Letters to and from are listed in date order, newest last. The correspondence began in late 1999 and mainly relates to Dr Healy's concerns about the risk that fluoxetine, paroxetine, sertraline and other SSRIs may induce in a small but significant number of users suicidal feelings or acts, or extreme aggression towards others. The correspondence is telling, not only in relation to this central concern, but also for what it reveals about the methods and stance of the Medicines Control Agency (MCA) - and above all their blind reliance on the manufacturers to provide and interpret data for them.

The turning point comes in June 2001, with the judgement in a Cheyenne, Wyoming court that paroxetine (Paxil/Seroxat) had contributed to the wrongful and violent deaths of Don and Rita Schell and Deborah and Alyssa Tobin and that SmithKline Beecham (now part of Glaxo SmithKline) had been responsible for failures to test and warn. In the course of this case, David Healy (as an expert witness for the Plaintiffs) discovered key company documents, detailing the results of very early studies in which paroxetine had been taken by healthy volunteers.

These not only revealed, for the first time, a high level of agitation, nervousness and extreme restlessness (akathisia) among volunteers - the very symptoms believed to be associated with acts of violence and self-harm - but also clear evidence of a withdrawal syndrome, found "at a much higher rate than occur on benzodiazepines."  Because these studies were done on healthy volunteers, there can be no doubt this was a true withdrawal syndrome, rather than 'relapse' - and the implications are profound.

In particular, if SKB knew of the existence of a withdrawal syndrome from the 1980s, how could they make claims for the long-term effectiveness of paroxetine, on the basis of a study which discounted the possibility that withdrawal symptoms existed at all? Healy suggests, "This seems to be close to frankly deceiptful ...". We agree. That study was conducted jointly by a representative of SKB and a member of the Committee on Safety of Medicines (CSM) - and has also been the been the focus of analysis and much correspondence between Social Audit and the MCA/CSM.

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