Violence Caused by Antidepressants: An Update after Munich  

The media is now reporting biographical details about the 18-year-old youth who shot and killed nine and wounded many others before killing himself on July 22 in Munich. Reportedly, he was suffering from multiple “mental health” issues, underwent treatment in a psychiatric facility for two months in 2015, and was currently taking unspecified psychiatric medications.  There is no indication he was psychotic.

The mass murderer was born in Germany of Iranian parents.  He left behind a manifesto, as yet to be released, reported focused on personal humiliations rather than religious convictions.

Many mass murders are driven by two distinct and largely separate sets of motivation.  One set can be called personal ideology, where the individual develops a rationalized hatred for his family, peers, or other groups, often attributed to acts of bullying and humiliation.   Their manifestos may also include outrage against society, but without identifying with a particular political/religious viewpoint.   The other set of motivations can be called political/religion ideology.  It will be important to determine if the Munich shooter is among the first who is obviously motivated by both personal and political-religious ideologies.

My clinical and forensic experience leads to another distinction among people who murder under the influence of psychiatric drugs, especially antidepressants.  Those who kill only one or two people, or close family members, often have little or no history of mental disturbance and violent tendencies. The drug itself seems like the sole cause of the violent outburst, with only minimal provocation or family conflicts.  On the other hand, most of those who commit mass violence while taking psychiatric drugs often, but not always, have a long history of mental disturbance and sometimes violence.  For these people,  the mental health system seems to have provoked increasing violence without recognizing the danger.

The Munich shooter, according reports, possessed written materials about American mass murderers who were similarly driven by personal ideologies, including Eric Harris and Dylan Klebold, the 1999 Columbine High School shooters who murdered 12 classmates and a teacher, and Cho Seung-hui, a student who killed 32 people at Virginia Tech in 2007.

My present report about five different murderers who were taking antidepressants presents new facts and new conclusions based on my involvement in civil or criminal legal cases surrounding their actions. These five represent only a fraction of the cases I have evaluated and testified in concerning psychiatric drug-induced violence.

James Holmes (Aurora, Colorado)

On March 16, 2012, Holmes was a 24-year-old graduate student who was having trouble with his studies and whose girlfriend was breaking off from him. He sought help from the university clinic where the social worker quickly noted that he had feelings of violence toward people in general.  On March 21, the social worker questioned whether Holmes might have psychotic thinking but did not diagnose him with a psychotic disorder.

From many sources, including his computer purchases and notebooks, there is no evidence that Holmes at this time had begun the elaborating planning and purchases that would lead up to his assault on the theater.  Instead, he was seeking psychiatric help, something he would not have been motivated to do if he was already making concrete plans for mass murder.

On March 27, he saw the clinic psychiatrist prescribed him Zoloft (sertraline), an SSRI antidepressant similar Prozac, Paxil and Celexa. Given the doctor’s concerns about psychotic thinking and his obviously violent tendencies, exposing Holmes to Zoloft was like pouring gasoline on a fire.

On May 17, the social worker described Holmes more definitively as suffering from a psychotic level of thinking with paranoid and hostile feelings. She did not consider that the medication could be making him worse.

Holmes’ psychiatrist last saw him on June 11, 2012, six weeks before his assault on the movie theater.  At this time, he had been on Zoloft for 75 days.  His psychiatrist was very concerned about his deterioration, potential for violence, and increasing paranoid, hateful feelings toward people in general.  His psychiatrist was also worried about his long-time fantasies about killing as many people as possible but found no plans.  She wondered if he was having his first psychotic break and noted unspecified paranoid delusions.  Throughout the rest of the day, she was a part of multiple phone calls with school authorities discussing her patient’s potential dangerousness; but she eventually concluded that Holmes was not an immediate threat to himself or others.

According to a written prescription dated April 17, the psychiatrist raised Holmes’ Zoloft dose to 100 mg twice a day with a one-month supply of 60 tablets and one refill.  If taken as directed, this would have lasted through June 17.  A contradictory note in the medication summary chart (the prescription is more likely to reflect reality) states that on April 14 she gave prescribed him a prescription for Zoloft 100 mg, 1 ½ each day, 45 tablets, with two refills.  This would have lasted him through the rampage at a slightly lower dose.  Additional information given to me indicates that he stopped his medication abruptly around June 30, twenty days before his rampage.

An abrupt withdrawal might have worsened his condition, but the main contributing factor to the violence was his lengthy exposure to a drug that worsened his condition and drove him into psychosis.

