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Considering over 30,000 suicides in Japan

Author: Setsuo Ide

Ide Paediatrics, Kagoshima Prefecture

Editor: Chiharu Kawasaki

School of Medicine, Teikyo University

This article is a translation of Japanese MRIC published on December 29, 2021

● Suicidal ideation

Attempts to choose death to escape illness, relationships, financial problems, etc., are called suicidal thoughts.

A vague wish to die without a concrete reason is called 'suicidal ideation.'

I experienced suicidal ideation after taking the SSRI (serotonin reuptake inhibitor) Paxil for just three days. It was something similar to 'the elation of death being a comfort' From my experience, I feel that 'suicidal ideation' can best be described as being obsessed with the feeling of 'okay, I'm going to die

Suicide in depression is characterized by the fact that it often occurs during the recovery period from depression. Suicide is less common in depression because the depressed person has no energy to do anything at all.

However, suicide can occur because the depression improves and the person has the energy to act where they are on the mend, making the illness ephemeral.

I was reminded of SSRIs at the end of December 2012. In September of that year, I had a sudden hearing loss and had to be hospitalized for a week.

I couldn't stay out of the clinic forever, and after a week or so, I was discharged from the hospital and started practicing, but my hearing loss in my left ear made it difficult for me to hear speech, and the sound echoed in my healthy right ear, which increased my irritable mood.

At the end of the year, the number of flu cases increased, and my busy schedule made me even more irritable.

At that time, I remembered something I had seen on T.V. about Happy Drugs. An NHK program reported SSRIs, which were not yet in use in Japan at the time, as happy drugs.

Remembering the happy drug, I contacted a pharmaceutical wholesaler and ordered 10 mg of Paxil, an SSRI.

On the 28th, 29th, and 30th of December 2012, I took one 10 mg tablet of Paxil every morning. I stopped taking it three days after my son, a pharmacology student, warned me about the dangers of SSRIs. Although I had only been taking it for three days, I was haunted by a suicidal thoughts like 'the elation that death is a comfort.'

I was in a daze for a few days. I took it for only three days, but I thought about death a lot for some reason. It was a strange experience: "If I put a string on the handle of a chest of drawers, I could die, and my wife would have to die with me." I had no fear of death, no sense of reality at all, and felt that death was right there and that it was something completely casual.

But in the meantime, the feeling of being obsessed with death somehow disappeared.

It was around April after the new year when I had the opportunity to look into ADHD (Attention Deficit Hyperactivity Disorder) in children. I was looking at treatments and things like that and noticed things like drug-induced aggression.

I remembered that the 1999 Columbine High School shooter, who shot and killed 12 students, seriously injured 24 others, and two high school students committed suicide, was taking medication. When I looked into it, I learned that the shooter was taking SSRIs.

So I researched SSRIs and discovered that SSRIs have a tremendous side effect called Activation Syndrome. "Anxiety, agitation, hostility, impulsivity, panic attacks, and worse, suicidal behavior," it said.

● Suicidal

In searching the internet for information about SSRIs, I noticed a post by what appeared to be a psychiatrist that said, "Patients on SSRIs can commit suicide very quickly.

As someone who experienced near-suicidal thoughts of death being close by after taking just 10 milliliters of Paxil once a day for three days, I was struck by the horror of SSRIs.

It is said that in the case of suicides by people who take SSRIs, there is often a "lack of consideration for being out of sight," but this is not a question of "consideration for being out of sight." It is a question of the person committing suicide believing that "death (suicide) is not a shocking thing, but something that is not at all easy to handle." This is not a matter of "consideration for the public eye" but because the person who commits suicide is caught up in the thought that "death (suicide) is not a shocking thing, but something completely easy."

This is why outsiders see suicide as an easy way to kill oneself, even if there is no good reason.

The fact that the Activation Syndrome, which causes suicide attempts, occurs within a concise period of time, within two weeks of starting medication, is also frightening.

● Thinking about the more than 30,000 suicides in Japan.

I began to wonder if SSRIs had anything to do with the "more than 30,000 suicides in Japan" that started in 1999, based on my own experience of suicidal thoughts and a post by a supposed psychiatrist saying that "patients taking SSRIs commit suicide very easily."

Yearly changes in the number of suicides

The number of suicides in the 22,000 range from 1991 to 1994 suddenly rose to the 30,000 range in 1998 (Heisei 10) and has not decreased since then.

The number of suicides, which was in the 24 000 range in 1997 (Heisei 9), suddenly rose to the 30 000 range in 1998 (Heisei 10) and remained in the 30 000 range for 15 years.

The increase in suicides is no wonder, as the post-bubble recession worsened with the bankruptcy of Yamaichi Securities in November 1997, the fraud at the Naga Bank, and the banks' reluctance to lend money.

It is often said that the cause of over 30,000 suicides in Japan is the recession caused by the burst of the bubble economy, but first of all, suicide as a social phenomenon occurs during boom times, as described as 'anomic suicide.' The bursting of the bubble economy indeed had a significant economic impact. However, the economic impact of the bubble burst does not last for more than a decade.

