Many experts say the wide-spread epidemic of mental health problems in the US is man-made. The case of Susan Florence is a testament to this theory of man-made insanity.
While mania, psychosis, anxiety, agitation, hostility, depression, and confusion may be signs of mental illness, these same "symptoms" are referred to as side effects on the labels of the most commonly prescribed psychiatric medications used to treat mental illness.
Once Susan Florence was placed on medication, whenever she experienced a side effect from one drug, her doctor simply prescribed another until she ended up in a drug-induced frenzy for which it would have been impossible to distinguish which drug, or combination thereof, was causing the adverse reactions.
The frenzy got worse and worse until she finally realized that she would have to get off all the prescription drugs if she wanted it to end.
Susan was first prescribed the SSRI antidepressant, Paxil for anxiety. She began experiencing side effects from Paxil immediately and two weeks after she began taking the drug her doctor put her on Klonopin.
Klonopin is used for treating seizure disorders and panic attacks. The package insert says "less serious side effects" that may be likely to occur include drowsiness or dizziness, poor coordination, nervousness, and depression.
It also says, Klonopin may increase the effects of other drugs that cause drowsiness or dizziness, including alcohol, sedatives, other seizure medicines, pain relievers, antidepressants, anxiety medicines, muscle relaxants, antihistamines, and others.
So now Susan has Paxil, an antidepressant, and Klonopin an anticonvulsant, all mixed together in her system even though she never had depression or a seizure disorder.
In 2001, Dr Stefan Kruszewski, a Harvard-trained psychiatrist working for the Pennsylvania Department of Public Welfare, began documenting cases of what he refers to as "insane polypharmacy," the widespread off-label prescribing of drugs for uses not approved by the FDA.
He found Neurontin, a drug with FDA approval for controlling seizures, "was being massively prescribed for anxiety, social phobia, PTSD, social anxiety, mood instability, sleep, oppositional defiant behavior, and attention deficit disorder."
"There's almost no evidence to support these uses," Dr Kruszewski says.
There was no evidence to support placing Susan on an anti-seizure drug and doing so led to more side effects. "Between the Paxil and especially the Klonopin," she said, "I became more sedate than I wanted to be."
Mentioning this side effect, prompted the doctor to add another drug to Susan's regiment.
Next, he prescribed Provigil, "as an antidote to psychotropics that had me over-sedated," she explains.
"I think it's supposed to be for narcolepsy," Susan added.
But here again lies the problem. Susan says she never had narcolepsy. "I was just sluggish-feeling," she says, "I didn't feel sleepy at all."
Provigil was approved to treat narcolepsy. According to the August 4, 2005 Wall Street Journal, Provigil was approved by the FDA in 1998, to treat excessive sleepiness and in 2003, it was approved to for the treatment of "shift-work sleep disorder."
The drug was certainly never approved for use in treating adverse reactions caused by the combination of Paxil and Klonopin.
As it turns out, when it comes to off-label use, Provigil is a legend. SG Cowen & Co analyst Eric T Schmidt figures more than 50% of the drug's sales are for unapproved uses, according to Business Week Online on November 4, 2004. "Doctors now prescribe it to treat everything from attention deficit hyperactivity disorder (ADHD) to fatigue associated with multiple sclerosis and depression."
The WSJ says doctors wrote 1.9 million prescriptions for Provigil in 2004, generating $414 million in sales for its maker Cephalon, almost half of the company's total revenues.
Susan's case is a perfect example of the vicious cycle that develops when doctors prescribe drugs for unapproved uses. She was given Provigil to counter the sedating effects of Klonopin, which was prescribed to counter the side effects of Paxil.
The adverse reaction that Susan experienced when Provigil was added to the mix was terrifying. "I took one pill and I thought I was coming out of my skin," she says. "It was one of the worst experiences of my life."
"I felt as if someone had climbed inside me," Susan recalls.
"I moved more agitatedly, more stuccato in rhythm; I had trouble concentrating; I couldn't find focus," she said, "and I kept forgetting what I was thinking a second earlier."
"It was nightmarish, because I didn't feel like me," Susan continued, "I didn't think like me, everything felt off."
Twenty minutes after she took the first pill, she called her doctor and told him that she had never felt so depersonalized in her life. "I remember saying that word," Susan recalls.
The doctor explained that the sense of "not being me" was called depersonalization.
Her experience after taking one pill was so horrible that Susan says, "you'd have had to tie me down, hold my nose and open my mouth with pliers to get another one in me."
But was her reaction really due to the Provigil? Its hard to see how anyone could say yes with absolute certainty. Its important to remember that Susan was given Paxil for anxiety.
The latest FDA warnings say SSRI drugs like Paxil can cause anxiety, irritability, hostility, aggressiveness and impulsiveness. Certain behaviors are "known to be associated with these drugs," including "anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness)," according to Proven Dangers of Antidepressants by psychiatrist Dr Peter Breggin.
"Akathisia makes people profoundly agitated, uncomfortable in their own skin, jittery, impulsive," says Dr Joseph Glenmullen, author of Prozac Blacklash.
Akathisia sounds pretty much like what Susan described to me. So was it a reaction to Paxil or Provigil or both?
And Susan's story did not end with Provigil. The mad chemist was not through with her yet.
After reporting the reaction she experienced after taking Provigil, the doctor told her to quit taking the drug. He then prescribed Tenuate, a diet pill that has since been pulled off the market. Tenuate comes with the warning that it may cause dizziness, blurred vision, or restlessness, and that it may hide the symptoms of extreme tiredness.
According to Susan, through it all, she stressed to her doctor that she did not want to take any drug that could be addictive.
Well, on Drugs.com, Tenuate is listed as habit forming. In fact, you can become physically and psychologically dependent on this medication, and withdrawal effects may occur if you stop taking it suddenly after several weeks of continuous use, according to the warnings accessed on March 2, 2006.
Drugs.com says Tenuate is similar to an amphetamine and stimulates the central nervous system. Instructions for use say before taking this medication, tell your doctor if you have an anxiety disorder.
Which means Susan went full circle and was back at square one being the whole nightmare began when she was prescribed Paxil for anxiety.