that in half, too, to get to 2.5 milligrams.

“Finally, she was off of it altogether for a couple of days and then she started to have panic attacks. Her heart would just race, and then she’d think she was going to be sick–and she hates being sick. So we called the doctor, and he said to put her back on it.”
For the next three-plus years, they tried other tactics for weaning her off the drug. They tried switching her to Celexa, another SSRI. That failed. They tried the same tactic, but using Prozac. They tried anti-nausea drugs, acupuncture–“everything,”
Murphy says, “but nothing helped.”

In addition to excruciating stomach pain, Kelly was so nauseated she couldn’t sleep or eat. Doctors examined her upper gastrointestinal system. She had a CT scan, an ultrasound, and countless other tests. Each showed her to be healthy. And yet each time she stopped taking Paxil, she found herself homebound. And each time, she went back on Paxil–at a higher dosage.

Kelly’s mother, Maureen Murphy, was forced to quit her job to stay home with her. She missed months of school. “We had to get a tutor for her so she wouldn’t fail school,” Kevin Murphy says. “She lost 10 pounds. She would be up until 1:00, 2:00, 3:00 a.m. trying to sleep.

“And all the while her psychiatrist said, ‘This is really weird. I’ll check with the drug company and see what’s going on.’ And they told him that nothing like this happens with this drug,” he recalls. As for Kelly, he adds, “She told me several times she wished she were dead.”

Right now she’s trying one more time to taper off Paxil. On the advice of a psychiatrist, she switched to a liquid form of the drug so she could decrease her dose by one milligram each month.

Last fall, Murphy became one of 34 named plaintiffs in a class-action lawsuit filed in U.S. District Court in Los Angeles. Since then, some 6,000 people have joined the suit. Several other law firms are pursuing similar suits in the United States. In addition, suits have been filed in Canada (in British Columbia, Ontario, and Quebec) and in England.

In 1992, when Paxil hit the market, it faced a seemingly uphill battle to wrest customers from older SSRIs such as Prozac and Zoloft. The U.S. Food and Drug Administration had approved Paxil for the treatment of depression, like those drugs. But its manufacturer, SmithKline Beecham (because of a 2001 merger, now GlaxoSmithKline), was more interested in positioning Paxil as a remedy for anxiety disorders.

Before SSRIs, anxiety had been treated mostly with psychotherapy. In the most serious cases, psychiatrists turned to Valium and other benzodiazepines–again, drugs with a host of serious side effects. Just as Prozac had revolutionized the treatment of depression, SmithKline promised to change the treatment of anxiety disorders by providing a safe alternative.

The company quickly secured permission to market Paxil for the treatment of panic disorder and obsessive-compulsive disorder. By mid-1995, Paxil had become the fastest-growing SSRI in the United States. In 1996, sales of the drug had climbed 54 percent to $291 million.

Impressive though those numbers may be, SmithKline was on the verge of a much bigger marketing coup: The company had been working to win approval from the U.S. Food and Drug Administration to market Paxil as a treatment for the first of a series of little-known mental health ills. In 1999, the FDA agreed to allow Paxil’s prescription for the previously rare “social anxiety disorder.”

SmithKline hired a New York public relations firm to raise awareness about the syndrome. According to the trade journal PR News, Cohn & Wolfe “developed a plan to educate reporters, consumers, and, in some cases, physicians, in an effort to encourage diagnosis and treatment.”

All indications are that the agency earned its fee. “Paxil’s reintroduction secured nearly 1.1 billion media impressions in 1999, with 400 million generated in the month that the drug was granted FDA approval,” raved PR News. “Media highlights included the cover of U.S. News and World Report, The Howard Stern Show, Parade, National Examiner, the New York Times, Good Morning America, and Vogue. Ninety-six percent of media coverage delivered the key message, ‘Paxil is the first and only FDA-approved medication for the treatment of social anxiety disorder.'”

Earlier studies had suggested that perhaps two percent of the population suffered badly enough from social phobia to warrant treatment. Far worse than simple shyness, these people harbored “persistent irrational fear and the need to avoid any situation in which one might be exposed to scrutiny by others and potentially embarrassed or humiliated,” according to one medical dictionary.

Following SmithKline’s PR and advertising campaigns, however, sufferers were presenting themselves for medication in record numbers. “Paxil sales surpassed those of Zoloft,” PR News reported, “and tied those of Prozac for the first time in history, and the Social Anxiety Disorder Coalition received nearly 12,000 calls to its 800 number.”

A support group funded by the pharmaceutical industry, the coalition recruited patients to share their sagas with the media. Donny Osmond–diagnosed with the condition by the head of one of the coalition’s member groups–recounted his struggles with the disorder on network television. “Never underestimate the power of a celebrity to invigorate a tired media story,” observed PR News. A few weeks later, PR News recognized Cohn & Wolfe’s campaign with its Platinum PR Award.

“Every marketer’s dream is to find an unidentified or unknown market and develop it,” Barry Brand, SmithKline’s product director for Paxil, told Advertising Age. “That’s what we were able to do with Paxil.”

Last year, GlaxoSmithKline won FDA approval to sell Paxil for generalized anxiety disorder, a diagnosis that was created by psychiatrists as something of a catchall entry in the Diagnostic and Statistical Manual of Mental Disorders. Sales shot up 17 percent to $2.1 billion. A few months later, post-traumatic stress disorder was added to the list.

SmithKline’s so-called public-awareness campaigns were just one half of a coordinated strategy, though. In 1997, the FDA relaxed its rules on pharmaceutical advertising to let the pharmaceutical industry bypass healthcare providers to market its wares “direct-to-consumer” (DTC in marketing shorthand). In 1996, drug companies spent $595 million on advertising. Within a year, spending rose to $843 million. By 2000, the amount had shot up to nearly $2.5 billion.

