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Thursday, 11 August 2016

Our web site is being updated

APRIL charity has had a web site for over 15 years - this is currently being upgraded, August 2016 - Please follow us on Twitter @APRIL_charity 

Donations towards the upgrade of the web site will be appreciated - please read our Fundraising Appeal here:

Link to Charity Choice Fundraising site, click on 'Our Appeals : https://www.charitychoice.co.uk/april

Direct link to the Appeal:
https://www.charitychoice.co.uk/april/appeals/psychiatric-side-effects-major-resource-upgrade-of-web-site/626

Please scroll down this blog for important information about antidepressants, Dianette, Non psychiatric drugs linked to suicidal behaviour and depression in a recent study by Professor Munir Pirmohamed and others.

Until the revised web site is available, it is still possible to research the information about medicines or other data on our web site archived by Wayback Machine - just go to the web site : http://web.archive.org/web/*/www.april.org.uk

waybackmachine.org is a great resource and they state for www.april.org.uk it has been
Saved 158 times between August 24, 2000 and April 26, 2016.

Latest news on activities of APRIL
Antimalarial drug
Today 31 August 2016 on BBC TV Victoria Derbyshire programme focus was partly on the #psychiatric adverse reactions to #Lariam #Mefloquine the drug recommended for prevention of #malaria


Follow her on twitter too: @VictoriaLive 

After hearing the evidence in the programme one may wonder why nothing was done to protect the public and our troops from the long term mental health issues triggered by this drug, there are suicides and homicides linked to the adverse effects too. 

The answer is the pharmaceutical company threatened that if any kind of campaigning were to continue in the UK the cost would be too great.

details are here:

APRIL has a dossier of testaments from the public about the dreadful effects of the drug. It may be of use for 'curing' malaria but as a preventative the harm seems to outweigh the benefit.
_____________________________________________________________

Apart from editing and revising the web site, Millie Kieve the founder of APRIL Tweets to doctors and others - Please follow us on Twitter @APRIL_charity

This week a good result was when Dr Mark Porter mention Millie Kieve had tweeted to ask why he did not promote patient reporting of ADRs:
http://www.bbc.co.uk/programmes/b07mxk4g  BBC broadcast 9th & 10th August 2016

After radio 4 programme 'Inside Health' prog last week (2nd & 3rd August), item on statins, when they discussed the conflicting evidence re benefits and harms. I tweeted direct to Dr Mark Porter how important to balance the misinformation and why did he not promote the Yellow Card reporting system for patients as doctors so seldom report ADRS. (more than one tweet of course as words so limited in tweets!) - I believe the incidents of memory loss, depression and muscle weakness caused by statins is under reported!



And Dr Porter quoted my tweet to instigate a discussion on Yellow Card reporting in this week's prog and even mentioned my name!

This is about 15 mins into the programme after the hip treatment discussion. 


I hope the MHRA will be pleased but still wonder why they don't do more to publicise the Yellow Card system. This lack of effort to promote the scheme to the public re-enforces the Health Committee Inquiry finding:
The MHRA have a conflict of interest in trying to manage safety of medicines while they are supported by and have to promote the pharmaceutical industry. 

Friday, 29 January 2016

Antidepressants double risk of aggression & suicide for young, according to meta analysis of data

Children and adolescents have a doubled risk of aggression and suicide when taking one of the five most commonly prescribed antidepressants, according to findings of a study published in The BMJ today. (The following is taken from the email sent to APRIL by the BMJ.)

However, the true risk for all associated serious harms, such as deaths, aggression, akathisia and suicidal thoughts and attempts, remains unknown for children, adolescents and adults, say experts.
This is because of the poor design of clinical trials that assess these antidepressants, and the misreporting of findings in published articles.

Selective serotonin reuptake inhibitors antidepressants (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed drugs for depression.
A team of researchers from Denmark carried out a systematic review and meta-analysis of 68 clinical study reports of 70 trials with 18,526 patients to examine use of antidepressants and associated serious harms.
These included deaths, suicidal thoughts and attempts as well as aggression and akathisia, a form of restlessness that may increase suicide and violence.

They examined double blind placebo controlled trials that contained patient narratives or individual patient listings of associated harms.

