Antidepressants and murder: case not closedBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3697 (Published 02 August 2017) Cite this as: BMJ 2017;358:j3697
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The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed: “Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt” ... “All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants” (1).
Such daily monitoring is, however, a fake fix. People cannot be monitored every minute and many have committed SSRI-induced suicide or homicide within a few hours after everyone thought they were perfectly okay.
As the published trial literature related to suicidality and aggression on antidepressants is unreliable, we looked at 64,381 pages of clinical study reports (70 trials) we got from the European Medicines Agency. We showed for the first time that SSRIs in comparison with placebo increase aggression in children and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81) (2). This is an important finding considering the many school shootings where the killers were on SSRIs.
In a systematic review of placebo-controlled trials in adult healthy volunteers, we showed that antidepressants double the occurrence of events that the FDA has defined as possible precursors to suicide and violence, odds ratio 1.85 (95% CI 1.11 to 3.08)(3). The number needed to treat to harm one healthy adult person was only 16 (95% CI 8 to 100).
Based on the clinical study reports, we showed that adverse effects that increase the risk of suicide and violence were 4-5 times more common with duloxetine than with placebo in trials in middle-aged women with stress urinary incontinence (4). There were also more women on duloxetine who experienced a core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81). The number needed to harm was only seven. It would have been quite impossible to demonstrate how dangerous duloxetine is, if we had only had access to published research. In accordance with our findings, the FDA has previously announced that women who were treated with duloxetine for incontinence in the open-label extension phase of the clinical studies had 2.6 times more suicide attempts than other women of the same age (5).
Looking at precursor events to suicide and violence is just like looking at prognostic factors for heart disease. We say that increased cholesterol, smoking and inactivity increase the risk of heart attacks and heart deaths and therefore recommend people to do something about it. Psychiatric leaders, however, routinely try to get away with untenable arguments. Many say, for example, that antidepressants can be given safely to children arguing that there were no more suicides in the trials, only more suicidal events, as if there was no relation between the two, although we all know that a suicide starts with suicidal thoughts, followed by preparations and one or more attempts. The same can be said about homicide. It can no longer be doubted that antidepressants are dangerous and can cause suicide and homicide at any age (5-7). It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt (8) and when psychotherapy does not increase the risk of murder.
1. FDA. Antidepressant use in children, adolescents, and adults. http://wayback.archive-it.org/7993/20170111122946/http://www.fda.gov/Dru...
2. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
3. Bielefeldt AØ, Danborg PB, Gøtzsche PC. Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. J R Soc Med 2016;109:381-392.
4. Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ 2017;189:E194-203.
5. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.
6. Healy D. Let them eat Prozac. New York: New York University Press; 2004.
7. Breggin P. Medication madness. New York: St. Martin’s Griffin; 2008.
8. Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017 (in press).
Competing interests: No competing interests
I completely agree with Prof David Healy's comments on this short article. Only the one psychiatrist who considered the drug had no part in the murders, is quoted. Comments from the two others (one of which was Prof Healy) who both took the opposite view, were not mentioned. For many psychotropic drugs, abruptly ceasing the medication is highly inadvisable as it may result in further serious psychiatric symptoms. This would be especially the case for this patient whose dose had been increased, despite the presence of contraindications for doing this.
The author comments that there are no simple answers. Perhaps the answer to this dreadful occurrence, some other murders (and many suicides) are more straightforward than many doctors and the drug companies involved are prepared to face.
