Ann Tracy knows hundreds of grisly stories: the professor on Prozac who bit her mother to death; the Stanford graduate on Paxil who stabbed herself in the kitchen while her parents slept; the mother who bludgeoned her son and then drank a can of Drano; the 12-year-old girl who strangled herself with a bungee cord she attached to a plant hanger on the wall.
Sit with Tracy for an hour and pretty soon your head is swimming in details: the shooting at Columbine, a study of violent mice, the conversation she had with Rusty Yates, whose wife drowned their five children in a bathtub. Andrea Yates was on maximum doses of Effexor and Remeron, she reminds you. The world according to Ann Tracy is a place full of people who were put on antidepressants and then went on to do horrible things.
Tracy is executive director of the International Coalition for Drug Awareness, which she operates out of her home office in West Jordan, a home she has mortgaged twice to pay for her 15-year crusade against antidepressants and the pharmaceutical companies who make them.
She is heartened by recent scrutiny of the drugs. Last year, the British version of the FDA banned all antidepressants other than Prozac for use in children under 18. In March, the Food and Drug Administration issued a Public Health Advisory about antidepressants urging doctors and families to monitor adult and child patients on the drugs and then appointed a panel of experts to reanalyze the incidence of suicide attempts during clinical trials of teens. In June, New York Attorney General Eliot Spitzer sued the makers of Paxil for consumer fraud, and 30 Utahns joined a nationwide class-action suit charging that GlaxoSmithKline "concealed, suppressed and downplayed" severe withdrawal reactions in people trying to go off the antidepressant.
But Tracy won't be happy until the drugs are banned altogether. They cause people to become violently suicidal and homicidal, she argues. They cause cancer, she says, and heart disease and diabetes and divorce.Some people call her a visionary. Others roll their eyes and call her misinformed and worry that she is hurting the very people she wants to help.
Panacea or Pandora?
In 1991, Tracy wrote an 80-page pamphlet called "Prozac: Panacea or Pandora?" Three years later she expanded it into a 424-page book that she published herself. She wrote a lot of it longhand, while sitting in the Salt Lake LDS Temple: the one place, she says, where she was sure Satan didn't have a foothold.
Hers was one of the first books to criticize antidepressants, but others followed: Dr. Peter Breggin's 1995 "Talking Back to Prozac," Dr. Joseph Glenmullen's 2000 "Prozac Backlash," Dr. David Healy's 2004 "Let Them Eat Prozac." As the titles suggest, Prozac has become shorthand for antidepressant, the way Kleenex is shorthand for tissue, because Prozac was the first of a new class of antidepressants called SSRIs (selective serotonin reuptake inhibitors). But there are now plenty of others, including Paxil, Effexor, Zoloft and Luvox.
According to IMS Health, a market research company for the pharmaceutical industry, sales of antidepressants worldwide in 2003 reached $19.5 billion, up 10 percent from 2002. Some of this growth, according to the IMS Web site, can be attributed to the use of antidepressants in "lifestyle disorders," which now include or could feasibly include, according to IMS, premenstrual dysphoric disorder, smoking cessation, weight loss and shyness a list that causes some people, like Jim Harper of prozactruth.com, to complain that antidepressants are now prescribed "if you bite your nails."Tracy started the International Coalition for Drug Awareness in 1997. The coalition has a Web site, www.drugawareness.org, volunteer directors in 30 states and board members in Bulgaria and Singapore. The most celebrated member of her board is Dr. Candace Pert, the Georgetown University School of Medicine neuroscientist who a generation ago helped discover and map the kind of receptors that regulate mood and health.
On the case
Distraught parents of suicidal teens, and the relatives and attorneys of people accused of murder, call Tracy asking for her help. But Tracy also keeps her antennae up for stories about violent deaths that might possibly be linked to antidepressants. If she reads a newspaper account about a man, say, who has gone on a shooting rampage at work as happened in July at a ConAgra Foods plant in Kansas she will immediately get on the phone to flesh out the details, trying to find out if the assailant had been on an antidepressant. Occasionally the victims are famous, and sometimes the assailants become famous for their horrific crimes, but either way Tracy is not afraid to insert herself into their lives or their deaths.
The day after she heard that Brynn Hartman had shot her husband, comedian Phil Hartman, and then herself, Tracy called up Phil Hartman's brother, whose number she found on the Internet. Tracy had just returned from being an expert witness at the trial of a Wyoming woman on Paxil who had shot her husband and later reported that she didn't remember anything about the murder except standing there with the smoking gun. So Tracy told the Hartmans: "Don't you stop till you find one of these drugs." Brynn Hartman, it turned out, had been on Zoloft; drugmaker Pfizer settled an eventual wrongful death case for an undisclosed amount.