Harms associated with antidepressants are often not included in published trial reports, explain the authors. This is why they analysed clinical study reports, prepared by pharmaceutical companies for market authorisation, and summary trial reports, both of which usually include more information.
In adults, they found no significant associations between antidepressants and suicide and aggression. However, a novel finding showed there was a doubling of risk for aggression and suicides in children and adolescents.

This study has shown limitations in trials, not only in design, but also in reporting of clinical study reports, which may have lead to "serious under-estimation of the harms," write the authors.
They compared the results from the clinical study reports with data from individual patient listings or narratives of adverse effects. This revealed misclassification of deaths and suicidal events in people taking antidepressants.

For example, four deaths were misreported by a pharmaceutical company, in all cases favouring the antidepressant, and more than half of the suicide attempts and suicidal ideation, for example, were coded as "emotional lability" or "worsening of depression."
In the Eli Lilly summary trial reports, almost all deaths were noted, but suicidal attempts were missing in 90% of instances, and information on other outcomes was incomplete. These were "even more unreliable than we previously suspected," write the authors.

Clinical study reports for antidepressants duloxetine, fluoxetine, paroxetine, sertraline and venlafaxine were obtained from regulatory agencies in the UK and Europe. Summary trial reports for duloxetine and fluoxetine were taken from the drug company Eli Lilly's website.

However, clinical study reports could not be obtained for all trials and all antidepressants, and individual listings of adverse outcomes for all patients were available for only 32 trials.
"The true risk for serious harms is still unknown [because] the low incidence of these rare events, and the poor design and reporting of the trials, makes it difficult to get accurate effect estimates," they explain.

They recommend "minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant," and suggest alternative treatments such as exercise or psychotherapy.
They also call for the need to identify "hidden information in clinical study reports to form a more accurate view of the benefits and harms of drugs."

In an accompanying editorial, Joanna Moncrieff from University College London, agrees that "regulators and the public need access to more comprehensive and reliable data", and that clinical study reports "are likely to underestimate the extent of drug related harms."
Over half the clinical study reports had no individual patient listings and "this begs the question of how many more adverse events would have been revealed if [these] were available for all trials, and raises concerns why this information is allowed to be withheld."
Link to research
Link to editorial

Monday, 12 January 2015

Acne drug Dianette (Diane-35) obtains new depression and suicide risk warning


Foreword to readers:

Thanks to women who contacted APRIL and those who have heeded our request to report side-effects for Dianette (Diane-35).

It is due to the efforts of APRIL for many years requesting the Medicines & Healthcare Products Regulatory Agency to review the emails we received from women, with detailed explanations of the way Dianette affected them, that eventually the MHRA reviewed the drug for safety issues. This review, started in 2006, led to the manufacturers adding an additional warning about depression which previously had been listed under MILD side effects.

The MHRA requested APRIL to urge these women to report using the Yellow Card system. Compliance with this request has led to reports of psychiatric adverse drug reactions (ADRs) soaring in a few years from 3% of all reports to 33% of all reports by 2011. Due to the increased number of reports recorded on Drug Analysis Prints by the MHRA the manufacturer has added the warning as mentioned below in this post.



Dianette, the hormonal acne treatment manufactured by the German pharmaceutical company Bayer, has had a label change in the UK, following a number of reports of depression and suicidal thoughts.

Patient Information Leaflets should now include this warning in each box of Dianette:

“Post-marketing reports of severe depression (including very rare reports of suicidal ideation or behaviour) in patients using Dianette have been received.  However, a causal relationship between clinical depression and Dianette has not been established.”

The drug is prescribed to 62,000 British women and millions of women worldwide each year for acne and excessive body hair (hirsutism). Hundreds of adverse drug reactions and some fatalities have been reporting for people taking Dianette, also known as Diane-35 and other generic names.

In the USA the medication has not been approved by the Food and Drug Administration (FDA), and France banned the drug altogether in 2013** after its links to at least four French deaths from blood clots and 125 patients suffering serious side effects. The European medicines agency released a statement reported on BBC News (27 February 2013) about the decision of the French medicines agency ANSM to stop distribution:

“ANSM considered that Diane-35 and its generics carry a risk of thromboembolism which has been well known for many years, while their effectiveness in treating acne was only moderate and alternative treatments for acne are available.”

