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Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings

Quacks detest science-based medicine (SBM) in general, but there are certain specialties that they detest more than others. For instance, you won’t find too many quacks attacking trauma surgery because even they know that when a person’s body has been on the losing end of a confrontation with a bullet or a car, no amount of laying on of hands, homeopathic nostrums, “energy healing,” or herbal remedies are going to stop the hemorrhage, mend broken bones, or repair holes in various internal organs. That’s why even homeopaths will concede that “allopathic medicine” is good for emergencies. It’s also why sketches like this one resonate:

However, from there the distrust of promoters of unscientific and pseudoscientific medical systems and treatment modalities for SBM appears to increase in direct proportion to the urgency and need for direct physical repair of damaged organs, with the possible exception of cancer, for which the standard physical treatment (surgery) is attacked nearly as much as chemotherapy.

Be that as it may, arguably the specialty most attacked by quacks is psychiatry. Many are the reasons, some legitimate, many not. For example, the Church of Scientology in particular despises psychiatry, even going so far as to maintain through its anti-psychiatry front group the Citizens’ Commission on Human Rights (CCHR) a risibly nonsensical “museum” in Hollywood dedicated to psychiatry that they charmingly call Psychiatry: An Industry of Death. It’s so ridiculously, painfully over-the-top, a veritable self-parody of anti-psychiatry hyperbole, that it inadvertently undermines the very attacks on psychiatry frequently leveled by Scientologists and quacks that it’s meant to reinforce. Indeed, not having visited its website for several years, I notice that the CCHR has totally revamped it, now including a virtual 3D tour of the museum, along with video clips from its many “exhibits” available online. I’ll have to file that away for later blog fodder, because the misinformation, cherry picking, and pseudoscience flow freely, as one would expect from a Scientology propaganda project. In the meantime, suffice to say that it’s not just the Church of Scientology that despises psychiatry. It’s founder L. Ron Hubbard and his disciples merely represent the most ridiculously over-the-top and vociferous anti-psychiatry group that I’m currently aware of.

Let’s face it, psychiatry hasn’t always had the best history. It’s a very hard to study human behavior and disorders of human behavior in a rigorous fashion, but to my mind that didn’t excuse the the widespread acceptance for many decades of the ideas of Sigmund Freud, which were little removed from pseudoscience in many respects. Also, psychiatry has not always had the best history, particularly in the early part of this century. Too often, psychiatry has been used as a tool of control rather than a means of helping people who are suffering. Perhaps the worst example is the misuse of psychiatry by various totalitarian regimes, be it the Nazis using it as a primary tool of its T4 euthanasia program or the Soviet Union declaring enemies of the state to be mentally ill and shipping them off to Gulags.

Although there is a ways to go, however, psychiatry in 2012 is much better than psychiatry, say, 50 or 75 years ago. It wasn’t so long ago that, popularized by Walter Freeman, thousands of “ice pick lobotomies” were performed for all manner of indications, few of which had what we would consider to be compelling scientific support to back them up. Over the last half-century, better psychiatric drugs to treat different conditions have been developed, leading to their widespread use for a number of indications.

There are, of course, legitimate criticisms of psychiatry to be made, but that’s not what quacks are interested in. Their hatred of psychiatry is particularly pure, to the point where they look for any excuse to attack psychiatric medications. Indeed, there is even a phenomenon known as “mental illness denial,” which denies that mental illnesses even exist and, therefore, that psychiatry can possibly be a legitimate branch of medical science. Again, Scientologists are the most prominent proponents of mental illness denial, but such “thought” (if you can call it that) permeates many areas of “alternative medicine.”

One of the more odious byproducts of mental illness denial is a depressing eagerness among the anti-psychiatry quack crowd to leap on any mass murder that occurs as an excuse to blame the crime on psychiatric medications. I first noticed this particularly disgusting phenomenon in the wake of the Virginia Tech shooting five years ago, and, unfortunately, I’m noticing it again now, in the wake of the Sandy Hook Elementary School mass shooting in Newtown, CT, which is not too far from where our fearless leader Steve Novella lives, as he discussed in his ruminations on this tragedy. Indeed, it’s hard to believe that it was only a week and a half ago when a mass murderer, Adam Lanza, walked into Sandy Hook Elementary School and callously gunned down 26 people, including 20 children between the ages of 6 and 7, before shooting himself. A mere two days after the shooting, for instance, Mike Adams, the proprietor of one of the most wretched hives of scum and quackery on the Internet, NaturalNews.com, wrote a post he entitled, Gun control? We need medication control! Newton elementary school shooter Adam Lanza likely on meds; labeled as having ‘personality disorder’, in which he ranted:

According to ABC News, Adam Lanza, the alleged shooter, has been labeled as having “mental illness” and a “personality disorder.” These are precisely the words typically heard in a person who is being “treated” with mind-altering psychiatric drugs.