Paxil was the first central-nervous-system drug to be advertised by name on television, according to Advertising Age. With such tag lines as “Your life is waiting” and “What if you were allergic to people?”, the spots targeted 18-to-34-year-old professionals.
In the weeks following the attack on the World Trade Center, Glaxo positioned Paxil as the perfect antidote to post-9/11 anxiety. “Your worst fears,” agonized one woman, seated at a kitchen table, “the what-ifs… I can’t control it.” “I’m always thinking something terrible is going to happen,” another woman fretted. “It’s like a tape in my mind,” a third confessed. “It just goes over and over and over.”

“DTC is a great way to create demand,” the trade journal Drug Topics quoted one marketing VP as saying. “Advertisers are trying to help consumers recognize a specific symptom and then recognize that something can be done to alleviate the symptom.”

The ads pay off for drug companies. Ninety-one percent of people surveyed in 2000 by Prevention remembered seeing a drug ad; one third of them then asked their doctor about the medicine. Seventy-one percent of patients who asked for a drug they had seen advertised left with a prescription.

The statistics don’t surprise the Mental Health Initiative’s Turnquist. “I get phone calls from people who’ve seen the ads and they may be doing okay, but they say, ‘Hey, I want to try this new drug,'” he says. “The patient sees an ad on TV, and there’s a smiley, happy face bouncing across the screen, and they aren’t feeling that well.” It seems like it’s worth a try, especially because the drug is billed as harmless.

The FDA’s new rules on promotions freed drug companies from listing all of the side effects associated with every drug in every ad, but they still require accurate and balanced information about a drug. Nonetheless, the FDA frequently reprimands drug companies for TV and magazine ads that downplay a drug’s risks, misstate its benefits, or wrongly characterize it as better than another.

In November 2000, for example, the agency took Eli Lilly to task for a TV spot for Sarafem, the name given to Prozac when it is sold as a treatment for premenstrual dysphoric disorder (PMDD). “Think it’s PMS?” the voiceover asks, as a frustrated woman tries to wrestle a shopping cart. “It could be PMDD.” The FDA complained that the ad made no distinction between PMS and the much more rare and serious PMDD; that jumpy graphics distracted viewers’ attention from the list of side effects and risks; and that other vital information was listed in type that was all but invisible.

Poor compliance aside, the pharmaceutical industry has begun a campaign to have the FDA’s authority over advertising loosened even further. The companies want to use much shorter lists of possible side effects in magazine ads, for instance. Leading the FDA’s review of the rules is the agency’s chief counsel, Daniel Troy, an attorney with a history of challenging the FDA on marketing issues, including attempts to restrict tobacco advertising.

The Chemical imbalance ‘theory’… come on Glaxo – PROVE it now

When I started taking Seroxat in 1997, I wanted to know how this great new drug worked – the PIL (the leaflet that came with the tablets told me)“it boosts the levels of serotonin in your brain and that’s what makes you stop feeling depressed” I was told. It’s a simple chemical imbalance said the PIL.

By 2003, GSK said in it “Seroxat is one of a group of medicines called selective serotonin reuptake inhibitors (SSRIs) and works by bringing the levels of serotonin back to normal.”

All lies.

The chemical imbalance ‘theory’ HAS NEVER BEEN PROVED. NEVER.

Finally by mid 2006 GSK was starting to get closer to admitting the truth in its PIL “It is not fully understood how Seroxat and other SSRIs work…” At least that’s what they tell us in the UK and USA… however today in Australia, Aropax (the Aussie name for Seroxat/Paxil) still works as it “corrects the chemical imbalance and so helps relieve the symptoms of depression.”

Now read on:

“The Media and the Chemical Imbalance Theory of Depression” by Jonathan Leo & Jeffrey R. Lacasse is a follow up to their seminal article in PLoS Medicine (2005), in which they debunked the “chemical imbalance” theory of depression.

The “chemical imbalance” theory in psychiatry rests on the observation that mood could be artificially manipulated with drugs-those which raised monoamine levels improved mood, while those which lowered amine levels led to depression, but it remained to be seen if naturally occurring fluctuations in neurotransmitter levels were responsible for, or caused, the ebb and flow of mood levels. As the authors point out, in spite of the enormous amount of money and time that has been spent in the quest to confirm the chemical imbalance theory, direct proof has never materialized. Moreover, during the past several decades, a significant amount of evidence has accumulated which calls the theory’s validity into question.

Of particular note, in the two years since publication of their PLoS article, not a single scientific article challenged their conclusion. Indeed, the chairman of FDA Psychopharmacology Advisory Committee acknowledged that the “chemical imbalance” theory was but a “useful metaphor”–as opposed to a valid hypothesis.