After reading about Mark Barton, the Atlanta day trader who killed his family and then drove to work and killed nine more people before also turning the gun on himself, Tracy phoned his mother. It wasn't until six months later that Atlanta police reported that Prozac had been found in Barton's car, so Tracy was operating on instinct when she urged Barton's mother to have his body tested for antidepressants. "Not all coroners check for these drugs," Tracy explains. "It requires a few extra tests, and not all states will pay for it. That's why you need to get to the families right away."
But things don't always work out the way Tracy would hope. In the Atlanta day trader case, she says, she had his body ready to be shipped to an independent forensic toxicologist in Oklahoma City, but Barton's mother changed her mind. Maybe, Tracy says, the coroner told Mrs. Barton that Tracy was a Scientologist.
The Scientology charge still surfaces occasionally, because Scientologists are famous for their opposition to psychotropic drugs and in fact to psychiatry in general. ("Psychiatry is seeking to create a world where man is reduced to a robotized or drugged, vegetablelike state so that he can be controlled," Church of Scientology founder L. Ron Hubbard once wrote.)Vicki Cottrell, executive director of the Utah chapter of the National Alliance for the Mentally Ill (NAMI), is sure Tracy has Scientology ties. "She says she's not a Scientologist, but she has the same philosophy," says Cottrell. "Of course I don't have the thing on paper, in writing, but I believe they finance her." Tracy denies any connection to Scientology and says in fact that Scientologists don't like her because she won't go after psychiatrists. She says her war against antidepressants has put her $100,000 in debt (mostly from phone bills and publishing her book). Tracy accuses NAMI of getting money from drug companies.
Cause and effect
Emotions run high because, on both sides, there is a belief that lives are at stake. Mental-health advocates argue that antidepressants have helped millions of people, and they worry that crusades like Tracy's will convince the very people who need drugs to go off them. The stories of people who have committed suicide or crimes while on antidepressants are sad and regrettable, they agree, but anecdotes aren't scientific proof.
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Did Mark Barton, for example, kill his family and co-workers because he was on Prozac orwhile he was on Prozac?
"It's a cause-and-effect issue," says Dr. Meredith Alden, president of the Utah Psychiatric Association. "People make assumptions about cause and effect when there is only an association."
Yes, sometimes people on antidepressants kill themselves or act violently, she says, but that's because "you're already dealing with people who are prone to violent behavior." And, she says, "people who are depressed are going to be at greater risk of hurting themselves."
Sometimes, concedes University of Utah psychiatry professor Dr. David Tomb, "some people will briefly feel more suicidal" when they're first put on antidepressants, but that happens when they first go into psychotherapy, too, he argues, "or just because they're getting better by tincture of time." Tomb, like a lot of people in the field, offers this explanation: A really depressed person may not have the energy to kill himself; then he starts taking medication, still feels depressed, but suddenly has enough energy to follow through with his suicidal thoughts.But what about the people who weren't suicidal until they took the drugs, Tracy asks. What about the people who had no history of violence but then killed their own children?
FDA weighs in
The FDA, in its Health Advisory issued in March, asked drug companies to add stronger warnings to their package inserts, cautioning physicians and families to "closely monitor" both adults and children for suicidal thinking, and "certain behaviors that are known to be associated with these drugs," including mania and hostility, especially at the beginning of treatment, or when the doses are increased or decreased. The FDA stopped short of requiring the companies to issue these warnings, though, and made it clear that the matter of cause and effect has not been settled yet.
The FDA appointed a panel of independent experts to review clinical trials of antidepressant use in children and teens, trying to determine if these studies report more suicide attempts in patients prescribed the drugs compared to those given a placebo pill. The review follows allegations that GlaxoSmithKline failed to report trials that showed an increase in suicide attempts, as well as those trials that showed that Paxil was no more effective than a placebo for younger patients. According to the Wall Street Journal, which obtained a draft of the panel's review last week, the clinical trials show children and teens on the drugs were indeed more likely to have thoughts that appeared to be suicidal.
Earlier this month, Health Canada, the Canadian version of the FDA, issued a warning that newborns may suffer withdrawal and other possible symptoms (seizures, constant crying, etc.) when pregnant women take SSRIs during the third trimester of their pregnancies.
In June, the National Association for the Mentally Ill (NAMI) Policy Research Institute issued a report urging that psychotropic drugs should be prescribed for children "only when the anticipated benefits outweigh the risks." Next month, a congressional committee will hold hearings about the safety of antidepressants and the FDA's alleged censoring last winter of a staff member who argued that the drugs are dangerous for young people."From those who have seen the internal company documents," says Tracy, "we know that there is no distinction in age groups with these suicidal reactions. These reactions are the same across the board, no matter the age."
Tracy argues that the perpetrators of some of Utah's famous violent crimes Margaret Kastanis, who stabbed herself and her three children in 1991; Sergei Babarin, who shot five people at the LDS Family History Library in 1999; Lenny Gall, who killed his mother with an axe in 2001 were violent because they were either on antidepressants or had gone off them too abruptly.
