Saturday, November 7, 2009

Antidepressants and Violence

In 1989, Joseph Wesbecker shot dead eight people and injured 12 others before killing himself at his place of work in Kentucky. Wesbecker had been taking the selective serotonin reuptake inhibitor (SSRI) antidepressant fluoxetine for four weeks before these homicides, and this led to a legal action against the makers of fluoxetine, Eli Lilly [1]. The case was tried and settled in 1994, and as part of the settlement a number of pharmaceutical company documents about drug-induced activation were released into the public domain. Subsequent legal cases, some of which are outlined below, have further raised the possibility of a link between antidepressant use and violence.
They were dispensing care to soldiers, that the soldiers themselves called cookie-cutter treatment where everyone would be given a 20-minute briefing and sent off with a prescription for the anti-depressant Zoloft.
UPDATE: My contacts in the pharmaceutical forensic community are pointing to the anti-malarial drug Lariam, routinely administered to deploying troops, which has a history of inducing psychotic side-effects. The product information says, "Mefloquine (the generic name for the drug) may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior." Vanity Fair is on the case. Was Nidal Malik Hasan Taking Lariam?


Watson said...

I think that the main theory of depression these days is as an emotional reaction to loss. However, there is an older idea of depression as inwardly directed anger. If an antidepressant drug were to relax the repression of pent up anger, that anger could flare up.

And there are always idiosyncratic pharmacological effects.

Jack said...

The problem is that the "science" of psychiatry doesn't have a reasonable clue as to the causes of dression, nor whether depression is the same dysfunction from one person to another. Pharmaceutical manufacturers don't do research on the causes of mental or emotional impairment. it would appear that someone has a hunch about a potential drug effect and then they try it out on a large group. Whether the research is well controlled or not is secondary. Whether the results support the hunch or not is also secondary. The research, if it can be called that, is aimed at finding and providing support for the use of the drug.

Listen carefully the next time you see a commercial on TV for an "anti-depressant" drug. The list of disclaimers is enlightening and frightening at the same time. The advetiser is telling us up front, "This stuff might kill you or make you nuttier than you already are. Take this drug at your own risk. Ask your doctor about it" What they're not telliong you is, "We provide financial support to your doctor. We invite your doctor to neat vacations where we tell them a lot about our products, but not everything they need to know."

Anonymous said...

RAP says
Of course ever act of violence has a "psychiatric" cause. A bad night's sleep, a lost cat ... a drug. Hasan was an Islamist fanatic practicing a fanatic's religion. Violence is as much a part of Islam, the "religion of peace," as its subjection of women. You're in denial, or in the last spasms of PC. Hasan was a terrorist. Surely we know enough of those, don't we.

John Emerson said...

Yeah, America's Christian soldiers are non-violent. Problem solved!

PT-12599 said...

Assuming Hasan recovers, Anon, he still would have ways to go before killing the tens of thousands of people as our very Christian last president, W.

Jazzbumpa said...

I love the way Anon states you're in denial for a claim you didn't even make.

Even more so, equating Islam with fanaticism. Have you ever had a conversation with a Muslim, Anon?


And, BTW, Anon - give yourself a name and a least a modicum of credibility.

Moving on - I thought it was pretty well established that depression is caused by chemical imbalances in the brain. Is that wrong? The problem (OK - A problem) with drug therapy is you NEVER have a complete handle on the side effects. And the bad news is always suppressed. There are $$$ to be made.

Jack said...

Psycho-neurological research is extraordinarily difficult to carry out for several reasons that should be obvious. The difficulty with interpreting the findings of "chemical imbalances" which may be found to accompany any form of behavioral activity or mental status is complicated by the simple issue of "which came first?" Such imbalances may be a result rather than a cause. They may otherwise be the result of some other causative variable.

"The problem (OK - A problem) with drug therapy is you NEVER have a complete handle on the side effects." If by handle you mean a prior understanding or awareness, that statement is not quite accurate. The disclaimers that accompany the advertisements for anti-depressant meds indicates very clearly that the manufacturers know that there are serious debilitating side effects.
If by handle you mean some form of control over the side effects, well of course not. That's why they're called side effects, reactions that accompany the expected and desired effect, but can't be controlled.

Rdan said...

Third generation drugs work on balances of seritonin, neoprenephrin, and dopamine. Several types work on more than one to date in different combinations, and can be changed to adjust for these balances.

It is of course still crude, involves brain levels which are not ususally measureable (blood levels are not the same but is the standard).

Reaction to events is one form of depression, but the interplay between depression and trauma (adult combat for instance, or childhood trauma) is not well understood.

It also depends on intensity and duration of events, and social network supports a person allows to help.

Of course, it easily could be something else as a clinical diagnosis as opposed to a media diagnosis.

Current practice CBT is dominant in the US, and the military has its own demands.