Another credible, evidence-based assessment of the “chemical imbalance” theory is to be found on the website of The Mental Health Service at McGill University: “The term ‘chemical imbalance’ is thrown around a lot these days. True conditions caused by chemical imbalances are relatively rare. All thoughts, feelings and motions in the brain are mediated by the release of chemicals in brain pathways. Every person’s brain is unique, leading each of us to have different traits and abilities. Just because your brain works in a particular way does not mean that you have a chemical imbalance. A certain amount of sadness, anxiety or other emotional upset is normal, and though we may be able to block these feelings by chemicals, this would tend to dehumanize us. Even when we use medication to help an individual with overwhelming emotions, most of the time this is not to repair a ‘chemical imbalance’ but simply to help contain symptoms.” (Link here)

However, invalid thought it may be, as Drs. Leo and Lacasse point out the “chemical imbalance” theory has had extraordinary commercial value for both the pharmaceutical industry and psychiatry: “With the advent of the chemical imbalance theory, the companies were no longer just providing soothing tonics, they were now providing medications to treat diseases, as exemplified by an early SSRI advertisement stating: “When serotonin is in short supply, you may suffer from depression.” The wording here is all-important. The advertisement takes a correlation between serotonin shortage and psychological stress-and even this is highly questionable and unverifiable in any individual case-and makes a leap of faith to the conclusion that depression is caused by a serotonin imbalance, not that psychological stress impacts the serotonin system. And the marketing did not stop with depression; eventually we were told that whatever our problems might be, whether anxiety, excessive shyness, depression, or the inability to pay attention, the underlying cause was a faulty transmitter level which could be rectified with a pill. A 2005 survey from the Harvard School of Public Health reported that nearly half of all Americans will at some point develop a mental illness, presumably from a chemical imbalance, with 29% developing an anxiety disorder and 20% a mood disorder.”

The “chemical imbalance” theory has provided promoters of psychoactive “feel good” prescription drugs with the means for distancing their products from illicit street drugs whose chemical action is almost indistinguishable. Whereas drugs used to “take the edge off” stress are typically considered street drugs and are consumed by “users” or “addicts,” substances used to rectify a “chemical imbalance” can be called medications–and these are legitimately consumed by patients.

A fly in the ointment occurred when Ricky Williams, the star running back for the Miami Dolphins who had been “diagnosed” with Social Anxiety Disorder, and for several years was paid by GlaxoSmithKline to promote Paxil for anxiety disorder, was described in 2002, by People magazine, as suffering from a “depression-like chemical imbalance that affects roughly three million Americans.” Williams tested positive for marijuana on several occasions. But while his marijuana use was frowned upon, his use of Paxil was considered acceptable. One was a medication supposed to treat a chemical imbalance, while the other was a drug signaling a lack of willpower.

However, Williams’ contract with Glaxo came to a sudden halt in 2004, when he stated that marijuana was ten times better than Paxil. What got him into hot water, Drs. Leo and Lacasse, note, was not so much praising the competition, but rather putting his sponsor’s “medication” in the same category as an illicit drug. Williams threatened the assumption underlying the conventional unsupportable divide between legal and illegal drug use. His juxtaposition threatened the most powerful industries–including professional sports, the pharmaceutical industry, psychiatry, and the mass media.

Another fly in the ointment raising questions about the validity of the dividing line between prescribed and illicit psychoactive substances, is a recent controlled clinical trial conducted by researchers at Johns Hopkins. The researchers ostensibly tested the “Mystical” effects of psilocybin, the active ingredient in mushrooms which is an illegal drug that causes hallucinations. However, two months after the trial they found that “79% of those prescribed psilocybin reported moderately or greatly increased levels of life satisfaction compared with those given a placebo. A majority said their mood, attitudes and behaviors had changed for the better.” [Link] No SSRI clinical trial had that high a rate of long-lasting improvements in mood, attitude and behavior.

The authors sent inquiries to reporters who mentioned the “chemical imbalance” theory as if it had been proven, asking for citations of such proof. The responses–or lack of responses–and the biased, pro-industry reporting about mental health treatments, are no less troubling than the biased reporting in the New York Times about the events leading up to the Iraq War.

“In hindsight, as the Times editors now acknowledge (5/326/04), Judith Miller’s war coverage was overly one-sided. Her fundamental flaw could be described as a lack of professional skepticism toward the Bush administration, as she willingly parroted what those pushing for war were saying, while giving little credence to the stance of the other side. Writing in the New York Review of Books, Michael Massing commented that the Times and Miller’s reporting were examples of media “submissiveness.”

This depiction could just as well apply to the media’s reporting of mental health issues. As just one example, in some cases, the media still go to the people responsible for the original problems. For instance, several of the researchers involved with the studies of SSRIs in children are still cited in the press even though the following information has come out about their published studies: they downplayed the suicide risk; they exaggerated the benefits; and the papers published under their names were actually written by ghostwriters paid by the pharmaceutical industry.

The Times editors have acknowledged both the problems with Miller’s reporting and their own lack of editorial oversight of her. It remains to be seen if members of the media will ever look inward and reflect on their role in the promotion of the chemical imbalance theory. (For those familiar with the New York Times’ coverage of mental health issues over the past 10 years, it is refreshing that after a series of health reporters who essentially abdicated their role as investigative journalists, there is a newer group of Times reporters with more skeptical inclination…

Thanks to the AHRP blog for this.

Both articles by Jonathan Leo and Jeffrey Lacasse are freely accessible. The first is here and the latest paper can be found here.

I’ve written on this issue before – to catch up please have a look here and here.

And remember this – the chemical imbalance ‘theory’ HAS NEVER BEEN PROVED. NEVER.

All it is, is a marketing idea – a sales tool.

Seroxat comics once again

Happy Xmas everyone – enjoy the comics:

Comic 1

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Comic 2

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Comic 3

buying_our_silence_1.jpgbuying_our_silence_2.jpgbuying_our_silence_3.jpgbuying_our_silence_4.jpg

I’m not sure which one I like best – it’s maybe a bit unfair to pick on poor Alastair Benbow quite so much because Breckenridge was just as useless when he was interviewed on Panorama.

OK – I’m sorry, I’ve had a chance to reconsider that last remark – I take it back. Pick on Benbow as much as you like, he deserves it!