Dianette can be taken off-label as a contraceptive pill, but is unlicensed for this purpose due to its significantly higher risk of blood clots compared to other pills. Professor Dominique Maraninchi, director-general of the ANSM, believes doctors are giving women the drug as a contraceptive off-label too often, saying:

"Diane-35 is an acne treatment that also blocks ovulation. We have several inquiries going on that show that this non-authorised use is significant."

Between 2010 and 2013, the MHRA revealed that seven women in the United Kingdom have died whilst taking the drug, with 83 reports of side effects such as thrombosis and depression.

Last year, a Dutch report revealed up to 27 women, most of whom under 30, died from blood clots believed to be caused by Dianette.

Despite being listed as a Black Triangle Drug under further review by the medicine’s regulator, Dianette and its generic counterparts remain on license in the UK.

Earlier this year Jessica Eales, a young sailing champion, took her life after her 17th birthday, following 4 months of using Dianette as an acne treatment. The coroner Graham Short could not conclude any links between her suicide and the drug as she had not presented any noticeable signs of depression before this. The coroner quoted the European Medicines Agency review of Dianette in his report, which had concluded the benefits of the drug outweigh its risks. However, the EU report only took into account the risks in respect of thrombosis; the risk of depression and suicidal thoughts and actions was not considered in this review.

Following the death of Charlotte Porter, who died of a blood clot in 2010 whilst on Dianette, an MHRA spokesman announced: ‘Dianette is an effective medicine for treating the distressing conditions of severe acne and excessive hair […] Despite recent developments in France, we have no new concerns.’ German manufacturer Bayer said: ‘Bayer believes that Dianette has a favourable benefit-risk profile when used in accordance with the label.’

Prior to the publicity instigated by APRIL, we were told of many instances where antidepressants were prescribed to women who complained of depression, and left uninformed of the link or told to stop taking Dianette. APRIL’s research on patient safety collated 102 adverse drug reaction reports sent in by 2011 by women on their use of Dianette. Several personal accounts document that once removing themselves from the drug, their mood clears, following severe depression in some instances.  One patient described how “The cloud lifted when I stopped taking Dianette”. Woman’s hour described similar stories in their programme about contraceptive pills and mood.

This change in patient information is one step forward to informing the patient of the risks to their mental health when taking Dianette. Once a change in a patient leaflet is made, however, the GP may not be aware of the new information. However, we are hopeful that following this change in labelling, there may be further consideration of Dianette’s psychiatric side effects taken by prescribers as well as by coroners.

Crucially we urge those affected to report adverse side-effects using the Yellow Card reporting system in the UK. From this, we can build a stronger and more accurate profile of this drug for both prescribers and the prescribed to be aware of its risks.


Jacqueline Bond 

** Edit: The ANSM's decision to suspend Dianette was overruled as the European Commission's decision to maintain marketing authorisation was implemented in all EU Member states.

Thursday, 16 October 2014

Non-psychiatric drugs linked to suicidal behaviour and depression in new study

Adverse side effects of medicines can be underestimated and often not recognised as such. 110 drugs prescribed on the NHS have been linked to depression, self-harm and suicidal behaviour in a scientific study of patient Yellow Cards drug reaction reports sent to the Medicine’s Regulatory agency, the MHRA.

The paper published this September 2014 in the journal BMC Pharmacology & Toxicology is believed to be the first UK systematic review of psychiatric side-effects. Researchers found reports of 11,000 cases of depression, self injurious and suicidal behaviour following prescribed drug use between 1964 and 2011. This number covered 1.65% of all reports received in this time period.

Anti-depressants, acne, smoking cessation and weight-loss drugs were most frequently linked with serious psychiatric adverse drug reactions (ADRs). Clozapine, the anti-psychotic drug, had the highest reporting rate of suicide, with 78 reports between 1998 and 2011 linking the fatality to the drug.

Both nervous system and non-nervous system drugs met the study’s thresholds of at least 20 reports for depression, 10 for non-fatal suicide and 5 for fatal suicide between 1998 and 2011. Topping the charts with most frequent reports of depression were smoking cessation medicine, varenicline (Champix / Chantix) and bupriopion (Wellbutrin / Zyban), followed by paroxetine (Seroxat or Paxil), the SSRI antidepressant. Also high on the list of drugs linked to depression were the acne treatment, isotretinoin (Roaccutane / Accutane), and rimonabant (Acomplia), a drug for weight loss. For suicidal and self injurious behaviour, SSRIs, varenicline and clozapine occurred most often.

