Honourable members, I'm a medical doctor. Twenty-four years ago I began working in psychotherapy, and 12 years ago I confined my practice to PTSD. I, too, have treated a number of different groups with post-traumatic stress disorder, such as train engineers, police officers, firemen, victims of rape and childhood abuse and neglect, and veterans of World War II and Afghanistan.
Today I wish to make three points, which have been partly made.
There are effective treatments for PTSD. These treatments are psychotherapeutic. PTSD is caused when the psyche is overwhelmed by severe trauma, and it can only be cured or healed by psychological interventions.
Nutraceuticals and nutritional supplements are extremely helpful.
Point three is that the antidepressants, mistakenly called selective serotonin re-uptake inhibitors, have been shown to be no better than a placebo.
Regarding point one, there are a number of effective treatments for PTSD, but they're all trauma-focused. They're formally recognized, and I'm certified in one of these, EMDR, eye movement desensitization and reprocessing. The published research, which empirically validates EMDR, arose largely from its application to soldiers traumatized in combat. The practice guidelines of the U.S. Department of Defense/Veterans Affairs place EMDR in the highest category, recommending it for all trauma populations at all times. But it's one of a certain number of trauma-focused therapies. It's not talk therapy, because actually its efficacy has been shown using talk therapy as a control.
A Canadian veteran from Afghanistan, who recently appeared before this committee as a witness, was a patient of mine. He suffered from severe PTSD, but I should mention that prior to his trauma he was normal; he had no childhood trauma or neglect. Before he came to me, the Veterans Affairs staff were trying to help him with his debilitating symptoms from PTSD, and they repeatedly suggested he take antidepressant medication. He refused this and went to a naturopath, who subsequently referred him to me. In this case, after only three months of EMDR he now no longer satisfies the official criteria for PTSD.
My second point concerns the use of nutritional medicine for PTSD. I'm a member of the International Society of Orthomolecular Medicine. I started to use therapeutic doses of B vitamins, essential fatty acids, magnesium, tryptophan, and especially inositol in order to help wean my patients off antidepressants and help them deal with high levels of anxiety.
With regard to PTSD, I found that high doses of inositol, 12 to 18 grams, as documented by the Israelis, is very helpful for anxiety. Most brain and central nervous system and insulin-related functions depend upon inositol, and under extreme or prolonged stress the body does not synthesize sufficient amounts, hence supplementation helps in those cases.
My third point has to do with the SSRIs and the newer so-called antidepressants. I'll explain why I call them “so-called” in a minute. These are recommended in a number of practice guidelines for PTSD. All current guidelines were written before the latest revelations were published, which show that the SSRIs are no better than a placebo. They have serious, sometimes irreversible, side effects and they may be based on fraudulent research. I refer you to Paul Taylor's excellent article in the April 26 edition of The Global and Mail and I quote:
...it became apparent that the trials were stacked in favour of the corporate sponsors right from the start.
In a 2007 study demonstrating the difference between the response to Prozac and to EMDR, Bessel van der Kolk, a renowned researcher in this field, ran a trial involving 88 subjects. He compared EMDR, Prozac, and a placebo. At six months follow-up after the termination of the study, 75% of the EMDR group of adult-onset PTSD had achieved a symptom-free functional state. None in the Prozac group achieved this. I have performed a single-design case study that had similar results.
The problem with the so-called antidepressants, and SSRIs in particular, is fourfold. First, the serotonin hypothesis upon which they are based has no verifiable foundation. I refer you to the article entitled “Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature”. No wonder, then, that PTSD cannot be cured simply by redefining it as an illusory problem, a serotonin malfunction. PTSD, the psyche, and depression are just not that simple.
This study I'm going to mention right now has caused a great furor in the British press. It was published in March of this year, and they reviewed the original FDA data that gave approval for the SSRIs a number of years ago. They reviewed the data on approximately 5,000 subjects, and what they showed was that the drug was then known to be no more effective than a placebo.
Thirdly, these drugs came to market because the experts reviewing the raw data for the regulatory process were duped. One of these experts, Dr. David Healy, a British pharmacologist and psychiatrist, helped to expose this fraud and wrote the famous book, Let Them Eat Prozac. In January 2004, he presented his findings here in Ottawa.
The medical profession and the public continue to prescribe and take these drugs, because of the observable short-term placebo effect and because they may be difficult to discontinue once they're started. With PTSD, as with all mental disorders, the placebo effect is on the order of 80%. This is an important point to consider.
Fourthly, the side effects are very serious and eventually are felt to a greater or lesser extent by almost all who take the drugs. The side effects are often deadly or irreversible. David Healy concluded this from a review of the raw data of the clinical trials he obtained when he was an expert witness in a suit against Glaxo-SmithKlein. He found that the rate of suicide in subjects in those studies was up to 10 times higher on SSRIs than on placebo.
The Compendium of Pharmaceuticals and Specialties, the CPS, which is found in every doctor's office and every pharmacy in Canada, now warns us:
There are... reports with SSRIs and other newer anti-depressants of severe agitation-type adverse events coupled with self harm [suicide] or harm to others [violence and manslaughter].
I also refer you to the website www.ssristories.com. It provides public information on many of the school shootings and other violent events that during the past three decades were caused by people on these drugs.
You might ask why some patients have the early onset of significant adverse effects while others have no effect whatsoever from the same dose of the drug. Since the 1970s, we have known the answer to this question, owing to our knowledge of the variation in certain liver enzymes in the super-family cytochrome P450.
Some people are slow metabolizers and some are fast. The rest are in a so-called normal range. The slow metabolizers get the adverse effects very quickly. However, long-term use of most of these drugs will eventually overload the ability of the liver to metabolize them, precipitating adverse events, or blunt the ability of cell receptor sites, rendering the drug ineffective.
Careful reading of the literature and clinical experience shows that PTSD is most effectively treated and has the best chance of long-term improvement or cure with trauma-focused psychotherapy, such as EMDR.
Nutraceuticals should be used because extreme and prolonged stress causes nutritional deficiencies. They have no major side effects and can be managed by anyone with less knowledge than it takes to manage self-medication with aspirin. They don't require regulation.
In PTSD patients, psychotropic drugs should not be used because they're not effective and their side effects are unacceptable. If anything, they prolong the illness.
The CBC reported on April 19 of this year that the rate of suicide in Canadian soldiers doubled in 2007 compared to the year before. This corresponds with the move from Kabul to Kandahar, where the Taliban is more active. Undoubtedly, one would expect an increase in PTSD cases from intensified combat, but PTSD does not have to automatically lead to suicide.
How many of Canada's soldiers who committed suicide were exposed to an increased risk because they were prescribed one or more antidepressants? This committee could seek an answer to that question. If a substantial number were on these medications, the logical conclusion is that a different approach is urgently needed. Funding for this class of drugs should also be questioned. They have been shown to be ineffective and to cause disastrous side effects. More trained trauma therapists are, of course, vitally necessary.
Thank you.