You’ll remember that Benbow is the man, who, when asked on television by pharmacology expert Dr Andrew Herxheimer about why GSK had given no warning about the severe reactions from Seroxat despite knowing about it for 5 years… simply replied “Seroxat has provided countless benefits to many people and enabled them to do more, live longer and feel better… and I think that speaks for itself…”

That reply certainly does speak for itself – Glaxo’s corporate mission statement is “… enabling people to do more, feel better and live longer.” In fact, you can download GSK’s corporate brochure here – it’s entitled “Do more, feel better, live longer”.

Good to know we can rely on Dr Alastair Benbow to seriously address patient concerns about one of Glaxo’s drugs without even bothering to consider the direct question that had been asked.

Watch Benbow in action here and marvel at the way he continually avoids questions.

“Please give me my Paxil,” begs prisoner

Thoughts of suicide began to form in James Johnson’s mind. He felt nauseous. He couldn’t sleep. He was confused.

“Please give me my Paxil,” he begged the jail’s corrections officers.

Johnson, 50, had been booked into the Marion County Jail in March on a charge of driving with a suspended driver’s license. It wasn’t his first time. This time, though, he was charged as a habitual offender and held without bail. He admits he was at fault.

What he didn’t understand then – or now – is why the jail’s medical staff refused to give him the legally prescribed medications he had taken for years for his clinical depression, including the anti-depressant Paxil, an anti-psychotic called Seroquel and the sedative Trazodone.

“The psych nurse came to me and said, ‘You’re not going to get this medication,'” Johnson said in a recent interview. “I said I’d get violently ill.”

And so he did.

He began throwing up.

He grew increasingly agitated.

Nurses wrote in his medical records, day after day, that he was asking for his medication; that Johnson was “doubled over in anguish evidenced by facial expressions”; that he was making suicidal statements.

His father, James Johnson Sr, called the jail to share his fears that his son was “very suicidal.”

He was taken in and out of a suicide prevention cell.

At one point, he sat on the floor and began to pray with his cellmates.

The Lord is my shepherd, I shall not want

He maketh me to lie down in green pastures, he leadeth me beside the still waters.

Johnson’s son, Jordan, said an off-duty corrections officer called and pleaded with him to do something.

“She was in tears and she said I need to get my dad out and get him a lawyer. She said they were torturing him,” Jordan recalled.

As Johnson’s pleas for help went unanswered, he became more desperate.

By the seventh day, he was wailing and flinging himself headlong into the concrete walls hoping to either lose consciousness or alert the guards to the depth of his agony.

“He started going crazy in front of my eyes,” said Kyle Morrill, one of his cellmates. “I woke up in the middle of the night and he was running from one side of the cell and banging his head on the other side.”

Johnson’s frightened cellmates begged officers to do something – anything – to relieve his suffering.

But nothing changed.
So when officers opened Johnson’s cell on the 10th day after his arrest, he bolted up a nearby stairway and leapt off the balcony, crashing onto the hard floor 14 feet below and shattering his right leg.

That jump earned him a trip to the hospital, where a psychiatrist put him back on an anti-depressant and painkillers and sent him back to jail.

Johnson eventually was released after 90 days on the same combination of medication he was on before he was incarcerated: an anti-depressant, an anti-psychotic and a sedative.

His son said Johnson looked like a zombie the day he walked out of the jail.

And Johnson says for the first time he’s dealing with a new manifestation of his illness – paranoia.

Anti-depressants and massacres – Fox news investigates

I believe that anti-depressants can cause extreme violence.

I have written on the subject before. All too often it seemed that the only other people in the world who would ever begin to entertain the possibility were people such as Micheal Moore and Dr Peter Breggin in the USA – and in England David Healy, Andrew Herxheimer and David B. Menkes, who co-authored a paper on the subject in 2006 – Antidepressants and Violence: Problems at the Interface of Medicine and Law.

Now maybe the rest of the world is slowly starting to catch up. The video below is from ‘Hannity’s America’ on Fox News and was aired a couple of days ago. It explores links between extreme examples of violent behavior among teens on anti-depressants:

I suggest you also watch The Drugging of our Children – this feature-length documentary examines the alarming growth in the prescription of powerful psychotropic drugs for adolescents and children. Leading experts, as well as Neil Bush, Michael Moore and Gary Null, provide insightful commentary about the growing trend to pathologize the behavior of children, and then require them to take mind-altering pharmaceutical drugs as a “cure.” The documentary recounts the national tragedy of Columbine and focuses on the largely unknown fact that teenage shooter Eric Harris was on the psychotropic drug Luvox at the time he and Dylan Klebold took the lives of 13 other students at their high school. Violence and aggression, precipitated by prescribed drug use, is also explored in an unprecedented discussion between Mark Taylor, the first shooting victim in the Columbine tragedy, and Cory Baadsgard, a teenager on Paxil and Effexor who, in another violent incident, took his teacher and 23 students hostage at gunpoint in his Washington high school.

If you want more information, then you can read follow up with these links:

Nebraska shooting – antidepressant connection yet again?

Lost in translation – were Anti-Depressants Involved In Finland School Massacre?

A brief history of school shootings

The Finland Massacre

SSRI storiesAntidepressants and violence

Join up the dots?

Important new Paxil withdrawal documentary finally completed

Phil Lawrence, the film maker who filmed his withdrawal from Paxil (Seroxat) has just posted a trailer for his movie on the internet – thanks are due to Truthman30 for letting me know:

Phil summed things up really well a while back:“I’m starting to think that antidepressants are like the ‘perfect storm’ – everything came together to create the ultimate moneymaker. You’ve got the perfect consumers – people who desperately want and need help. You’ve got the perfect illness – one that cannot be scientifically proven and is subjectively diagnosed. You’ve got the perfect marketing scheme – huge advertising campaigns in magazines and on television that play directly on the consumer’s fears and desires to get better. And, you’ve got the perfect pushers – government regulators and a professional community that have bought into the whole thing hook, line and sinker. The result of this perfect storm is a tremendous amount of power and influence that allows the industry to keep the wave rolling.