The point at which Holmes stopped his medication is not critical.  He became increasingly violent while taking Zoloft, during which time he began his plans for the assault.  He had a manic-like psychosis while taking the Zoloft and this would not have abated for some time after stopping the medication.  Patients who develop mania and/or psychosis while taking antidepressants are often hospitalized.  Although the offending drug is stopped, treatment often goes on to require a lengthy hospitalization, antipsychotic drugs, and sometimes restraint and isolation.  I have no doubt that Zoloft contributed to Holmes’ escalating violence and that without it he probably would not have committed mass murder.

Eric Harris (Columbine High School)

Eric Harris’s probably did not start his journals until shortly after he was placed on antidepressants.  He had no history of violence, and based on his journals and other sources, he did not begin planning his violent assault with his co-perpetrator Dylan Klebold until months after being on antidepressants.  Eric’s counselor made the recommendation to Eric’s family doctor to start him on an antidepressant.  The physician diagnosed “possible depression” and ADHD.  The doctor soon switched Eric to Luvox because Eric was becoming “a bit obsessional” with unspecified “negative” thoughts.  Luvox was FDA-approved for 6-17 year-olds for OCD.  Eric filled his first prescription for Luvox 25 mg on April 28, 1998, almost one year before the assault on Columbine High School.  His journal would grow increasingly bizarre and violent over the period in which he continued to take increasing amounts of Luvox.

Eric’s Luvox dose was doubled to 50 mg on May 31 and to 100 mg on July 9. It reached 150 mg on January 7.  In mid-March, approximately one month prior to his attack on his classmates and teachers, Eric’s doctor wrote that his Luvox had been raised to 200 mg per day, and on March 13 Eric filled his last prescription, five weeks before the April 20, 1998 rampage at his high school. His prescription record indicates enough available pills to cover through the April 20, 1998 attack on his high school.

The autopsy toxicology report found a “therapeutic level” of Luvox in his system.  The half-life of Luvox—roughly the time it takes for 50% to be deactivated or cleared out of the body—is only 15 hours.  Therefore, the presence of such an amount on routine toxicology confirms that he recently took the drug.  This is important because the media have reported that Eric was not taking the antidepressant at the time of the mass murder.

Joseph Wesbecker (Louisville, Kentucky)

Joseph Wesbecker, born April 27, 1942, entered his former place of employment on September 14, 1989, where he shot 20 people, killing seven, and then killed himself.  Wesbecker had a long history of feeling persecuted and angry at work, and was hospitalized for making threats.  He was doing relatively well in his psychiatrist’s opinion when he put Wesbecker on Prozac.  One month later when Wesbecker returned for follow-up, he felt the medication was helping him.  However, he was psychotic for the first time, expressing the delusion that he had been sexually abused by one of his bosses in front of his assembled coworkers.   The psychiatrist also observed, “Patient seems to have deteriorated,” that he was “weeping” and displayed “increased level of agitation and anger.”  The doctor wrote “Prozac?” to indicate that he suspected that the antidepressant was the cause of Wesbecker’s new psychosis and delusion, and stopped the medication.  Three days later, Wesbecker brought an arsenal of weapons to his former workplace and reportedly looked robotic as he systematically perpetrated mass murder.  The half-life of Prozac is approximately 10 days, and he would have been experiencing the direct toxic effect more than withdrawal at the time.

The Case of C.P.J. (Canada)

The story of C.P.J. exemplifies overstimulating by antidepressants leading to violence.  Cases where the violence falls short of mass murder provides us many similar examples where the individual showed no signs of violence before taking the antidepressant drug.  C. P. J. was a sixteen-year-old taking Prozac for feelings of sadness that were no apparent to those who knew him.  With no history of violence or serious mental illness, he abruptly and without provocation stabbed his friend to death.

The boy had been taking Prozac for three months, during which time his behavior deteriorated. He became impulsive and unpredictable, and suicidal. He also began to talk at times as if fantasizing about violence. He seemed to become a different person to his distraught parents. His primary care physician and his parents alerted the prescribing psychiatric clinic to the boy’s deteriorating condition, but the clinic continued the Prozac.  At C.P.J.’s last visit to the clinic, he told the psychiatrist that he liked the feelings Prozac gave him.  Despite warnings from his mother at the same meeting, the psychiatrist doubled the dose.  Seventeen days after the increase in dosage, while sitting and relaxing with two friends, he turned and abruptly stabbed his close friend to death.

The great majority of violence cases, like C.P.J., have had a change in dose, usually starting the drug or increasing it, within one or two months of the event.   The FDA label refers to increased danger at the time of dose changes, up or down.