One of the most common side effects of psychiatric drugs is violent outbursts and thoughts of suicide.

Note: The shooter was originally mid-identified as Ryan Lanza but has now been corrected to Adam Lanza.

The Columbine High School shooters were, of course, on psychiatric drugs at the time they shot their classmates in 1999. Suicidal tendencies and violent, destructive thoughts are some of the admitted behavioral side effects of mind-altering prescription medications.

Then, rather incoherently, Adams switches gears to the claims that prescription drugs cause 100,000 deaths a year and arguing that guns should’t be banned based on this shooting incident but rather psychiatric drugs are at the root of the violence:

For guns to be as deadly as medications, you’d have to see a Newton-style massacre happening ten times a day, every day of the year. Only then would “gun violence” even match up to the number of deaths caused by doctor-prescribed, FDA-approved medications.

Why does America grieve for the children killed in Newton, but not for the medical victims killed by Big Pharma? Are the lives of people on medication not valuable compared to the lives of children in elementary school? Will Obama shed a tear for the victims of Big Pharma, or are his tears reserved only for politically expedient events that push his agenda of unconstitutional gun restrictions?

If our goal us to stop the violence in America, we are completely dishonest if we do not consider the mental causes of violent behavior. And that starts with mind-altering psychiatric drugs which I believe have unleashed a drug-induced epidemic of violence across our nation.

This is a claim we hear frequently from quacks like Mike Adams. Of course, at the time he started making these charges he had no evidence that Adam Lanza was even on psychiatric medications, much less that they caused or contributed to his having turned a school into an abattoir. Of course, little things like facts and science never stopped Adams in his relentless quest to be the firstest with the craziest, and this was no exception. A couple of days ago, not to keep the crazy under check, Adams followed up his original article with one entitled The solution to the insanity: Ban all people on psychiatric medication from owning guns, driving cars or voting for President. In his “satire,” he advocated banning people on psychiatric medications from driving, owning guns, or running for public office, proclaiming that “medication makes some people go crazy with violence.”

Nice how Mike Adams so casually demonizes those with mental illness, throwing around terms like “crazy.”

Be that as it may, Mike Adams isn’t the only one doing this. For instance, Teresa Conrick, over at the antivaccine crank blog Age of Autism, wrote a post the other day with a title almost as charming as Mike Adams’, Pharmagunddon: School Shooters and Psych Meds. After correctly castigating some media reports that the shooter Adam Lanza had Asperger’s, a justified response to the implication in some of these reports that it was autism that lead Lanza to become so violent, unfortunately Conrick goes straight into an anti-psychiatry rant as bad as anything Mike Adams has done.

If there’s one thing antivaccinationists are good at, it’s confusing correlation with causation. After all, the entire antivaccine belief system involves correlating increasing prevalence of autism over the last 20 years with increases in the number of vaccinations in the recommended childhood vaccine schedule. So it’s not at all surprising that Conrick thinks she’s found a correlation:

“Despite 22 international drug regulatory warnings on psychiatric drugs citing effects of mania, hostility, violence and even homicidal ideation, and dozens of high profile school shootings/killings tied to psychiatric drug use, there has yet to be a federal investigation on the link between psychiatric drugs and acts of senseless violence.”

“At least fourteen recent school shootings were committed by those taking or withdrawing from psychiatric drugs resulting in 109 wounded and 58 killed (in other school shootings, information about their drug use was never made public—neither confirming or refuting if they were under the influence of prescribed drugs.) The most important fact about this list, is that these are only the shooters where the information about their psychiatric drug use was made public. To give an example, although it is known that James Holmes, suspected perpetrator of a mass shooting that occurred July 20, 2012, at a movie theater in Aurora, Colorado, was seeing psychiatrist Lynne Fenton, no mention has been made of what psychiatric drugs he may have been taking.

She then lists 14 more incidence of violence in which the perpetrator was taking psychiatric medications. As I said, confuse correlation with causation for vaccines, confuse correlation with causation regarding psychiatric medications for this issue. So what is the actual evidence? Clearly quackery supporters like Conrick and Adams are not interested in a balanced presentation; they’ve cherry picked their evidence to find only studies that suggest a link. The most prominent of these studies, which is referred to time and time again by those of Adams’ ilk is a study that was published in PLoS ONE a couple of years ago by Thomas J. Moore, Joseph Glenmullen, and Curt D. Furberg entitled Prescription Drugs Associated with Reports of Violence Towards Others.