It’s intimidating – and a little overwhelming to actually fight the storm and try to get someone to listen – or make a change, or for that matter, tell the truth – but at this point, what other choice do we have?”

Catch up on Phil and his documentary in my previous posts:

Corruption? Glaxo? FDA?

I’m not buying it. Not any more.

FDA hearings 2006

Update on Phil Lawrence and his Paxil withdrawal documentary…

Don’t just take my word for it – have a look at Medications.com

An interesting web site – medications.com

This registry is a place to share positive or negative side effects of using Paxil. If you directly experienced a side effect while using Paxil, then we encourage you to enter it here. Please note that entries here are the experiences of individual users, and in no way means that you or anyone else will experience the same side effect, since the same medication affects people in different ways. Please always contact your physician.

Have a look at the 150 entries for Paxil side effects here.

I wonder which are real and which might have written by employees of Glaxo… who knows?

“I had always been a teetotaller purely because I didn’t enjoy alcohol and hated losing control. At the grand old age of 44 I was prescribed Seroxat and suddenly started craving alcohol.”

“I would like to stop taking paxil, I have been on it for 3 yrs. When I skip my medicine I get what feels like electrical shocks in my neck & head. I wasnt sure if I had a pinched nerve at 1st but began to associate this with the event that I had not taken my meds. I also have onset of panic attacks & rapid heart, & terrible terrible forgetfulness, as to even what cabinet I would like to open, I open the wrong one, go into the wrong doorway, wrong driveway. I am very concerned. I have told my Dr. that I would like to get off this Paxil but Ive been told that it would be best since I was suffering from anxiety attacks in past. I would like to be committed to be able to handle the withdrawls. If anyone has been successful in stopping Paxil and now feels pretty back to normal, please let me know. Thanks”

“I know what most of you are going thru,I myself am still taking paxil. i have been taking the med on and off for about two years. The side effects for me right now are dimoralizig, Ihave perfuse sweats in the middle of the night ,sweaty palms,hand shakes,and worst of all i am a 35year man that went from sexual peak to not even being able tofunction sexualy. My wife who is 7years younger does not understand where my desire went ,but also wants me to take the meds. because it heps my anxiety out.”

“This is both one of the BEST and WORST drugs for anxiety/depression. I was on Paxil CR 37.5mg for five years for moderate anx./dep., and yes, the weight gain (10-15 lbs.), vivid dreams, sweatiness, etc. were all side effects. But the Paxil so thoroughly balanced out my anxiety and depression that the side effects seemed a fair tradeoff.

(P.S. Nothing kills a libido like Paxil.)

And then, I went off the Paxil b/c I was changing insurance companies. Having read all of the terrible withdrawal symptoms, I scheduled myself a full four months to taper off. I lowered my dosage every week by only 2-3mg at most. (This involved cutting up the pill, which *they* say never to do, but of course *they* also claim that there are no withdrawal symptoms.) As a result, my withdrawal symptoms were negligible at best.

This past year, I went back on the Paxil CR 37.5mg and for a short while it worked again. And then it suddenly STOPPED. *They* don’t want us to know that once you’ve been on, then off, Paxil, when you return to it, its chances of working again are slim to none. I took less time (only 2 months) to withdraw this time around, and the withdrawal symptoms were HIDEOUS. I’ve never felt so scared of what my body exhibited–unbelievable dizziness, terrible electric “shocks,” headaches. And abject rage that I’ve never experienced before in my life. So much incredible nervous energy that I couldn’t sit still. A rotten memory and confusion. Horrible symptoms. And yet, while I was withdrawing, I could see my body improving in other areas–far less appetite, for one, far less need for sleep, and less exhaustion.

While my anxiety and depression have returned, and while I’ll probably need to be put on a different pill, I now at least know to research not just “official” medication Web sites but also patients’ anecdotes. If I’d done so the first time around, I never would have stopped the Paxil at all. Pharmaceutical companies are just pimps who own doctors, so drs. are never going to warn you about the bad side effects of what they prescribe!! “

So tell me again Glaxo – what does Seroxat (Paxil) do to you – and how does it do it?

How safe is it for people to take?

What happens when you become addicted to Seroxat?

The end of the year approaches…

… and it’s a time for reflection.

The older I get, the more I tend to take to stock of the past year and look forward to the coming year.

2007 has been very good to me – the best year I’ve for a decade or more. As for 2008 – who knows… I wait with great interest to see developments with the UK group action in the High Court against GSK and Seroxat.

It really is time someone had their day in court so that the truth can be reported. There is so much that the general public simply does not know about this story and we all know the media loves a long court case that helps to fill their airwaves and column inches. It’s a story that has to be heard and a story that will shock and surprise.

The other reason for reflection is that today is the first birthday of Seroxat Secrets – my first post here was December 18 2006. When I started the blog I wanted to create an internet resource – somewhere that would gather together information and links and allow people to make an informed choice about medication they were taking or were about to take.

I’ve picked quite a few regular readers along the way – the list below includes a few Pharma companies, their lawyers, their PR advisors and their Advertising agencies – all of whom regularly monitor Seroxat Secrets.