Competing interests: No competing interests
As a member of the online support community for prescribed drug dependence, you can imagine the dismay that has rippled through our ranks in the past week. We waited in anticipation to view the Panorama programme: "Prescription for Murder?" The links between SSRI drugs and violent acts are nothing new. I was advised of such risks some 30 years ago when first being prescribed an SSRI. The criticism of the documentary from certain quarters seemed unwarranted and exaggerated. As patients who have been significantly harmed by drugs of dependence, we are in no doubt that SSRIs can cause altered behaviour and many other terrible symptoms. Many of us live with them every day, tortured by neurological symptoms, altered states of consciousness, memory loss, inability to perform simple daily tasks, burning brain and so on and so forth. We are also very aware of the increasing body of evidence that suggest lack of scientific evidence that support the use of these drugs. We are told that antidepressants save many lives. Yet the suicide rates have recently increased at a time when antidepressant prescribing is at an all time high. (1)
The Royal College of Psychiatrists announced a Twitter-based Q&A session on 3rd August. The online support community submitted many, many intelligent and probing questions. The responses were few in number and lacking in substance. We were advised that the Royal College "thinks" the benefits of antidepressants outweigh the harms but no supporting evidence was provided. Today I read with even greater dismay an article entitled "Pharmacological iatrogenesis: substance/medication-induced disorders, that masquerade as mental illness". (2) Although the study was conducted in Australia it is confirmation of what many already suspect here in the UK, that SSRI drugs are causing significant harm to many patients and this has become a major public health issue. In October 2016, the BMA announced the need for a national helpline to help and support patients withdraw from drugs of dependence. (3) The Department of Health however insists there is insufficient evidence that such a service is warranted. The reality is that most patients who are trying to come off these drugs cannot find a doctor with sufficient knowledge of the adverse effects of psychotropic drug withdrawal and when patients describe their horrendous symptoms they are generally met with disbelief and often labelled as mentally ill. This causes deep distress to patients who are already suffering so very much. It seems that many GPs are quite simply out of their depth and have no idea what to do for such patients. Often more drugs are offered which only serves to make matters worse. Personally, I have withdrawn from a benzodiazepine and an SSRI and am physically and cognitively disabled. No doctor will acknowledge the cause of my symptoms or my disability.
Competing interests: No competing interests
Seldom can two respondents from disparate backgrounds have demolished so completely, on one page of your website, the profit-driven charades that occupy many of we medical professionals, in our every day working lives.
David Healey’s fourth and fifth paragraphs reduce much of psychotropic prescribing to a level of ignorance and incompetence that speaks highly of the power of the pharmaceutical industry to manipulate our prescribing decisions.
His colleague, Peter Gøtzsche, has documented the consequent ill effects on our patients, for those who wish to learn. (1)
Steve Hinks’ first paragraph is too charitable. (2) Surely he should be amazed by the sheer ignorance of most doctors and health professionals with respect to basic knowledge of vaccine benefits and risks, rather than just many of them ?
Doctors follow NHS protocols on vaccination, and are paid fees for doing so.
They are not paid to seek out and to examine the evidence for themselves.
Hinks’ response makes the search for evidence easier, for those who wish to look, and learn.
Psychotropics and vaccines are the biggest profit makers for Pharma.
Corporate and company law enshrine the need to put shareholder return on investment as first priority.
Any effect on the public good is only a means to that end.
1 Peter Gøtzsche. Deadly Psychiatry and Organised Denial. Peoples Press 2015
Competing interests: No competing interests
Dr Adshead misses the point behind this program. This was not a program attempting to prove antidepressants can cause homicide. This has already been conceded by prosecutors, regulators and company personnel. As early as 1983, Pfizer personnel had noted that this class of drug (SSRI) might lead to aggressive behaviour.
Nor was it about whether sertraline caused James Holmes to commit murder. Having spent time with the man, my view is that it did, and more could have been done to persuade viewers of this.
The key issue was this. If it has been conceded this drug can cause events like this, and if a case could be made that it did so in this instance, why did Holmes' legal team not run it?
The answer in part lies in the fact that academic literature on SSRIs is almost entirely ghost-written and there is no access to the data generated by the RCTs of these drugs. The BMJ and other journals play a part in this situation. This means that to acquit Holmes. a lawyer has to persuade a jury that most academics and journals are guilty of failing to adhere to the norms of science.
Holmes was in a Guildford Four quandary. Paraphrasing Lord Denning in that case " If his [their] story is right, it is such an appalling vista it cannot be. Wrongfully convicted prisoners should stay in jail rather than be freed and risk a loss of public confidence in the law".
Holmes had a public defender. His legal team did the best job it could but if it had been better resourced things might have been different. The rest of us who end up on the wrong end of one of the close to 100 drugs, including respiratory, skin and cardiac drugs, that prosecutors or companies have indicated can cause violence risk ending up in the same legal quandary Holmes was/is in.
There have been a lot of comments, coordinated by the Science Media Centre, that this program cast aspersions on a useful group of drugs. We need to find some balance between raising alarms about a drug and ensuring we do not compromise an innocent person's right to a fair trial.
Competing interests: Involvement in the Panorama programme