Basically, this study was a review of adverse event reports from the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) from 2004 through 2009, searching for drugs with a disproportionate number of reports of AEs involving violence towards others. Disproportionality in reporting was defined as “a) 5 or more violence case reports, b) at least twice the number of reports expected given the volume of overall reports for that drug, c) a χ2 statistic indicating the violence cases were unlikely to have occurred by chance (p<0.01).” The authors identified 1,527 cases of violence reported disproportionately for 31 drugs. Some of the drugs included varenicline (used for smoking cessation), 11 antidepressants, 5 sedative/hypnotics, and three drugs for attention deficit hyperactivity disorder. Among the drugs, varenicline stood out.

Of course, those of you who’ve been reading my posts on vaccines will see the problem with this study. The AERS database is one letter removed from the VAERS database (i.e., the Vaccine Adverse Events Reporting System). In fact, these days, it’s known as FAERS, the FDA Adverse Events Reporting System, and it serves essentially the same function as VAERS, namely to serve as a post-approval surveillance system, to serve as the “canary in the coal mine,” so to speak. However, it also shares all the problems with VAERS. The biggest problem is that FAERS, like VAERS, is a passive reporting system to which anyone can report suspected adverse events:

Reporting of adverse events and medication errors by healthcare professionals and consumers is voluntary in the United States. FDA receives some adverse event and medication error reports directly from healthcare professionals (such as physicians, pharmacists, nurses and others) and consumers (such as patients, family members, lawyers and others). Healthcare professionals and consumers may also report adverse events and/or medication errors to the products’ manufacturers. If a manufacturer receives an adverse event report, it is required to send the report to FDA as specified by regulations. The reports received directly and the reports from manufacturers are entered into FAERS.

Scott Gavura recently wrote in depth about the strengths and weaknesses of adverse events reporting systems, including both FAERS and VAERS, reinforcing that the biggest problem with AERS, be it FAERS or VAERS, is that there is no denominator. We have no idea whether an increased number of reports indicates a true increase in incidence or represents an artifact of increased reporting. For instance, it’s been suggested that, thanks to trial lawyers wanting to sue vaccine manufacturers, the VAERS database has been hopelessly distorted with increased reports of autism being caused by vaccines, even though rigorous controlled epidemiological trials do not support this link. As a result, not surprisingly, I don’t take this study very seriously.

I also can’t resist pointing out that what’s good for the goose is good for the gander. Critics of big pharma frequently castigate studies by investigators with conflicts of interest involving big pharma; so the conflicts of interest of the authors of this study are fair game in my book. They’re doozies, too:

Mr. Moore has received consulting fees from litigators in cases involving paroxetine, and was an expert witness in a criminal case involving varenicline. Dr. Glenmullen has been retained as an expert witness in cases involving varenicline and psychiatric drugs including antidepressants, antipsychotics, benzodiazepines, mood stablizers, and ADHD drugs. Dr. Furberg has received consulting fees from litigators in cases involving gabapentin.

Kind of like Andrew Wakefield being funded by trial lawyers, isn’t it?

Speaking of Andrew Wakefield, I also can’t resist mentioning that last Friday Wakefield himself decided to throw himself into the fray by publishing a tirade on the antivaccine crank blog Age of Autism that is just as misguided, wrong-headed, and inept as anything that Mike Adams, or Teresa Conrick has written entitled Patterns In Chaos: Child Psychiatry, Violence and Autism. Like Conrick, he begins by correctly countering the misinformation rampant in the media in the wake of the Sandy Hook shooting that Lanza had Asperger’s syndrome and correctly asserting that there is no good evidence of a link between autism or autism spectrum disorders and an increased propensity for violence and mass murder. Unfortunately, Wakefield then does what antivaccinationists do so well and proposes an alternate explanation that involves the same confusion of correlation with causation that Mike Adams and Teresa Conrick fell for, tying them to vaccines:

And for those at risk – young people receiving off-license mind-bending drugs, an urgent overview of individual indication, efficacy, compliance, and adverse effects must be undertaken, funded by the relevant players in the pharmaceutical industry and conducted independently of any other input from them.

Tragically, predictably, there will be more events like that at Sandy Hook Elementary. The vast number of individuals with developmental disorders presages such events. This is not because of their diagnosis, per se, but rather I would suggest, because they may be at increased risk for adverse reactions (due to pre-existing conditions) and are being inappropriately medicated with drugs for which violence is a recognized adverse reaction. These drugs are being prescribed by a “mainstream” medical system that, through clinical neglect, has run dry on alternative treatments for autism spectrum disorders while enjoying Parma’s inducements way too much to look for any.

