Dec 24 2012
Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings
You are currently browsing comments. If you would like to return to the full story, you can read the full entry here: “Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings”.
14 Responses to “Anti-psychiatry and anti-vaccine activists shamelessly taking advantage of the Sandy Hook Elementary School shootings”
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
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.
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).
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…).
Dr. Gorski:
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.
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.
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.
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.
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.
@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?
Given that you have claimed to be as accurate as imaging in “pinpointing” a stroke, “could” is probably a bit too generous.
@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?
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.
@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.