Antidepressants have been reported to cause a state called “akathisia,” where people feel extremely agitated and restless and may become preoccupied with thoughts of violence. In a new article, to be published in the latest issue of the Journal of Forensic and Legal Medicine, researchers investigate the role of antidepressants in three recent murders.
The researchers, a medical specialist and a forensic psychiatrist and pharmacogeneticist, suggest that tests may be done to assess the role of antidepressant toxicity in violent events that may affect legal determinations, potentially even absolving people charged with homicide.
The “new generation” antidepressants, SSRIs and SNRIs, appeared in the 1980s but, according to the reviewers, “their adverse effects and clinical trial data have not been fully disclosed.” In 2004, the FDA published a public health advisory warning of worsening depression and suicidality in some patients being treated with antidepressants. In 2007, a Black Box suicide warning was extended from just teenagers and suggested monitoring all patients up to age 24 for anxiety, agitation, panic attacks, hostility, impulsivity, and akathisia.
Recent findings show an increased risk for violent crime in young adults taking antidepressants and a groundbreaking reanalysis of the infamous Study 329 on the effects of Paxil on teens found a heightened risk for suicide that was not initially disclosed by the drug companies.
The authors report that genetic variations in metabolism affect how individuals react to antidepressants and that research indicated that “ultra-rapid metabolizers” may be at an increased risk for changes in behavior.
“Fast-changing levels of psychotropic substances, up or down, can cause behavioural changes as the neurotransmitters in the brain react to reach some equilibrium,” they write. “This phenomenon makes starting and stopping medication the most dangerous times for suicide and violence, but both can happen at any time, with stress, provocation, dose change, addition or subtraction of a medication.”
In 2000, this research was used by police in the investigation of the death of a nine-year-old girl taking methylphenidate, codeine, and fluoxetine. They found that a genetic variation (CYP2D6) led to a toxic level of drug metabolism, thus ending a homicide investigation into her parents. The researchers offer three case studies that they propose are instances of antidepressant-induced, akathisia-related homicide where genetic variation in metabolism contributed to toxicity.
All three cases involve individuals in middle-age with no previous diagnosis of “mental illness” who were prescribed antidepressants after experiencing difficult events including divorce, the loss of a parent, or an unfaithful spouse. All three committed homicide and two also attempted suicide.
“None had known that they needed to take medication regularly or how to stop taking it safely. None improved on medication, and no prescriber recognized their complaints as adverse drug reactions or was aware of impending danger. Interviews elicited accounts of restlessness, akathisia, confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and incomplete recall of events. Weird impulses to kill were acted on without warning. On recovery, all recognized their actions to be out of character, and their beliefs and behaviours horrified them.”
The researchers conclude:
“As forensic medical and toxicology professionals become aware of the biological causes of these catastrophic side effects, they may bring justice to both perpetrators and to victims of akathisia-related violence. The medicalization of common human distress has resulted in a very large population getting medication that may do more harm than good by causing suicides, homicides and the mental states that lead up to them.”
Eikelenboom-Schieveld SJM, Lucire Y, Fogleman JC, The Relevance of Cytochrome P450 Polymorphism in Forensic Medicine and Akathisia-Related Violence and Suicide, Journal of Forensic and Legal Medicine (2016), doi: 10.1016/j.jflm.2016.04.003. (Abstract)
…but while this is a beginning, I suspect just relying on such testing might be a move in the wrong direction, as it doesn’t take into account the underlying failure to prove that “anti-depressants” in fact have little if any benefit over a placebo and have a wide range of effects aside from not helping alleviate “depression”, including akathisia and its related violence.
The assumption might be to conclude that as long as you’re not genetically “in the group”, the drugs will work, which, of course, is a false assumption.
Additionally, to alleviate the risk, we would need to test EVERY person BEFORE they are put on the drugs because start up and dose change etc are the key danger periods…hmmm…that would be great as people would have to have genetic testing and incur serious expense before they could be handed these nasty little pills, and hence, they’d be informed of the risk and might look more closely at whether to take them.
An acknowledgement of their very real dangers might just bring about a wake up call about how dangerous these drugs really are.
It’d be good if a new warning were placed on the box reading,
“These drugs may cause some people to commit murder”.
Slowly the truth leaks out.
People might do well in light of the proclivity of mass media to highlight catch phrases and buzz words to repeatedly and continually employ the phrase “psychiatric drug murders” when writing letters to editors, calling talk radio, etc.
It’s good to see this addressed seriously in a journal. Remember, similar case studies and problems were described several years ago by Peter Breggin in his book, “Medication Madness.”
Yes, Breggin’s work was/is brilliant…but this involves lawyers defending potentially highly emotional and public cases involving murder. In some ways it actually builds on and validates his work.
However, that these ineffective drugs can lead to people behaving in such out of character and totally unpredictable ways really is big news when it hits the courts and the media. It lifts it out of inter-psychiatry differences of opinion and launches it into the courts.
Plus, police and courts as well as lawyers and the media may now look for psych med use as being causal, rather than immediately blaming “mental illness” for such acts. That they are legally prescribed “medications” approved by the FDA and used by millions of people at a time when murders are on the increase may well provoke great interest in why psychiatrists and primary care doctors are handing these out so freely.