My opinion is neither mine alone, nor is it new. In attempting to make sense of the “senseless” it offers both tangible reasons and approaches to prevention. It is not enough that our hearts break for those affected; we are compelled to act. Perhaps inevitably, I am left with a mental image of Pharma lobbyists scaling Capitol Hill like an army of Orcs closing on Helm’s Deep. It’s a hideous sight.

No, the hideous site is someone like Wakefield, who has arguably done more than any single person in the world to endanger public health than any living person through his dubious, trial lawyer-funded research that sparked the anti-MMR scare that spread from the U.K. to the world, lecturing anyone on anything having to do with vaccines or drug safety. Wakefield then goes on, like Adams and Conrick before him, to list violent crimes and mass murders in which the perpetrator was taking psychotropic medication. It’s not for nothing that Wakefield richly deserved being awarded the Golden Duck Award by the the Good Thinking Society for lifetime achievement in quackery. Truly, Wakefield is in the good company of quacks when one of his articles is indistinguishable in anything other than tone from an anti-psychiatry rant by Mike Adams or Gary Null.

But back to the study and conflicts of interest.

One notes that Dr. Glenmullen has also written books about “solutions” to getting off of antidepressants and castigating antidepressants as causing violence and all sorts of other horrific symptoms. One wonders what Conrick or Adams would say about studies showing these drugs not to be linked with violence if any of the study authors had been paid by a pharmaceutical company to sing the drugs’ praises or had written books about how great the drugs were. I think not. Of course, a COI alone does not mean that the study isn’t a good one or that it should be dismissed out of hand, nor am I advocating that. I do, however, marvel at how closely the competing interests line up with the findings of the study and am pointing out that the authors do have an ax to grind, which should color your interpretation of their results, along with one’s knowledge of how FAERS is like VAERS. Granted, it appears to be more rigorously administered than VAERS in that there is more medical moderation to assess potential plausibility, but it suffers from the same basic issues that VAERS does. Also, in all fairness, the majority of reports to FAERS come from health care professionals and pharmaceutical companies, which are required to report all AEs reported to them to FAERS within a short time period.

Be that as it may, this study is clearly based on finding correlations. It is preliminary, but that doesn’t mean the authors might not be on to something. After all, given the psychotropic effects of certain drugs it’s not implausible that some of them might be linked with violent behavior, and there is certainly other evidence that suggests that certain drugs can make violence more likely. On the other hand, one big problem with studies of this sort is that they rarely control for obvious confounders, such as measuring the baseline rate of violent behavior in patients with the condition who are not treated with the drug in question. As one commenter after a post about this study put it, “Did they screen for people being violent before they took medication? Violent? No, no I was neveeeer violent until I took this pill…” Again, it’s all correlation in a database not well equipped to provide anything but preliminary hypotheses to test in more rigorous trials, and there is no control group. An excellent review article points out some of these difficulties:

A number of epidemiological studies suggest that drugs can induce aggression, unfortunately many fundamental limitations exist in these types of studies linking crime to drugs. Most crimes are the result of a combination of factors such as economic, cultural, genetic, environmental, and interpersonal.8,13 Even when the drug is the cause it is often one of many factors that played a part in the event.8 The definition of “drug related” varies from study to study and among individuals. Many epidemiological studies rely on urine testing for drugs of abuse. Standard urine tests are often limited to a handful of substances.16 Certain substances, such as lysergic acid diethylamide (LSD), are difficult to detect by standard urine drug testing methods.16 Additionally, reports by offenders may minimize or exaggerate the contribution of drugs to the given crime, leading to complications in reporting. Most forensic cases involve illicit drugs rather than prescription drugs. These drugs often come from clandestine sources, so the purity and authenticity of the substances cannot be certain. Direct human studies related to drug-induced aggression are limited and animal studies may provide as background information as to whether a drug can cause violence, for example cocaine.17

Psychiatric conditions associated with criminality include delirium, delusional disorder, dementias, impulse control disorders, bipolar disorder, depression, schizophrenia, schizoaffective disorder, paraphilias, and traumatic brain injury.18 It is important to emphasize that most persons with mental illness are not violent and just having a diagnosis does not create additional risk for aggression. One could extrapolate that if a drug causes delirium or delusions (especially paranoid delusions) then it could result in violence. Unfortunately, mental illness is often a confounding factor in case reports both clinical and forensic. Mental illness may or may not be addressed in epidemiological studies.