Figures found in the study are likely to underrepresent the true count of iatrogenic effects (drug-induced side effects) as the Yellow Card reporting system remains relatively underused by both patients and healthcare professionals.

The paper recommends the drugs most commonly arising in patient reports for grave psychiatric conditions need further analysis to understand the reasons why these drugs might be causing undue harm.

When a drug is licensed for prescription, pre-market trials do not undergo full powered studies into adverse drug reactions (ADRs) as this would require larger numbers of participants. Post-marketing pharmacovigilance using the Yellow Card reporting system and its careful analysis is therefore one of the main ways we can achieve a fuller picture into the neglected area of patient experience with medication.
Due to poor publicity and the underpowered studies of iatrogenic effects, psychiatric drug reactions and withdrawal effects are neither sufficiently well recognised nor analysed in the medical community. A study published in 2004 found that fewer than half of pharmacy programmes and medical schools provided students with a guide to reporting ADRs. Yet NHS Education for Scotland (NES), in a press release published in June 2014, stated that 7% of acute hospital admissions were due to ADRs. The NES have thus launched six new e-learning modules to support healthcare professionals identifying and reporting iatrogenic symptoms. Clinical pharmacologist Dr Simon Maxwell published an article reporting that undergraduate study is in urgent need of review to improve the safe and effective use of drugs in patients. 74% of medical students felt the amount of teaching in this area of safe prescribing  was ‘too little’ or ‘far too little’, and most disagreed that their assessment ‘thoroughly tested knowledge and skills’.

If we are to reduce the effect of ADRs on the population, and their economic impact that costs the NHS an estimated £2 billion each year, healthcare professionals and pharmaceutical companies need to make best use of new information made available by patient reporting.

Jacqueline Bond blogging for APRIL

Thursday, 2 October 2014

Study of Children Harmed by Medicines finds Doctors Fail to Listen


Report on Adverse Drug Reactions in Children reveals

better communication needed between doctors and patients





Of 5118 children admitted to Europe's largest children's hospital between 1 October 2009 and 30 September 2010, 17.7% experienced at least one adverse drug reaction (ADR), according to a new report.

The Adverse Drug Reactions in Children (ADRIC) report, was funded by the National Institute for Health Research and is the first large-scale and long-term study of its kind to report on the ADRs of children under hospital care.

The aim of the research that took place in the largest children’s hospital in Europe, Alder Hey Children’s Hospital, is to improve the safety of medicines administered to those under 16. Many common medicines are licensed without being tested on children thoroughly, if at all, yet are used regularly in paediatric healthcare.

Drug safety in paediatric care is a neglected area of research. Most medicines go through drug trials using primarily adult samples. In 2006, 75% of all 317 European centrally licensed drugs were relevant and used for children yet only half of these had indications, or validated medical reasons, for child use. This means a large proportion of drugs used for children are ‘off-label and/or unlicensed’ (OLUL). These have not undergone thorough trials to gain evidence for calculating appropriate dosage and efficacy in children of different ages. It is therefore difficult to evaluate the risk-benefit ratio for the children taking OLUL drugs, therefore increasing the risk of ADRs.

Simple extrapolation of pharmaceutical data for adult to child use is inappropriate, given the size differences in children that would alter optimal dosages as well as the developmental changes in a child’s physiology that could affect responsiveness to a drug.

The ADRIC study discovered 31% of acute children’s emergency admissions to hospital were attributable to OLUL drugs. Perhaps unsurprisingly these drugs were also found significantly more likely to be implicated in ADRs than for drugs licensed for children.

Drugs most commonly implicated in admissions were cytotoxic agents, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) vaccines and immunosuppressant drugs. Adverse side-effects from medication taken at home accounted for 3% of admissions to the Alder Hey Children’s Hospital, where the reaction was the main reason or contributed to the reason of their visit. Of the reactions, one-fifth was found to be either definitely or possibly avoidable. In most cases, it was found these would have been prevented if not for oversights by the doctor of previous ADRs to the same drug, insufficient patient education of possible ADRs, and prescribing that could have been more rational, with possible use of alternative drugs.