It could get very interesting indeed from a legal perspective…retrials of convicted murderers in some cases and/or re-considerations of sentences perhaps?
There would certainly be a reasonable argument for extenuating circumstances at the least.
For me akathesia was a type of state of absolute fear, and vulnerability that I had never experienced before, and I’ve attempted suicide twice under this influence.
The physical symptoms of akethesia can vary, but for me the mental state was the most dangerous. My first experience of this took place the day after my first depot injection in the 1980. My last akathesia experience was in April 1984 in Ireland – and when I reacted my reactions were suppressed on the Records.
I lived 5 minutes away from the ‘Unit’, but these injections are often given to young men in rural Ireland, to insure they they remain medicated. And when they kill themselves nobody is any the wiser.
For me, akathisia meant increasing and relentless thoughts of suicide. Toward the end, I sat alone in my room and Googled methods of ending my life. I was hostile and lashed out at others. Tapering off, the thoughts vanished as if turning down a rheostat, and now they are non-existent. These are dangerous drugs, and it’s gratifying to see more and more mainstream buy-in to the belief that these are drugs that can cause far more harm than good.
Exactly Engineer – “….far more harm than good.”
It’s about time the lawyers start acknowledging the crimes of today’s scientifically invalid, thus neo-Naziesque, psychiatrists. How very sad this country has sunk to a level where the PCPs are handing out dangerous, mind altering “antidepressants” to innocent people like candy, while claiming they are “safe … meds.” And then they claim to be ignorant of the common adverse effects of the antidepressants, and DSM-IV-TR misdiagnose the adverse effects of the antidepressants, in millions of people, as “bipolar.” Resulting in an antipsychotic prescription.
And every doctor should know, combining the antidepressants and antipsychotics, will make a person “mad as a hatter,” via anticholinergic toxidrome. But since anticholinergic toxidrome is not a billable DSM diagnosis, this always gets misdiagnosed as a billable DSM “psychotic” illness. It’s a shame today’s psychiatrists have created an iatrogenic illness creation system, and are torturing and killing millions of innocent people, for profit.
The pure evil behind such a system is quite staggering – every bit as evil as the Nazi psychiatrists. And the government, teachers, doctors, religions, lawyers, and judges all bought in because making innocent and healthy people sick is profitable, and the psychiatrists cover up their child abuse hobbies and easily recognized iatrogenesis. Really, though, could the medical field sink much lower? I had thought people had learned from WWII that making up “mental illnesses,” then unjustly torturing and murdering millions was unacceptable human behavior long ago. Shame so many, did not.
The vast majority of people on anti depressants are not violent, so these study does not really answer many questions that aren’t already addressed.
The black box warning covers the small population of people who have adverse reactions to anti depressants, and the best way to deal with them is to involuntarily commit them into mental hospitals and monitor their reactions.
The risk to society does not warrant it however, because only few people out of many millions become violent.
But which few will be violent, and how many people will they kill?
Will it be your child, your mother, perhaps even you?
Will they get suspended sentences because they were on prescribed “medication” to treat “mental illnesses” that have never been shown to have a biological cause, or really, even to have been shown to exist as medical conditions?
“The black box warning covers the small population of people who have adverse reactions to anti depressants, and the best way to deal with them is to involuntarily commit them into mental hospitals and monitor their reactions.”
Does the black box warning specifically mention “impulse/desire to MURDER other human beings” as a possible side effect? While you say it “covers the small population who have adverse reactions…” how does it protect/”cover” those people who will be murdered or maimed?
This compelling paper considers the personal catastrophe which follows the widespread failure of those prescribing SSRIs and SNRIs to consider AKATHISIA as the primary differential diagnostic possibility in someone who is suffering from a life threatening clinically recognisable, common ADVERSE DRUG REACTION due to prescription medication.
The complex physical, psychological and behavioural changes are dominated by OVERWHELMING AGITATION rather than “restlessness”. They can be identified promptly, with attention to pre-akathisia status, awareness and knowledge that recent introduction, increased antidepressant dosing, change of antidepressant or insufficiently tapered withdrawal are critical features of this syndrome When fastidious clinical observation is combined with a precise history of the presenting complaint akathisia, and it’s secondary suicidality, violence and homicidality, together with it’s almost unbearable suffering can be diagnosed and managed promptly and effectively. This commonly mis-diagnosed condition is iatrogenic in origin. It is hard to consider that failure to diagnose and manage safely is anything other than the primary professional responsibility of the prescriber.
To admit a severely dehydrated, acutely physically ill patient anywhere other than an acute general medical unit with access to intensive care facilities, and to fail to reverse the spiral of continuing and deteriorating biochemical imbalance in the acutely akathisic patient is the absolute antithesis of “safe” clinical management. The deterioration of this complex situation is aggravated by any delay in stabilising deteriorating body chemistry and physiology. This increases the very likely and catastrophic outcome which is misdiagnosis as a “serious mental illness” This psychiatric misdiagnosis is then followed by compulsory
“treatment” with antipsychotics and changed antidepressants inducing further iatrogenic injury via overwhelmed, compromised and dysfunctional CYP P450 metabolism failing to break down and detoxify this additional and inappropriate drugging.
Medicine and society MUST, via heightened awareness, recognise and report this devastating ADR in order to prevent the tragic sequalae and for the true and increasing frequency to be documented.