The review article also points out that many drugs have been linked with violence based on various evidence but that it’s really hard to demonstrate in any given case that a specific drug contributed to a specific act of violence. Unfortunately, that’s exactly what Adams and Conrick are doing: Trying to blame psychiatric medications for Lanza’s rampage, even though it’s not even clear whether he was on psychiatric medications, and, if he was it’s not known which one(s). A previous report allegedly from Lanza’s uncle that he was on Fanapt was apparently highly dubious.

In any case, regardless of whether Lanza was taking medications of any kind, psychiatric or other, there is no evidence that it was medications that caused his murderous child-killing rampage, any more than there is evidence that mental illness caused him to kill. Indeed, apparently he was assigned a school psychologist because of his social awkwardness and fear that he would be bullied by others or might harm himself. At this point, we just don’t know, and all too often people without a definable mental illness do truly evil things for reasons known only to themselves. While I can understand why a clueless wonder like Mike Adams is so anxious to blame evil acts on the products of big pharma. He thinks big pharma is the root of all evil and that the only answer are his “natural” cures. Conrick, on the other hand, has a special needs children. In correctly castigating writers who tried to imply that autism somehow led Lanza to kill, she turns right around and implies that it was medications associated with psychiatric conditions, thus demonizing those with psychiatric conditions as potential killers through their medications.

Such is the fruit of the anti-psychiatry misinformation spawned by groups like the Church of Scientology: The demonization of those with mental illnesses coupled with making it even harder than it already is for them to get treatment and live lives that are as normal as possible.

Posted in: Neuroscience/Mental Health, Politics and Regulation, Public Health, Vaccines

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14 thoughts on “Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings

  1. toffer99 says:

    The ER joke works superbly against woo. I first saw it on “That Mitchell and Webb Show” on British tv in 2009. Worth a look: http://youtu.be/HMGIbOGu8q0

  2. David Gorski says:

    Actually, the video I used to illustrate my initial point predates the Mitchell and Webb “Homeopathic A&E” sketch by well over a decade, having come from a sketch comedy show that ran from 1984 to 1999, Almost Live!. Interestingly, Almost Live! was the show where Bill Nye the Science Guy got his start, doing sketches that later became the basis of his PBS show.

  3. DugganSC says:

    One of the more unusual “violent drug reaction” situations I know of is Claritin (loratadine). A few years back, Dr. Scott of Polite Dissent posted a review of a Batman comic that was essentially being used to sell Claritin and one of the people in the comments posted their horror story of having their child on it and their normally sweet young boy changing into a raging child who seemed to show little concern for the well-being of others. I thought the same thing you were mentioning about the difficulties of telling when the problem started until the same thing happened to a co-worker of mine. The doctor switched her son to Claritin and a few weeks later, he was angry all of the time, and his drawings were predominantly about murder and death. I mentioned the (at the time anecdotal) case I’d heard of and she switched his allergy medications. Within days, he was back to his usual sweet self. Poking around online, it seems to be a rare, but definitely present, thing, albeit seemingly only for children.

    As regards the shootings, we’re probably lucky that people haven’t been hitting the mental health angle more strongly. As one commentator I saw put it, having a documented mental illness makes you somewhere around a hundred times more likely to shoot up a school than owning guns. Considering the massacre has people clamoring to ban the ownership of certain guns (and, for some, all guns, arguing that reducing calibres and clip sizes will just change how they go about it), how long would it take for someone to put legislation banning people with mental illnesses from owning guns or driving? Or, for that matter, putting kids with such problems on a watch list like we did with heavy metal music, trenchcoats, and writing stories with violence in them as in past cases? Me, I think that every one of these cases is complex, and trying to treat any one symptom is little more than posturing. We need better mental health care in this country. We also need it to be stigmatized less so that people feel free to seek out care. I know two different people who refuse to be treated for their depression because they know it will go on their records and fear that it will bar them from successful employment (in one case, the person was military, US Air Force, so they had a good point, as at the time, the Air Force had a zero-tolerance policy on mental illness in the ranks).

  4. Janet says:

    Unfortunately, the thinking of the Scientologists has permeated far beyond their own membership and is pretty much accepted wisdom to a large chunk of the non-science educated population. You cannot imagine the social isolation and outright condemnation I experienced when my own (then) teen-aged son was going through a trial of various psychiatric medications–some of which did, indeed, have some nasty side effects. Either I was told he just needed a good spanking, more “discipline”, more “structure”, or else a good dose of whatever woo the person was into.

    Luckily, he never became violent (he was pretty aggressive at times), but then I did not keep an array of deadly weapons in the house–or anywhere, or haul him off to the shooting range. He’s an adult now, and still struggles with meds, but at least he’s impermeable to sCAM, while at least two kids he grew up with whose parents shunned all psych meds have subsequently killed themselves (anecdote to be sure, but still…).