Nearly 20% of children and young people who had been inpatients at the hospital for over two days suffered at least one ADR from treatment during their stay. Opiate analgesics and general anaesthetic (GA) drugs were found responsible for over half the cases of ADRs in this group. General anaesthetic drugs presented a hazard to patients six times as high as any other drug administered to patients. Of the ADRs reported, 1% of these resulted in permanent harm or a higher level of care being required for the patient.
With few exceptions, parents reported poor management and communication from their clinicians about suspected ADRs. Reports described parents receiving inadequate or contradictory information from doctors about their child’s medical assessments. One parent described how “no-one actually said why it [the hallucination] was happening, the nurses just thought it was a bit funny”; others felt “fobbed off” by clinicians or even “lied to” when doctors could not explain their child’s ADR to them.
When there was an improvement in communication, it was when parents were more anxious. At these points parents reported a greater level of information from clinicians as compared to other times. When less anxious and therefore better placed to absorb facts, information received was “little or none”.  Reports from parents gave a sense information was conveyed only when it was pushed for.
The study observed a consequence of poor doctor-patient communication is the potential for missing out certain symptoms, such as hallucinations, anxiety, nausea and pain which can be described only by the patient verbally. It is possible that this explains the under-representation of ADRs of this type reported in younger children and those mentally disabled, than in adults.
The study looked at current methods of ADR identification and reporting. At present, the Yellow Card reporting scheme allows patients and relatives to report suspected or confirmed ADRs. These are sent to the MHRA, a regulatory board for pharmaceutical use in the UK. This scheme was reported to be relatively unheard of by patients, however when informed, the idea was much favoured by the parent and patient population as an essential tool for reporting ADRs.
Positively, the report found that parents, children and young people work on the same principles as doctors when evaluating the possibility of an ADR over an unrelated symptom, recommending them as equally reliable sources of detection. So, rather than being “ignored” and “dismissed”, the report’s findings recommend that patient and parental concerns ought to be taken more seriously by clinicians, with greater trust and emphasis put on patient self-evaluation.
With these changes taken on board, the ADRIC report believes the greater recognition and improved recording of ADRs could reduce the incidence of avoidable harm to patients from prescribed medicines and anaesthetics.  

References: Smyth RL, Peak M, Turner MA, Nunn AJ, Williamson PR, Young B, et al. ADRIC: Adverse Drug Reactions In Children a programme of research using mixed methods. Programme Grants Appl Res 2014;2(3)

Jacqueline Bond 02/10/14

Jacqueline is a graduate from Oxford University having read Psychology, Philosophy & Physiology, and a Masters in Neuroscience from Imperial College London. She is doing research for APRIL and contributes to the APRIL blog.

Added note from Millie Kieve, formerly chair of Advisory Group to Evaluation of Patient Yellow Card Reporting:


I wish to thank Jacqueline Bond for her careful review of the 200-page ADRIC report about the adverse drug reactions of children in hospital. The full report can be found here: http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0013/121414/FullReport-pgfar02030.pdf

I was involved with a study to evaluate the value of patient reporting in 2011, also funded by the The National Institute for Health Research (2). The researchers concluded  “patient reporting of suspected ADRs has the potential to add value to pharmacovigilance by reporting types of drugs and reactions different from those reported by Health Care Professionals.”
In regards to the low awareness of Yellow Card reporting of adverse drug reactions (ADRs), we have made multiple requests to the Medicines Healthcare Products Regulatory Agency (MHRA) to increase publicity and their availability. APRIL believes Yellow Cards and awareness of the Yellow Card system of pharmacovigilance is not well publicised.
Healthcare Professionals do not have a good record for reporting ADRs and those other than doctors have had to persuade, in the past, the regulatory body to accept their reports as valid. The official assessment of less than 10% of serious ADRs reports is a reflection of the poor awareness and promotion of the scheme.
We have requested that posters and YC cards be displayed in hospitals, doctors’ surgeries and in community and supermarket pharmacies. The lack of visible encouragement for patients, pharmacists, nurses and doctors to report ADRs raises the question of why this essential method of monitoring the safety of medicines is currently under-publicised.
Pharmacovigilance in the UK should be improved to increase awareness of the extent of iatrogenic (treatment-induced) injuries to mental and physical health. Hospital admissions caused by ADRs has been estimated to cost the NHS £466 million annually (1).