I’ve just found out that one of today’s Seroxat Secrets readers is APCO  – “Blogs are influencing public discourse in ways we never imagined possible” says Evan Kraus, director of APCO Online.

“Blogs are an incredible demonstration of how new media is democratizing public policy debates that used to be limited to talking heads,” said Craig Fuller, former chief of staff to Vice President George H.W. Bush and now a top APCO consultant. The APCO Online team uses existing tools – and creates new ones – to identify online leaders and examine the discussions taking place in well-defined blog communities comprised of everything from politicians to environmentalists, health care providers to stay-at-home parents. APCO Online identifies the top blogs for each relevant community as measured by leading services such as Google and Technorati. Once groups are identified, collected RSS feeds are used to generate a text cloud that shows what topics are most important to the selected groups.

Season’s Greetings to all my readers – and here’s to the next 12 months!

Abbott Laboratories, North Chicago, Illinois

Abbott Laboratories, Gurnee, Illinois

Abbott Laboratories, Libertyville, Illinois

ACCENTURE, United Kingdom

A C NIELSEN, New York

ACGME, Chicago, Illinois

ACTIVX BIOSCIENCE, La Jolla, California

Adpepper.com

Allegiance Healthcare, Waukegan, Illinois

American Red Cross, National Headquarters, Washington

American Society of Clinical Oncology, Alexandria, Virginia

AMGEN, Potters Bar, United Kingdom

AMGEN, Thousand Oaks, California

Anapharm, Quebec, Canada

APCO Worldwide (DC HQ), Washington, District of Columbia

Apotex Inc., Ontario, Canada

Arnold and Porter Partnership, London

Ashurst Morris Crisp, Edmonton, United Kingdom

ASSOCIATED PRESS TELEVISION NEWS LTD, London

Astra AB, Södertälje, Sweden

Astra Zeneca, Lenni, Pennsylvania, United States

Astra Zeneca, Montchanin, Delaware

Astra Zeneca, Thornton, Pennsylvania

Avalanche Strategic Communications, Hackensack, New Jersey

Aventis Pasteur, Maidenhead, Windsor

Aventis Pharamceuticals, New Jersey

AXA Ireland

Bausch & Lomb, Rochester, New York

BALLARD, SPAHR, ANDREWS, Philadelphia, Pennsylvania

Bayer Corporation, Pittsburgh, Pennsylvania

BBDO NY, New York

Bear Stearns Security Corporation, New York

Biogen, West Roxbury, Massachusetts

BIOSANTE PHARMACEUTICALS, Lincolnshire, Illinois

Bircham Dyson Bell, London, London

BMG Avocats, Genève, Geneve

Bny Esi & Co., New York

Boehringer Ingelheim Limited, Egham, Slough

Boehringer Ingelheim Pharmaceuticals, Danbury, Connecticut

Boehringer Ingelheim Pharmaceuticals, Redding, Connecticut

Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut

Boehringer Ingelheim Pharmaceuticals, Copenhagen

Booz, Allen, and Hamilton, Sterling, Virginia

BKD LLP, Springfield, Missouri

Bradley, Arant, Rose and White, Birmingham, Alabama

Brigham Young University, Provo, Utah

Bristol Myers Squibb Pharmaceutical Research Institute, Europe

Bristol Myers Squibb Pharmaceutical Research Institute, Monmouth Junction, New Jersey