  5. Chris says:

    Dr. Gorski:

    Interestingly, Almost Live! was the show where Bill Nye the Science Guy got his start, doing sketches that later became the basis of his PBS show.

    What was frustrating for them was they were canceled just before the WTO riots in Seattle. But they are coming back as “The 206″ (Seattle area code)! See the promo on YouTube. It looks like there will be more skewering of alt-med, since there is plenty of that here.

  6. Grant Jacobs says:

    The Australian anti-vaccine organisation, AVN — the subject of the previous article by Rachael Dunlop — put up a post on their Facebook page proposing SSRIs had a role in the shooting only to find the post condemned by their own membership. I can’t think of another time I’ve seen critical thinking on display by members of an anti-vaccine forum. It’s a great pity that their members don’t apply the same criticism to all that AVN writes.

  7. David Gorski says:

    One wonders if Aussies have a better class of antivaxers (or at least a slightly less nutty class of antivaxers) than we have., because I’ve been hard-pressed to find any criticism of the “psych meds cause mass murder” nonsense being promoted by Mike Adams, Gary Null, and now Andrew Wakefield on the antivaccine forums I’m familiar with.

  8. DW says:

    I would suspect it’s not an Australian thing, here is another thought. Could it just be that increasingly, even anti-vaxers will back off from pointing fingers at SSRI’s, as more of them take these drugs themselves? Just looked at logically, a certain percentage of the fervent alt-medders will have psychiatric problems themselves. Just as alt-medders will not turn down help in the emergency room if they’ve been in a car accident or sustain a gunshot wound, some probably seek legitimate psychiatric treatment (after herbs and meditation turn out not to work), but unlike a trip to the emergency room, 6-weekly visits to a shrink can be done more-or-less on the sly. Nobody really has to know if you see a psychiatrist, if you don’t want to jeopardize your alt-med cred. Then perhaps over time, as they sheepishly admit at least to themselves that the SSRI has actually helped them and has not, in fact, turned them crazy, they quietly tone down their militant anti-psychiatry rhetoric, or at least, perhaps they drop SSRI’s from their personal list of evil medications.

    Put simply, if you take one yourself you know that SSRI’s really don’t make most people freak out, or cause drastic personality changes … most people remain themselves, just a bit more upbeat. I think this argument follows simply from the sheer numbers of people taking SSRI’s.

  9. In a subgroup of physiologically susceptible people, SSRIs do prompt thoughts about, and actions upon, violence towards self or others.

    Sure, this is my opinion. I could be wrong.

    But it is ridiculous to discount the idea that SSRIs lead to violence. For years, I have been noting this relation. Why? Because before these drugs became popular, I was already successfully treating people for depression with psychological interventions, and so using prescription drugs has never made sense, except maybe for short-term or certain specific circumstances.

    I used to rant about this to my wife. She thought it was just me bringing my work home, som she ignored me. Then, a friend of our daughter, whom we had known for a couple years at the time, was started on one of these drugs, and became actively suicidal. My wife and daughter now believe. I mentioned this anecdote to my wife’s sister, who told me how a doc started her on one of these drugs, and she discontinued because she became violent towards family members. These behaviors have been once-in-a-lifetime events for these two people. Several years have gone by since these anecdotes happened, and these two people are doing just fine.

    Sure, they are just anecdotes. At some point, they begin to accumulate into a scary story.

    You SBM readers ought to browse ssristories.com to get a sense of the extent of this problem. Maybe 5% of the population are susceptible. That is a lot of people when you consider millions of Rx are written each year.

    I understand that any treatment given to potentially suicidal people can have the wrong appearance of causing the suicide. Correlation is not causation. And depressed people are the ones attempting suicide. But the violent homicides? come on now, docs. Time to wake up.

    I don’t agree with the Scientologists on most everything. I have to acknowledge, though, that they are wise to ride this true phenomenon.

    Here is one of the starting points of the emergence of this phenomena:
    “Antidepressant drugs and the emergence of suicidal tendencies.” Teicher MH, Glod CA, Cole JO. Drug Saf. 1993 Mar;8(3):186-212.