The use of SSRIs in Japan began in May 1999 with the sale of Meiji Seika Pharma's Depromer and Fujisawa Pharmaceutical's Luvox. GlaxoSmithKline's Paxil was launched in November 2000.

And with the launch of SSRIs, the number of patients with depression increased, and sales of antidepressants, which were around 17 billion yen in 1998, reached 100 billion yen within ten years of the launch.

Over 30,000 suicides in Japan began with the bubble bursting in 1998. However, it continued for the next 15 years, and it was not until 2014 (Heisei 24), following the declaration by the Psychiatric Association in 2012 (Heisei 24) that the drugs were not practical "for mild depression," that the number dropped below 30,000.

In an abstract in Clinical Pharmacology, Vol. 11, No. 10, Professor Yoshinori Cho of Teikyo University stated that akathisia and Activation Syndrome could occur as side effects (behavioral toxicity) of SSRIs and other antidepressants, and these can be linked to suicide-related events. The frequency of suicide-related events thought to be caused by antidepressants is up to 5-6%. A simple calculation here is that about 2.6 million people in Japan take SSRIs annually; 5% of 2.6 million people is 130,000. That would mean 130,000 people per year experience an event leading to suicide.

In the case of suicide, suicide attempts are said to be ten times more common than suicides. One hundred thirty thousand people experience a suicidal event annually; if 1/10th of these are suicides, that would be 13,000. The number of suicides in Japan has been increasing.

The merits and demerits of antidepressants (SSRI controversy and litigation)

"The merits and demerits of antidepressants (SSRI controversy and litigation)" is a book by British psychiatrist Professor David Healey.

Originally titled "Let Them Eat Prozac," it concerned suicides caused by the US Eli Lilly and Company antidepressant Prozac (SSRI fluoxetine hydrochloride).

Professor David Healy is a psychiatrist and psychopharmacologist who was also Secretary-General of the British Psychopharmacological Society.

"The merits and demerits of antidepressants (SSRI controversy and litigation)" focuses on the side effects of the antidepressant SSRIs (selective serotonin reuptake inhibitors), which increase suicidal impulses in depressed patients.

Suicide by antidepressant SSRIs

Eli Lilly and Company launched the antidepressant Prozac in the USA in 1988. Two years later, in February 1990, researchers at Harvard University reported that SSRIs cause suicidal tendencies, and the first paper was published in the Journal of the American Psychiatric Association.

However, for 14 years, the dangers of SSRIs were virtually silenced by related industries across the industry, government, and academia until after 2004, when the U.S., U.K., and E.U. Medicines Regulatory Agency began to take action, for example, by issuing warnings on SSRIs products.

Professor David Healey's book "The merits and demerits of antidepressants (SSRI controversy and litigation)," first published in August 2005, resulted from five years of intensive research into Prozac.

(1) That Prozac and other SSRIs have the potential to induce suicide and violence, that the companies that manufacture them know this, and that the system that allows this to happen could soon cause a drug or medical disaster that would make even the thalidomide incident seem small scale.

And Eli Lilly and Company has persisted in its claim about the risk of suicide in the antidepressant Prozac (SSRI), saying that suicide is not caused by Prozac but by the disease of depression.

(2) That because the disease of depression cannot be clearly defined, it is a manageable disease to create. Because anyone can easily be made depressed and the drug market is enormous, pharmaceutical companies may be keener to extract profits from health than to contribute to it.

(3) The way pharmaceutical companies market their products, and the number of new breakthrough drugs increasing suggests that they are now better at selling drugs than making them.

"The merits and demerits of antidepressants (SSRI controversy and court battles)" states that "SSRIs could cause a drug disaster that would make even the thalidomide case seem small-scale."

Thalidomide was launched in West Germany in 1958 as a sleeping pill under the trade name Contergan.

Afterward, reports of the development of 'congenital disabilities' began to appear here and there. The West German pediatrician W. Lenz pointed out that taking thalidomide in early pregnancy could result in congenital disabilities such as congenital disabilities.'

In November 1961, a meeting between W. Lenz and Grünenthal was held, and, due to media pressure, six days later, Grünenthal decided to stop the production and marketing of Contergan.

The thalidomide case, known as 'seal limb disease' because the hands of thalidomide children looked like seals, was a shocking drug case with around 10 000 victims worldwide. The thalidomide case has been called the worst drug case in history.

Professor David Healey's words that "the use of SSRIs will lead to a drug disaster that will make even the Thalidomide case seem small-scale" was a severe warning, meaning the tragedy of increased suicide among SSRI users.

● The increase in the number of depressed people in Japan

Professor David Healey's statement that "depression is a disease that has no clear definition, so people who are not depressed can be made depressed" took the form of "the launch of SSRIs and the increase in depressed patients" in Japan.

In fact, according to the Ministry of Health, Labour and Welfare, the number of patients with depression in Japan rose from 440,000 in 1999 to 1.04 million in 2008, just ten years later, and sales of antidepressants, which were only 10 billion yen per year, reached 100 billion yen. This is known as the SSRI phenomenon in Japan.