Bristol Myers Squibb Pharmaceutical Research Institute, Plainsboro, New Jersey

Brown University, Providence, Rhode Island

Burson – Marsteller BVBA, Brussels

Burson Marsteller, New York

Burson Marsteller (SEA) Pte Ltd, Singapore

CBS, New York

California State University, Northridge

Capital One Financial, Richmond, Virginia

Chamberlain Communications Group, New York

Carnegie Mellon University, Pittsburgh, Pennsylvania

Charles University, Prague, Czech Republic

Chemmedica, London

Church of Scientology International, Los Angeles, California

Clark Depew Tracey, Houston, Texas

Cleveland Clinic Foundation, Cleveland, Ohio

CMP MEDIA LLC, Great Neck, New York

Collective Intellect, Boulder, Colorado

Columbia-Presbyterian Medical Center, New York

Commission Europeenne, Wezembeek-Oppem, Brabant

Corbett Healthconnect, Chicago, Illinois

Cornerstone Partners, New York

Corp McCann Erickson, New York

Covington & Burling LLP,

Cypress Bioscience, San Diego, California

D’arcy Masius Bention & Bowles, New York

Dallas County (George Allen Courts Bldg), Dallas, Texas

Debevoise & Plimpton, New York

Dechert LLP, Philadelphia, Pennsylvania

Democratic National Headquarters, Washington, District of Columbia

DENDRITE INTERNATIONAL, Bernardsville, New Jersey

Department of Veterans Affairs, North Liberty, Iowa

DISTRIBUTION SOLUTIONS, Traverse City, Michigan,

DOIM, Laurel, Maryland

Edelman PR, Alexandria, Virginia

Edelman, London

Edelman PR, New York

Edelman PR, Seattle, Washington

E.I. du Pont de Nemours and Co., Wilmington, Delaware

Eisai Co., Ltd., Kashiwa, Japan

EXELIXIS, San Mateo, California

Eli Lilly and Company, Europe

Eli Lilly and Company, Indianapolis, Indiana

Eli Lilly and Company, Terrey Hills, New South Wales

Elron Technologies, Israel

Elsevier Science Limited, Bletchingdon, Oxfordshire

Emory University, Atlanta, Georgia

EURO RSCG MVBMS PARTNERS, New York

European Parliament, Brussels

Evergreen Medical Group, Kirkland, Washington

Experian Information Solutions, Roswell, Georgia

FDA, Parklawn Computer Center / DIMES HQ, Silver Spring, Maryland

Finkelstein, Thompson & Loughran, Washington, District of Columbia

Fisher & Paykel Ltd., Northmead, New South Wales

Foote, Cone & Belding , New York

Forest Labs, New Hyde Park, New York

French Embassy – French Trade Commission, Mc Lean, Virginia

GALDERMA LABS, Fort Worth, Texas

Genentech, Dixon, California

Genentech, San Francisco, California

General Medical Council, United Kingdom

General Motors Corporation, Bloomfield Hills, Michigan

Gerson Lehrman Group, Austin, Texas

Gilead Sciences, Boulder, Colorado

Glaxo., King Of Prussia, Pennsylvania

GlaxoSmithKline, London

GlaxoSmithKline, Philadelphia

Glaxo, Raleigh, North Carolina

GlaxoSmithkline, Mississauga, Ontario

Glaxosmithkline S.p.A, Verona, Veneto

Government of the Province of Ontario, Scarborough Junction, Ontario

Greek Academic & Research Computer Network, Athens

Grey Advertising, Brooklyn, New York

GREY GLOBAL GROUP, Shooters Hill, Newham

Group Health Cooperative, Seattle, Washington

Haymarket Media, Garfield, New Jersey

Health and Welfare Agency Data Center, Clarksburg, California

Healy Communications, Chicago, Illinois

Hearst Corporation, New York
Hikma Pharmaceuticals, Amman, Jordan

ICON CLINICAL RESEARCH, United Kingdom

Illinois Criminal Justice Information Authority, Chicago

Imperial College of Science, Technology and Medicine, London

INCYTE CORPORATION, Wilmington, Delaware

Institute for International Research, New York

Institute of Neurology, London University

Internal Revenue Service, Highland, Maryland

James, Houer, Newcome & Smiljanich, Birmingham, New Jersey

Jones, Day, Reavis & Pogue, Cleveland, Ohio

The Johns Hopkins Medical Institutions, Baltimore, Maryland

Josef Nopp KG, Leonding, Oberosterreich, Austria

Johnson & Johnson, Europe

Johnson & Johnson, Fort Wayne, Indiana

Johnson & Johnson, Fulmer, Slough

Johnson & Johnson, New Jersey

Johnson & Johnson, Raritan, New Jersey

Johnson & Johnson, Sydney, New South Wales

JP Morgan Chase & Co, Columbus, Ohio

JP Morgan Chase & Co, New York

Kaiser Permanente, El Cerrito, California

Kaiser Permanente Medical Care Program, Los Angeles, California

Kendle, Glasgow, Scotland

Ketchum Communications, Pittsburgh, Pennsylvania

King & Spalding, Washington DC

Kirkland & Ellis LLP, Midlothian, Illinois

Kunitz and Associates, Rockville, Maryland

Lehman Brothers, London

LEXIS-NEXIS, Dayton, Ohio

Life Science Communications, Upper Holloway, Redbridge

LNS Communications, Brookline, Massachusetts

Loyola Marymount University, Los Angeles

M&C Saatchi, New York

Management Centre Europe, Brussels

Marina Maher Communications, New York

Mayo Foundation, Rochester, Minnesota,

McCarter & English, Newark, New Jersey

MCKINSEY AND COMPANY, Boston, Massachusetts

Marcus Evans, Chicago, Illinois

McCann-Erickson GuangMing Lt, Hong Kong

McCann-Erickson, London

McCann-Erickson, New York

McCann-Erickson/Torre Lazur, Denville, New Jersey

MDE INVESTORS, Washington, DC

Medical Broadcasting Company, Philadelphia, Pennsylvania

Medicom Group, Newbury, United Kingdom

Meditech Media, London

Medstat Systems, Ann Arbor, Michigan

Medtrials, Dallas, Texas

Medtrials, Pennsylvania, United States

Merck and Co., Montgomeryville, Pennsylvania

Merck and Co., Skillman, New Jersey

Meta Pharmaceutical Services LLC, Conshohocken, Pennsylvania

Medicines Australia Incorporated, Napier, Western Australia

Medtronic, Incorporated, Minneapolis, Minnesota

Michigan Medical PC, Grand Rapids, Michigan

Microsoft Corp, United States

MORI, London

Morgen Walke Associates, Brooklyn, New York

Mount Sinai School of Medicine, New York

Munro and Foster, London

NATIONAL HEALTHCARE GROUP, Singapore

National Institutes of Health, Bethesda, Maryland