Lenny Gall's father, Len, contacted Tracy six months ago, before his son's sentencing hearing. Tracy then went through Lenny's medical records, Gall says, and found that "he had a very significant reaction to Paxil when he was 16" and was put on the antipsychotic drug Zyprexa "shortly before" the murder. "He's never had a shred of violence in him," Gall says.
Tracy has served as an expert witness in a dozen criminal cases most recently a Maryland case against a teenage boy who fatally laced his best friend's soda with cyanide and has been hired as a consultant in several civil cases against drug companies, including one that tried to implicate Luvox as the reason why Eric Harris shot students at Columbine High School. She estimates that the number of people she has consulted with about antidepressants how to safely get off them, how to find alternative methods for treating depression, what to do when a family member is suicidal or manic is now in the thousands.
Jason Atwood, who will be a senior this year at Copper Hills High School, credits Tracy with helping him get off antidepressants, first prescribed for him when he was 12. He tried suicide at least 15 times before reading Tracy's book and listening to her tape. It was then, he says, that he discovered that odd symptoms persistent dreams of gouging his eyes out, for example might be side effects of the drugs that were supposed to be making him feel normal. Following Tracy's advice, he slowly tapered off Remeron and now tries to avoid sugar, meat and dairy products. "I still have my moments of depression," he says. "But I haven't attempted suicide for over a year."
Ann Blake Tracy, according to the International Coalition for Drug Awareness web site, has a doctorate in health sciences with an emphasis on psychology. There is no mention of the institution that awarded her this degree George Wythe College, in Cedar City. Tracy explains that the Ph.D. was awarded for "lifetime experience," specifically for the writing of "Prozac: Panacea or Pandora?" which she says she has been told is the equivalent of, or "far beyond," a dissertation.
Self-published, the book contains spelling and punctuation errors and incomplete sentences (although Tracy says an edited version will be published in the next few weeks). It also contains page after page of references to studies that seem to cast a cloud over the safety of antidepressants.Tracy argues that the whole hypothesis of SSRIs is "backwards." She maintains that the drugs increase serotonin while decreasing the metabolism of serotonin, especially in the 7 to 10 percent of the population she says that studies have shown don't have the proper enzyme to metabolize SSRIs in the first place. The drugs, she charges, can also cause REM sleep behavior disorder (RBD), which can cause people to act out their vivid, violent dreams while in a dreamlike state.
"It's hard to know where to begin to detail the cognitive errors she's making," says psychiatrist Tomb about Tracy's book. "She is really taking license with the scientific method." Yes, Tracy is passionate about the evils of antidepressants, Tomb says, "but passion has very little place in the scientific method in terms of deciding what is accurate and truthful." The book is full of vignettes, but vignettes don't tell the whole story, he argues. "You could take aspirin and do the same thing: comb the literature and find horrible things that have occurred with aspirin."
But Dr. Donald Marks, an internal medicine physician from Alabama who was director of research at two large drug companies and now often testifies as an expert witness against the drugs, calls Tracy "in many ways a visionary." She "has observed a phenomenon that is now being validated," he says.
"I do think there are some people who don't understand Dr. Tracy and don't understand her passion and don't understand how smart she is," says Jennifer Tierney, a North Carolina mother whose teenage daughter was put on Effexor to treat her migraine headaches.
In her darkest hours when her cheerful, straight-A daughter first became "a monster" and later, in an effort to wean herself from Effexor, had withdrawal symptoms that left her unable even to walk Tierney called every antidepressant expert she could find on the Internet. Only Tracy called her back.
"Dr. Tracy never got one dime from me. She never mentioned money to me at all. When she first called me back and I said, 'What can I pay you?' she said, 'No. No.' You have to think that's pretty pure. And she helped me more than anyone else.""An unsung hero," says Cassandra Dawn Casey, a Utah County woman who started an antidepressant group called Aspire after her son's death two years ago. "None of us would have known what was causing these problems in our lives if it hadn't been for trailblazers like Ann."
Tracy's interest in antidepressants began in 1989 when, she says, she watched two LDS friends turn into alcoholics after being put on Prozac. After that she started reading about the drugs, and soon she was hunting down scientific studies, and then she got a button made that said "Just Say No to Prozac." After that she'd be at the grocery store or church and people would come up to her and start telling her their stories.
"There's great power in those stories," says Texas trial attorney Andy Vickery, who has been involved in more than 50 cases related to antidepressants. "They have a power to persuade and even change the bureaucratic forces of our country."
And that's just what Tracy expects to eventually happen. "I think these drugs are history," she says. Eventually, the stories told by parents, and the investigations into the clinical trials that the drug companies have suppressed, will add up to public outrage and then antidepressants will be pulled from the market, she predicts."What is sad," she says, "is that so many have had to die or have their lives ruined while we have learned that this was yet another terrible mistake in our hope of 'Better Living Through Chemistry.' "