Sales of SSRIs proliferated under the enthusiastic promotion of the disease by pharmaceutical companies and doctors and with catchphrases such as 'depression is a common cold of the mind.'

SSRIs were also promoted to general physicians other than psychiatrists under the indication of 'social anxiety disorder.

The number of patients with depression increased here and there, and the number of civil servants who took medical leave because of depression increased, and for a time in the mid-2000s, the media was abuzz with the news.

● Disease Mongers

Disease Mongers is a term that appeared in the review of Lynn Payer's book, 'Disease Mongers: How Doctors, Pharmaceutical Companies and Insurance Companies Make You Feel Sick,' by British Medical Association Journal in 1993.

The catchphrase' mental cold,' describing mild depression, was used in the marketing strategy of the American pharmaceutical company GlaxoSmithKline K.K. to sell the antidepressant Paxil from around 2000.

Barry Brand, product manager for Paxil, said, "It's every marketing guy's dream to uncover and expand a customer market that no one has noticed yet. That's what we're doing with Social Anxiety Disorder. It was a clever market strategy to "create a new indication, social anxiety disorder, and turn healthy people into sick people."

The fact that "depression itself is a disease that cannot be clearly defined, so it is easy to create, and anyone can be made to suffer from depression, so the market for drugs is large" means that sales of antidepressants in Japan, which were only around 10 billion yen when SSRIs were launched, jumped to 100 billion yen within ten years when SSRIs were first marketed. The fact that "the market for antidepressants is large because they are easy to use for depression" explains the situation where sales of antidepressants in Japan jumped from around 10 billion yen to 100 billion yen in less than ten years when SSRIs were launched.

●The effects of SSRIs are no different from flour.

The book "Medicines are meaningless for 80% of depression" is a book by Dr. Yutaka Ihara, Professor of the Department of Mental Health at Dokkyo Medical University Koshigaya Hospital, published in 2015. In that book, he states that "the effects of SSRIs are no different from flour."

It states that the papers by Kirsch of the University of Hull, UK, in 2008 and Fornia of the University of Pennsylvania, USA, in 2010, based on an analysis of a vast amount of data on SSRIs, announced that the effects of SSRIs were either none or minimal.

The publication of the Kirsch paper in 2008 and the Fornia paper in 2010 led to the removal of antidepressants as first-line treatment for mild depression by societies worldwide.

In 2012, the Japanese Society for Depression Research also withdrew its drumbeat that drugs work for depression. It declared that for 'mild depression, which accounts for the majority of depression, 'there are few treatments that show reliable efficacy against placebo.'

Here, the SSRI whirlwind with the catchphrase "depression is a common cold of the mind" came to a halt. At the same time, the number of suicides in Japan also decreased: in 2014, the number finally fell below 30,000.

Before this, SSRI prescriptions in the E.U. and the USA had been drastically reduced since around 2004, after the media had raised the issue of SSRIs several times.

However, between 2004 and 2012, the 'SSRI whirlwind' blew over in Japan, and SSRIs continued to be the most prescribed drugs in the world. Remarkably, the use of SSRIs in Japan was twice as high as in the USA and twice as high as in the E.U.

In Japan, SSRIs were marketed not only to psychiatrists but also to general physicians, and at their peak, SSRIs were prescribed to 2.6 million patients yearly.

SSRIs were easily prescribed to patients with minor mood swings under the invented indication of "social anxiety disorder." They were also aggressively prescribed for panic disorder, obsessive-compulsive disorder, and PTSD.

● Doctors who were considered experts were those in the industry.

In 2010, Dr. Tatsuichiro Tomitaka, head of the mental health department at the Panasonic Health Insurance Union, wrote a book entitled "Why the number of people with depression has increased." It is about the increase in patients with depression due to pharmaceutical company commercials and disease awareness raising saying that "depression is a common cold of the mind," as I learned in the book, "drugs cause 80% of depression". Why are more people suffering from depression?

The book 'Why the number of people with depression has increased' methodically discusses the significance of the increase in depression from 440,000 in 1999 to 1,040,000 in 2008, as well as questions about SSRIs.

Dr. Tomitaka did not discuss this at the conference but published the book out of the blue and directly questioned public opinion, which caused a sensation and was also criticized. The criticism was, "Shouldn't the experts have discussed this among themselves before asking the public opinion?"

Dr. Tomitaka responded that 'experts are in the industry, so it may be difficult to discuss issues that concern the interests of the industry.'

This reply by Dr. Tomitaka can mean that the words imply severe pharmaceutical money contamination of doctors in expert and leadership positions who also condone disease busting.

Of course, the doctors considered experts and leaders in leadership positions were aware of the danger of increased suicides caused by SSRIs.

The 'over 30,000 suicides in Japan' due to SSRIs is the kind of drug disaster that makes the thalidomide case seem small-scale.

However, SSRIs are still used in 30% of patients with depression and are prescribed to many patients with PTSD, panic disorder, social anxiety disorder, and obsessive-compulsive disorder.

My drug trial with Eli Lilly was motivated by my grief at Eli Lilly's insistence in Professor David Healy's book that suicide is not caused by Prozac but by the disease of depression.


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