With the media fixated on guns and violent video games, Connecticut's chief medical examiner says he's seeking genetic clues to help explain why a shooter killed twenty children and six adults in a Newtown elementary school. 60 Minutes reported that Adam Lanza was taking prescribed medication, but the mainstream media failed to follow up on this.
Sure, guns are rampant, too easy to get, and should clearly not fall into the hands of mentally disordered people, and violent video games are priming the pump - - all issues that I deem important to address, but I will leave that to all the others who have done it justice to date.
As a psychiatrist who is all too familiar with this issue, I am dismayed at this oversight, and believe that these tragedies should also contain some lessons going forward - both for the public and for prescribing doctors.
A common thread amongst the most horrific school shootings of the past 25 years is that the majority of the shooters were taking a psychiatric medication.
These drugs do not always cause violent behavior, of course, and in many cases, they are used to treat it. However, certain medications, such as Prozac, have been linked to increase risk for violent, and even homicidal behavior. Several of the most tragic cases of violent murder by prescription takers should be noted.
Many legal cases, with closed books due to settlement, document cases of suicides and homicides in individuals who had not been violent prior to taking medication, and often they were newly prescribed or on an increased dose.
Below are some of the mass-murderer statistics (thanks to Deborah Merlin and her book, Victory Over ADHD ):
The Virginia Tech shooter murdered thirty-two. Cho was prescribed the antidepressant drug Prozac prior to his rampage.
Jeffrey Weiss went on a shooting rampage on March 21, 2005, at Red Lake High School that left ten dead, including him. Earlier that day, Weiss had killed his grandfather and his grandfather's girlfriend. He was on Prozac and the dosage had recently been increased.
Eric Harris, one of the killers at Columbine High School, was on the antidepressant drug Luvox. Court records show that the prescription for Harris had been filled ten times between April 1998 and March 1999.Three and a half months before the shooting, the dosage had been increased. The Physician's Desk Reference records show that during controlled clinical trials of Luvox, manic reactions developed in 4 percent of the children given the drug.
In Houston, Texas, Andrea Yates drowned her five children while taking Effexor and Remeron.
Christopher Pittman shot and killed his grandparents at age twelve. He claimed a voice inside his head told him to kill his grandparents on November 28, 2001. Christopher had recently started to take Zoloft to treat mild depression.
A more complete list can be found here.
Is It the Illness or the Drug?
A recent study of reports to the FDA of drug-induced violence has demonstrated that antidepressant users have an 840% increased rate of violence. See also Robert Whitakers' article on the subject.
The National Center for Health Statistics (NCHS) reports the rate of antidepressant use in this country among teens and adults increased by almost 400% between 1988-1994 and 2005-2008.
Despite international drug regulators warning that these drugs can cause mania, psychosis, hallucinations, suicide and homicidal ideation, Congress has yet to investigate the role of psychiatric drugs in the vast majority of school shootings. Could this be due to the enormous influence of the pharmaceutical industry on the media? Has there been a purposeful media black-out here?
A 2011 article in TIME magazine notes that "when one particular drug in a class of non-addictive drugs used to treat the same problem stands out, that suggests caution: unless the drug is being used to treat radically different groups of people, that drug may actually be the problem."
The article cites 10 drugs from a study by the Institute for Safe Medication Practices which is derived from data from the FDA's Adverse Event Reporting System which identified 31 drugs that are disproportionately linked with reports of violent behavior towards others. Two common ones are:
Fluoxetine (Prozac) The first well-known SSRI antidepressant, Prozac is 10.9 times more likely to be linked with violence in comparison with other medications.
This next one is particularly scary, since it's for smoking cessation-- a seemingly good trade-off until you read the stats: The anti-smoking medication Varenicline (Chantix), affects the nicotinic acetylcholine receptor, which helps reduce craving for smoking. Unfortunately, it's 18 times more likely to be linked with violence compared to other drugs -- by comparison, that number for Xyban is 3.9 and just 1.9 for nicotine replacement.
Where to From Here?
While I am trained and licensed to prescribe these medications, I prefer to avoid them whenever possible, instead prescribing the natural precursors to the brain chemicals needed to restore balance. Believe it or not, they can be as effective as medication if not more so, and without the dire side effects. Doesn't it make sense to put back what is needed rather than cover up symptoms with strong chemicals that can cause harm? I have all too often seen that when a patient complains of side effects, the doctor increases the dose, with ensuing negative effects. There are excellent studies in peer-reviewed journals, covering vitamins, minerals, amino acids, and herbs for psychiatric purposes. A good summary with 107 peer-reviewed citations can be found here.
If one is going to be scientific about the use of these powerful drugs, there are tests that can be performed to fine-tune the diagnosis and choice of medication, and help determine if there is likely to be an adverse effect: Electroencephalograms, SPECT scans, and genetic testing that all help select the more appropriate drug for the individual.
My own bias is to test regardless, but then to treat as naturally as possible, working with the body's own chemistry to optimize brain function. And for those either considering medication or for prescribing physicians, I urge you to consider the possibly tragic downsides first.
Warning: Never discontinue taking stimulants or antidepressants without first consulting your health care professional. The withdrawal symptoms can be more severe than the adverse reactions to these medications; therefore, the process must be closely monitored by a physician or someone licensed to prescribe medications. In my own practice, I have found the use of specific supplements in the process can be especially useful in countering the withdrawal effects and shortening the overall process.