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Sunday, August 23, 2015

Antidepressants and Violence: The Numbers

How on earth could an antidepressant drug drive someone to murder? In the past two columns RxISK has heard from two people who know they can. In The Man Who Thought He Was A Monster, Steindor Erlingsson shared his own story of being tormented with urges to stab his wife and young children while on antidepressants.  

In last week’s column we “heard from” James Holmes, recently convicted of the inexplicable slaughter of twelve complete strangers in a Colorado movie theater.   Through Holmes’ personal diary and the testimony of his doctors, we traced how a shy, troubled young man who had never given anyone cause to fear him went from vague thoughts of doing away with the whole screwed-up human race, to actively plotting and carrying out a mass killing.

After reading these two columns RxISK volunteer Johanna Ryan had a question: If Steindor is right, and those who have murderous thoughts on antidepressants are often too afraid or ashamed to report them, is there any other complaint that might give us clues?

These drugs (Effexor, Zoloft, Cymbalta) has logged about 30,000 complaints, so it seemed valid to compare them. Steindor had been on Effexor, James Holmes had been on Zoloft, and Cymbalta had been implicated in another RxISK article in 2012: gory, disturbing dreams that resembled Hollywood horror movies, even among those who had always avoided such films.

It also impressed her that a few non-SSRI drugs, like Zyban/Wellbutrin and the anticonvulsant Neurontin which is widely used as a “mood stabilizer,” had been blamed for more suicides than the SSRI antidepressants. The FDA lists 2,168 suicides for Wellbutrin and 2,205 for Neurontin compared to “only” 1,130 for Zoloft.  Yet those drugs had far fewer complaints for violence-related symptoms.

Reports of both suicide and violence on paroxetine (Paxil or Seroxat) rival those for Zoloft, although the larger number of complaints for paroxetine make comparisons a bit tricky.  All the other SSRI drugs can cause these symptoms, although Paxil/Seroxat and Zoloft seem to lead the pack.  So can SNRI’s like Effexor and Cymbalta.

But Johanna also spotted one odd symptom for which Zoloft beat any other drug used for depression, hands down:  “Feeling guilty.”   What did that mean, she asked?

These drugs seem to have distinctive signatures. Cymbalta triggers gory dreams but not guilt, although a robust 1,776 say they “feel abnormal.”  Effexor also comes close to Zoloft and Paxil in the rates of homicide and homicidal ideation. And Effexor beats Paxil hands-down at making people feel guilty.

Who knows what is going on but it does seem that minor differences between these drugs can produce major differences in Us and in Our Experiences.  We need any of you who have had several different drugs and had different experiences on them to write in and tell us about what was different.

As Johanna found both anticonvulsants and antidepressants can cause suicide but the antidepressants seem more likely to cause violence.  We can only understand what might be going on here if some of you can give an account of your inner experience of these drugs that sheds light on what is going on.

The RxISK Stories

Johanna also took a look at Zoloft’s RxISK page, which includes excerpts from the reports we’ve received in the past three years.  She found plenty of relevant reports, some quite disturbing.

Physical Violence

There were at least five reports of actual physical assaults, two extremely serious:

I hit my husband in the head with a baseball bat while he slept. No history of any domestic problems or violence. We were together for 27 years, happily married for 25, until this one-time incident happened, and destroyed our marriage.  After the incident I never saw my husband again.  I found myself in the ER, then locked in.

I had an “abnormality of mental functioning” caused by triple dosing of the drug combined with alcohol and emotional state.  Am currently serving a minimum of 17 years in prison on a murder charge for killing a loved one.  Seriously considered suicide following the event.  No longer taking the drug.  Will appeal against the outcome and create awareness of such risks to the wider public.

Murderous Thoughts:

Two people reported specific thoughts of murder, such as this one:

I started having thoughts/visions of hurting or killing my children. These were accompanied by feelings of lack of control, extreme fear and anxiety and a physical sensation of warm tingles moving up my spine and out my extremities.


Four reported something like classic mania, including this woman:

Most people said that I was not behaving like myself at all, that my behavior was bizarre and often frightening. I was consequently hospitalized against my will. Switched rapidly from friendly and expansive to extremely angry at the slightest perceived provocation.  I was driving too fast and aggressively, screaming obscenities at my estranged husband and making perceived threats.  Grandiose ideas, talking to everyone I met; very impulsive and apt to make poor decisions.

Uncontrollable Anger:

There were many reports of repeated angry outbursts that went way beyond mere irritability, and were quite out of character for the person:

I would scream at everyone, especially my children. The hyper-stimulation of their just being around—talking, playing, moving—was too much to handle. Eventually, I had to have a sitter care for them at all times until I was well. Thankfully, I had enough support that I did not physically abuse the children, but I was very close to it on many occasions. It was an awful experience.