References to note

1)     Stage Three: Directive. Improving medication, error incident reporting and learning - 20 March 2014 MHRA Study NHS/PSA/D/2014/005
http://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-error.pdf

2)    Evaluation of patient reporting of adverse drug reactions to the UK Yellow Card Scheme  http://www.journalslibrary.nihr.ac.uk/hta/volume-15/issue-20

Friday, 5 September 2014

BLACK TRIANGLE DRUGS under High Scrutiny



Black Triangle classification on drugs your doctor may prescribe should be carefully monitored and ANY suspected adverse reactions reported to www.yellowcard.gov.uk a pharmacovigilance system we have to support as it is the only 'official' one. Please also report to the web site monitored by doctors https://www.rxisk.org   as they may take more active efforts to create awareness of newly discovered adverse drug reactions (ADRs) also please report all psychiatric ADRs to any medicine or following anaesthetics to APRIL www.april.org.uk 

Black Triangle Drugs now include Dianette (cyproterone acetate & ethinylestradiol)and Champix (Verenicline) the drug prescribed to help smokers also known as Chantix.

“The Black Triangle”

Although the Black Triangle has been used since the 1980s in the UK to indicate that a drug is under intensive surveillance, new pharmacovigilance legislation in Europe now extends the Black Triangle symbol across the EU.

The Black Triangle will have to be present in the manufacturer’s Summary of Product Characteristics (SPC) and associated packaging patient leaflet (PIL) of any product subject to additional monitoring, along with the phrase “This medicinal product is subject to additional monitoring”.

Further information about all drugs available in the UK are on the web site www.medicines.org.uk  this is the Association of British Pharmaceutical Industries (APBI) electronic medicines compendium and has masses of good information. The SPC contains more information as it contains data the manufacture must submit when the drug is first licensed and should be updated as adverse reactions not originally listed are discovered.
Additional monitoring under the Black Triangle scheme applies to:
§           all medicinal products with a new active substance
§           biological medicinal products, including biosimilars
§           Any other medicine a regulator can demonstrate a specific requirement for additional monitoring
Black Triangle status will normally last for 5 years, but can be extended if ongoing safety issues require it.
Please report ALL suspected adverse drug reactions to any drug which has a black triangle symbol next to it to www.yellowcard.gov.uk  and APRIL will appreciate information about psychiatric adverse reactions to add to our data, used to promote action and improve education for health professionals.
Black Triangle drugs in the EU full list: go to the complicated MHRA web site www.mhra.gov.uk and be patient ! click on
1.     Safety Information,
2.     MEDICINES (in left menu)
3.     How we monitor the safety of products
4.     Overview
5.     Medicines
6.     Black Triangle Medicines then right at the bottom of the page you will find a link to the latest list of drugs designated with the Black Triangle

If MHRA web site changes cause problems just put Black Triangle in search box at  www.mhra.gov.uk Unfortunately my attempts to provide a direct link to the information are unsuccessful. I have written to the MHRA to suggest the Black Triangle information should be on the home page or found with just one click.

Tuesday, 5 August 2014

Contraceptive Pill links to Depression on BBC radio 4 Woman's Hour Today


Contraceptive Pill links to Depression

Today on BBC Radio 4 in the excellent programme Woman's Hour, I heard a discussion about the contraceptive pill and links to depression.

I would like to congratulate the presenter, Emma Barnett for her enlightened attention to what is a serious problem for many women. Sadly so many women do not link their mood swings, depression and failure to cope, with prescribed medication including the Pill. Many women are prescribed antidepressants to help them deal with depression that may not be a problem once they stop taking a particular contraceptive or other medication.

Please refer to my campaign about Dianette ( click Dianette to link to Guardian article) as the doctor on the programme seemed to promote the fact that skin and other problems can improve with certain contraceptives.

He failed to mention that Dianette, the drug promoted for acne is the one that is not actually licensed for contraception (though it has a contraceptive action) due to higher risk of dvt, blood clots. Banned for a while by the EU this comes with warnings. It may be valuable for women considering this drug, to have their blood clotting factor checked before embarking on using Dianette (also known as Diane 35 and many other generic names.). The doctor did mention that loss of libido as a possible adverse drug reaction (ADR).

We will never know how many suicides are linked to prescribed drugs that cause depression - in other words, are not tolerated, with the addition drugs prescribed for the depression, that are also not tolerated.

You can hear the radio 4 programme on BBC iplayer Contraceptive Pill links to Depression

http://www.bbc.co.uk/programmes/b04cbv9g