    There are two lines of resch in the literature: one, coming from pharma-sponsored psychiatrists, that Rx SSRIs reduces suicidality, and one from various other analyses that either show no relation or increased suicide. This Juurlink article is an example:

    “The risk of suicide with selective serotonin reuptake inhibitors in the elderly.” Juurlink DN, Mamdani MM, Kopp A, Redelmeier DA. Am J Psychiatry. 2006 May;163(5):813-21.
    “…During the first month of therapy, SSRI antidepressants were associated with a nearly fivefold higher risk of completed suicide than other antidepressants (adjusted odds ratio: 4.8, 95% confidence interval=1.9-12.2). The risk was independent of a recent diagnosis of depression or the receipt of psychiatric care, and suicides of a violent nature were distinctly more common during SSRI therapy. Numerous sensitivity analyses revealed consistent results…”

    Suicides of a violent nature.
    Murders of a violent nature.
    These old people survived all kinds of life, then off themselves violently? SRSLY?
    But in our many sources of legitimate data, the degree of violence of the suicide is not noted. Failure to capture signal.

    Here is an analysis of the concidence between SSRI use and suicide in Sweden- where the epi data are fairly strong:
    “Psychiatric Drugs & Suicide in Sweden 2007,” Janne Larsson.
    http://psychiatricdrugs.jannel.se/#home
    “In total, 488 (39%) of all the 1255 persons who committed suicide for 2006 received treatment with antidepressants within 180 days before the suicide.”

    Of course, a physiological mechanism is needed for this to be science-based. There are several candidates. I will just give a couple to promote some grey area on this issue that for the general medical community seems to be a black and white issue:
    “Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood symptoms during antidepressant treatment.” Hunter AM, Leuchter AF, Cook IA, Abrams M. Acta Psychiatr Scand. 2010 Dec;122(6):461-9.
    “RESULTS: Antidepressant treatment-emergent SI (13.5%) was associated with a large transient decrease in midline-and-right-frontal (MRF) cordance 48 h after start of medication.”

    “Genetic markers of suicidal ideation emerging during citalopram treatment of major depression.” Laje G, Paddock S, Manji H, Rush AJ, Wilson AF, Charney D, McMahon FJ. Am J Psychiatry. 2007 Oct;164(10):1530-8.
    “RESULTS: Two markers were significantly associated with treatment-emergent suicidal ideation in this sample (marker rs4825476, p=0.0000784, odds ratio=1.94; permutation p=0.01; marker rs2518224, p=0.0000243, odds ratio=8.23; permutation p=0.003). These markers reside within the genes GRIA3 and GRIK2, respectively, both of which encode ionotropic glutamate receptors.”

    Of course, the genetic study has a great degree of potential bias from multiple-testing-associated false positive error.

    This is a tricky relation to be teased out. The positive treatment responses may swamp the modest portion of iatrogenic tragedies, the effect may be very different across SSRIs and SNRIs, and dosage is very difficult to ascertain, since most of the drugs prescribed are not taken in the prescribed way, if taken at all. Also, there may be both a serotonin drug effect and a serotonin drug withdrawal effect. With the withdrawal effect, the drug may be no longer detectable in the body at the time that the brain is finally influenced to the point of action by the disappearance of exogenously promoted serontonin levels. Also, I don’t have an explanation for the similar story tied to anti-epileptic drugs.

    But the data are what they are. It is time to consider seriously the theory that serotonin-acting drugs have a violent-behavior effect on some subset of people. In many of these “inexplicable” mass murders, the person had reportedly been Rx drugs OR had recently been in psychiatric care.

    We will eventually learn what meds Sandy Hook shooter Lanza was prescribed. We know he had been involved with psych care in the months leading up to his school shooting. Jeff Weiss, a Columbine shooter, was Rx Prozac. We know Batman shooter James Holmes had been in some soert of psychiatric care in the months leading up to his theater shooting event. Do we think a psychiatrist in the US passed up the opportunity to Rx an antidepressant?

    These can be dismissed- hey, crazy people do crazy things. Unfortunately, I know from hearing many anecdotes that physicians are quick to discount side effects from meds, and with psych meds it gets even easier since your patient is crazy.

    You all can ignore this if you want. I don’t care if Scientologists and anti-vaccers agree with me on this one. I have no interest or ties to the Scientologists or the anti-vaccers. A broken clock is correct twice a day, and these groups are correct on this one.

  10. Barry2 says:

    @MedsVsTherapy’s I think it’s important to keep in mind that right now we simply don’t know why Adam Lanza committed the shootings. I don’t think we even know if he was on any medication of any kind. As someone who has had dangerous reactions to psych meds, I could certainly give my own anecdotes and theories, but isn’t the point of Dr. Gorski’s post that people are misusing the Sandy Hook tragedy to further their own agendas, without regard to whether the facts of the case support those agendas?

    As for whether it makes sense to use antidepressants, I don’t think we can safely generalize from one therapist’s reported success in treating people with psychotherapy alone. Where’s the objective data? What percentage of depressed people meet the “certain specific circumstances” that would warrant medication? Aren’t these people less likely to go to you for treatment if you don’t think medication makes sense, and doesn’t this leave you with an unrepresentative sample to draw conclusions from?