Alcoholic Drinking

Several who had been either nondrinkers or very moderate drinkers reported drinking heavily and craving alcohol on Zoloft.  Two noticed a sudden ability to drink without any hangover the next day.  They all reported their behavior while drinking as aggressive and out-of-control.

Emotional Numbing

There were LOTS of reports of sexual dysfunction of course, from both men and women,” Johanna noted.  “Some were strictly physical, but many reported an inability to feel emotions or to care about other people as well.  For some this emotional numbing was the only problem, or was clearly much worse than any sexual dysfunction they had.

“One man’s story really seemed to echo James Holmes’ descriptions of losing normal fear.   Holmes wrote that the “fear of failure” had led him to do well in life far more than the “fear of consequences.”   His fear of failure – dropping out of college, becoming a weird loser socially, disappointing himself and his family – seemed very much tied to caring about certain people and certain goals.  Zoloft put an end to both types of fear, he said, which made him both “fearless” and uncaring. That gave the hostility room to grow and take over.

The story on RxISK was much more prosaic, but pretty alarming in its own way. The man said he stopped paying his bills, and was forced to retire early from his job, because he lost all “normal” anxiety.  He then spent his whole retirement account in a few years and neglected to pay the real estate taxes on his house as well, so he’s pretty much flat broke. Now that he’s off the meds he feels acutely what a fool he was – but he realizes he knew what he was doing all along. He was just unable to care.

To one extent or another, this happens to everyone on SSRI’s, and explains why people who are “much too sensitive” emotionally often find them helpful. It may also explain why doctors so often can’t spot the problem:  Letting your bills pile up and your kitchen sink overflow with dirty dishes are typical symptoms of “depression.” If this man’s doctor did not listen carefully he could miss the fact that his patient did not feel sad or exhausted – he may even have been out having fun while neglecting his chores. He just didn’t care anymore.

Antidepressants and Homicide

Antidepressants have been an issue in some of the horrific mass shootings of the past twenty years, and in many less publicized murders as well.  Most news accounts have nonetheless seen the problem as a lack of professional help or a failure to seek it because of stigma—ignoring the “professional help”, largely pharmaceutical, the person was receiving.  It has been very rare that defendants or their lawyers have raised the medication issue themselves – they have shied away.

It’s not hard to see why.   In America in particular, three decades of “tough on crime” rhetoric have taught the public to see most defenses based on mental illness as excuses for bad behavior, and view them with suspicion.  The idea of temporary insanity in a defendant who appeared to be functioning normally until shortly before the crime strikes many as outright fabrication.

Then there’s the drugs themselves.   In both Europe and North America the vast bulk of the psychiatric profession has declared SSRI’s and other antidepressants to be innocent of any harm, and in fact to be life-savers that have prevented thousands of suicides.  While the FDA found enough compelling evidence of suicidal impulses among children and teens to warn against using antidepressants in youth up to age 24, this Black Box warning has been so regularly disparaged and denounced by leading psychiatrists that it’s seldom brought into the courtroom.

These are also well-known drugs.  The average jury will contain at least one or two people who take them or have done so in the past, and everyone knows someone who has tried them.   Some people will feel they’ve been a godsend; some will feel they have helped somewhat, and others not at all.  Yet very few will link someone who has turned suicidal or violent, or completely changed character to the drug they might be on.

As one man recalled of his Zoloft drinking binges:

I thought I was drinking to get past the pain of my divorce, and I think that’s what family and friends thought too. None of us thought anything about Zoloft.  We just thought I was an out-of-control alcoholic, even though I never was a drinker before.

Faced with an acknowledged killer who blames his brutal actions on Zoloft, most in the jury box will say, wait a minute.  I know all about those drugs.  My mother’s on them, and my nephew, and a few coworkers too.  None of them have done anything crazy, so why would Zoloft drive this man out of his mind?

If they were that dangerous, the government or someone would have to warn us. Wouldn’t they?

Report your experience with prescription drug side effects

Although drug side effects are known to be a leading cause of death and disability, less than 5% of serious drug side effects are reported. Our mission is to capture this missing data directly from patients to help make medicines safer for all of us.

When you report your drug side effect, you also receive a free RxISK Report to take to your doctor or pharmacist. This report serves as a means to initiate a more detailed discussion of your treatment.

At the end of the reporting process, we also provide you with the option to take the information you have reported on RxISK and automatically create a form to send to your country’s health authority — for example, the FDA in the United States, Health Canada in Canada, and Yellow Card in the United Kingdom (more countries will be added soon).

Antidepressants and Violence: The Numbers August 17, 2015

BITTER PILLS The Dramatic Side Effects Of Prescription Drugs  August 23, 2015

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