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Antidepressants and murder: case not closed

BMJ 2017; 358 doi: (Published 02 August 2017) Cite this as: BMJ 2017;358:j3697

Rapid Response:

Re: Antidepressants and murder: justice denied

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

04 August 2017
David Healy
professor of psychiatry
Bangor University
Hergest Unit, Ysbyty Gwynedd