National Institute for Medical Research, London

Neuronetics, Malvern, Philadelphia

Nelson Mullins Riley & Scarborough, Columbia, South Carolina

Network of Shire Pharmaceuticals, United Kingdom

New York State Office of Mental Health, Albany, New York

News Corporation, New York

North Carolina State University, Raleigh, North Carolina

Northwestern University, Evanston, Illinois

Novartis AG, Europe

Novo Nordisk Pharmaceutical, Princeton, New Jersey

Norwegian University of Science and Technology, Trondheim

O’Melveny & Myers, Los Angeles, California

Ogilvy & Mather, Chicago, Illinois

Ogilvy and Mather Worldwide, New York

One to One Interactive, LLC., Boston, Massachusetts

Organon Pharmacy, Roseland, New Jersey

Otsuka America Pharmaceutical, Gaithersburg, Maryland

PARAGON BIOMEDICAL, Irvine, California

PAREXEL, Bedford, Massachusetts

Parklawn Computer Center / DIMES HQ, Rockville, Maryland

PDI, Saddle River, New Jersey

The Pentagon, Alexandria, Virginia, United States

Performance Systems International, Toronto, Ontario

Pepper, Hamilton and Sheetz, Philadelphia, Pennsylvania

PHARMACEUTICAL PRODUCT DEVELOPMENT, Raleigh, North Carolina

Pfizer, Australia

Pfizer, New York

Pfizer, Quaker Hill, Connecticut

Pfizer, United Kingdom

PHILLIPS LYTLE LLP, Buffalo, New York

Porter Novelli, New York

PricewaterhouseCoopers GTS UK, London

Publicis & Hal Riney, El Cerrito, California

QORVIS COMMUNICATIONS, Washington, District of Columbia

Quintiles, Raleigh, North Carolina

Ragan Communications Inc, Chicago, Illinois

Regulatory Affairs Professionals Society, Rockville, Maryland

Research Triangle Institute, Durham, North Carolina

R G C Jenkins & Co, London

R I S Christie, Toronto, Ontario

Rosen & Livingston, Brooklyn, New York

Ruder Finn, London

Sankyo Pharma, Parsippany, New Jersey

Sanofi Synthelabo, Guildford, United Kingdom

Sanofi Synthelabo (S) PTE LTD, Singapore

Sanofi Techniques, Bourg-la-Reine

Schering-Plough Corporation, Plainfield, New Jersey

Scientific American, New York

Scottish Association for Mental Health, Glasgow

Semyung University, Chungbuk, Kyongsang-bukto, Korea

Servier Laboratories, Slough, United Kingdom

SHIRE US, Valley Forge, Pennsylvania

Shire US, Wayne, Pennsylvania

Shock Hardy & Bacon, Overland Park, Kansas

Sisters of Mercy Health System, Saint Louis, Missouri

Simpson, Gumpertz & Heger, Waltham, Massachusetts

Smith Hanley, Indianapolis, Indiana

SmithKline Beecham, Ickenham, Slough, United Kingdom

SmithKline Beecham, North Weald, Havering, United Kingdom

SmithKline Beecham Biologicals, Brussels

SmithKline Beecham Biologicals, Brabant, Belgium

Spotts Fain PC, Richmond, Virginia

St. John Medical Center, Tulsa, Oklahoma

St Josephs Health System, Anaheim, California

State of CA, Dept. of Consumer Affairs (DCA), Sacramento, California

State of Maryland, Annapolis, Maryland

Steptoe & Johnson, London

Steptoe & Johnson, Washington, District of Columbia

Sweet & Maxwell Ltd, London

Syntex USA, Livingston, New Jersey

Syntex USA, Switzerland

Syracuse Research Corporation, Syracuse, New York

Takeda Pharmaceuticals A, Chicago, Illinois,

Takeda Pharmaceuticals North America, Lincolnshire, Illinois

Takeda UK Ltd, High Wycombe, Buckinghamshire

Technical University of Crete, Greece

Texas A&M University, Corpus Christi, Texas

The Bill & Melinda Gates Foundation, Newington, Virginia

The Connecticut Hospital and Affiliates, Monroe, Connecticut

The Gardiner-Caldwell Group Ltd, Macclesfield, United Kingdom

The McGinn Group, Fredericktown, Ohio

The Nielsen Company, New York

The Procter and Gamble Company, Cincinnati, Ohio

The United States Centers For Disease Control, Atlanta, Georgia

Trinity Mirror Group, London

TROUTMAN SANDERS, Atlanta

True North Communications, Chicago

TRW Space and Defense Sector, Torrance, California

Ulmer Berne, United States

Ulmer & Berne LLP, Cleveland, Ohio

UNDERWRITERS LABORATORIES, Mount Prospect, Illinois

Universiteit van Amsterdam, Amsterdam

University of California, Irvine, Irvine

University of Cape Town, Cape Town, South Africa

University of Manchester, Manchester, England

University of Newcastle upon Tyne, United Kingdom

University of New Hampshire, Durham, New Hampshire

University of Portsmouth, Portsmouth, United Kingdom

University of Toronto, Toronto, Ontario

University of Westminster, London

USA TODAY, McLean, Virginia

U.S. Dept. of Commerce – ITA, Cheltenham, Maryland

U.S. Dept. of Health and Human Services, Washington, District of Columbia

U.S. Department of State, Arlington, Virginia

U.S. General Accounting Office, Washington, District of Columbia

U.S. Senate Sergeant at Arms, Arlington, Virginia

V-Fluence, Salem, Massachusetts

Video Monitoring Services of America, LP, Bronx, New York,

VJIL Consulting, Hyderabad, India

Waldner & Associates, Houston, Texas

Waggener Edstrom, Portland, Oregon

Walgreens, Arlington Heights, Illinois

Warner-Lambert Company, Morris Plains, New Jersey

WATSON PHARMACEUTICALS, Riverside, California

Westminster Group, Westminster, United Kingdom

WILEY, REIN & FIELDING, Washington, District of Columbia

WPP Group, New York

WPP GROUP U.S. INVESTMENTS, Miami, Florida

Wyeth-Ayerst Research, Horsham, Pennsylvania

Wyeth-Ayerst Research, Waldwick, New Jersey

Yale University, New Haven, Connecticut

Young & Rubicam-Media Edge, San Francisco, California

Youngstown State University, Youngstown, Ohio

Zogenix, Emeryville, California

seroxatmad – UK forum

I always seem send people to Paxil Progress, but there’s good support to be had from a forum based in the UK called Seroxat Mad

I was looking around the site the other evening and it seems well worth regular visits. 

I’ve added it to my Blogroll and I can only offer apologies as I should have done this much sooner.

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