  11. Narad says:

    Sure, this is my opinion. I could be wrong.

    Given that you have claimed to be as accurate as imaging in “pinpointing” a stroke, “could” is probably a bit too generous.

  12. DugganSC says:

    @MikeW

    Frankly, I think it’s pretty safe to say there’s going to be some percentage of people who have an adverse reaction to SSRIs. Medicines have side effects and they’re pretty idiosyncratic based on personal chemistry, environment, and other circumstances. A good doctor monitors as best he can and gets the patient to also check for such issues. The fact that it sometimes happens, though, does not indicate that they’re worthless for everyone. It just means you have to observe. Does the fact that some people get thrown off of horses mean that horses have been a lousy form of transportation?

  13. Barry2 says:
    “isn’t the point of Dr. Gorski’s post that people are misusing the Sandy Hook tragedy to further their own agendas, without regard to whether the facts of the case support those agendas?”

    We probably agree on most everything.

    I agree that we don’t know what led to this mass murder. I agree that we don’t yet know whether Lanza was on meds or not, so we cannot yet declare meds as a possible explanation.

    I do believe that it is normal for all of us members of society to go ahead and discuss these tragedies, and discuss our speculations about why they happened. This is the first step of any decent changes happening.

    I believe that, in these discussions that include scientific-minded health care professionals, that somewhere along the line most of us ought to recognize this problem with the SSRI drugs.

    Somewhere along the line, along with speculations, evidence ought to get brought into the processes leading to changes, if any. Some people believe we should be limiting gun ownership. Some people believe we should have less violent video games. Some people believe we should have better parenting. I think we need to pay attention to the possible role of psychiatric drugs.

    I would bet money that this young man was on psych drugs. But I will not go so far as declare that as the problem. The lousy info we have, including the anecdote of the wary babysitter, suggests Lanza may have been psychotic for years. Since I have worked with hundreds of people who have benefitted from psych drugs, including those who hated taking them and had side effects, I would really hope that Lanza would be sustained on an effective drug regimen for that. Andrea Yates was not sustained on beneficial antipsychotics, and she killed.

    “As for whether it makes sense to use antidepressants, I don’t think we can safely generalize from one therapist’s reported success in treating people with psychotherapy alone. Where’s the objective data?”
    I specifically do not have outcomes data to share. There is a wealth of efficacy data for psychotherapy for depression and other psychological disorders. I hope you are not implying that the evidence for psychotherapy is lacking, while the evidence for antidepressants is satisfactory. Turner NEJM 2008 is a leading studiy for the line of research showing limited efficacy of antidepsssants.

    “What percentage of depressed people meet the “certain specific circumstances” that would warrant medication?”
    I don’t know exactly. I have opinions but they are not solidly based on evidence so I would not be the one to give a great answer. I think some people respond really well, and there can be familiy patters in who responds well. I believe the degree of genetic involvement varies across cases of depresssion, and it may be the more ‘genetic’ cases where drugs might be best. but I cannot readily cite a handful of fitting studies to support these ideas.

    “Aren’t these people less likely to go to you for treatment if you don’t think medication makes sense, and doesn’t this leave you with an unrepresentative sample to draw conclusions from?”
    Yes. And, there are studies showing that efficacy of depression intervention depends, to some degree, upon the degree that a patient prefers the treatment, whether meds or therapy. Adherence to treatment also depends upon preference. For one study to illustrate this, Raue and colleagues have a good one in Psychiatric Services 2009 v60 n 3 pp 337-343.

    So I think we should have a healthcare system that strives to suit patient preferences, along with efficacy data. This is not the healthcare system we have. Psychotherapy is becoming less common and prescription antidepressant use is becoming more common. This is contrary to the efficacy evidence for a range of psychological problems.

    We also should be aware that SSRIs may cause violent impulses in a subset of people, and we should monitor for this very closely, the same way we would monitor closely for agranulocytosis in someone taking clozapine, or lithium toxicity in someone taking lithium.

    We should not discount this SSRI-violence hypothesis simply because anti-med people (Scientologists, anti-vaccers) have adopted this specific issue into their broad anti-med view of the world.

  14. Barry2 says:

    @MedsVsTherapy

    “We probably agree on most everything.”

    I doubt that. Based on your comments on this post, you seem to concede scientific points when they’re brought to your attention, yet that doesn’t stop you from making unscientific points to begin with, or from trying to argue your way back to your original unscientific points afterwards. I hope that I haven’t been doing stuff like that.

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