On September 16, 2011, a Canadian judge in a criminal case issued an opinion that concluded, “Dr. Breggin’s explanation of the effect Prozac was having on C.J.P.’s behavior both before that day and in committing an impulsive, inexplicable violent act that day corresponds with the evidence.” He further observed about the youngster, “His basic normalcy now further confirms he no longer poses a risk of violence to anyone and that his mental deterioration and resulting violence would not have taken place without exposure to Prozac.” Also consistent my extensive report and testimony, the judge observed, “He has none of the characteristics of a perpetrator of violence. The prospects for rehabilitation are good.”  The judge came to this conclusion despite the opposition of the government and a respected local expert.

Reynaldo Lacuzong (California)

In 1999, an engineer named Reynaldo Lacuzong was prescribed Paxil 10 mg, the smallest available dose.  Three days later he drowned himself and his two small children in a bathtub.  By most definitions, the murder of two or more people at once in one place constitutes a mass murder or a spree.

The medication was prescribed to Lacuzong by his family doctor for tension that may have been associated with quitting alcohol, although he was taking only one or two drinks in the evening to relax. He had no history of violence or crime. He was described as developing akathisia (psychomotor agitation) immediately after starting Paxil, and akathisia is known to be associated with violence.  From my review of the secret files of GlaxoSmithKline, akathisia and other serious adverse effects frequently develop within the first three days.

How Antidepressants Cause Violence and Suicide 

The most complete review of the scientific evidence showing that medications can cause violence, and the greatest number of case illustrations ever put together, can be found in my book Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Crime and Suicide.

In 2003/2004 in the International Journal of Risk & Safety in Medicine,  I summarized the scientific literature and described the basic activation or overstimulation syndrome associated with many cases of violence: “Mania with psychosis is the extreme end of a stimulant continuum that often begins with lesser degrees of insomnia, nervousness, anxiety, hyperactivity and irritability and then progresses toward more severe agitation, aggression, and varying degrees of mania.”  I also mentioned the adverse effect called akathisia or psychomotor agitation as contributing to violence and suicide.

The 2004 FDA panel re-evaluated the labeling of antidepressants in respect to suicide and violence.  The administrator of the FDA panel asked me for copies of my 2003/2004 article on SSRI-induced suicide, violence and mania, which she then put into the official information packet of every panel member.  The new language that continues in the Warnings section of the label today closely corresponds to my own.  The section warns about antidepressant-induced “anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania.”  This list of activation or overstimulation effects occurs in the Warnings section which, according to the Code of Federal Regulations, requires a “reasonable evidence of a causal association with a drug; a causal relationship need not have been definitely established” (21 CFR 201.57, p.29, revised as of April 1, 2008).

In addition to warning about this class of drugs causing the activation syndrome, the Full Prescribing Information (the FDA-approved label) also warns broadly about “clinical worsening,” and suicidal thinking and behavior.  When starting to feel worse (“clinical worsening”) while taking a drug that is supposed to help, people can become despairing.  They fear that they must be so “bad off” that even the best medication cannot help them.  This can lead to further despair, and contribute to suicidal and violent feelings.

The Medication Guide for antidepressants — a brief summary that the FDA label urges prescribers to share and discuss with the patient and family — summarizes much of this information and also warns the patient and family to be alert for many dangerous adverse effects, including “acting aggressive or violent”:

• attempts to commit suicide
• acting on dangerous impulses
• acting aggressive or violent
• thoughts about suicide or dying
• new or worse depression
• new or worse anxiety or panic attacks
• feeling agitated, restless, angry or irritable,
• trouble sleeping

One study found that 8.1% of psychiatric admissions are for antidepressant-induced mania.  Even the American Psychiatric Association official Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) (2010, pp. 123-4, 127-129) notes that antidepressant drugs cause mania and psychosis, and that mania is associated with a broad range of destructive behaviors, including “harm to self and others.”

The Greater, Less Obvious Problem

My emphasis here is on the most severe violence in the form of murder.  However, antidepressants cause harm to millions of patients and their families by making the patients more irritable, angry, and easily frustrated, as well as indifferent toward their loved ones.  Marriages are wrecked by antidepressant-induced mania, domestic violence, hostility, sexual dysfunction, and lack of love.  Although the FDA-approved label emphasizes irritability, akathisia (psychomotor agitation), agitation, and hostility as adverse effects to antidepressants, clinicians often fail to alert patients to these very common adverse effects or to recognize them when they occur.

The Most Definite Study

Several years after the publication of the new FDA warnings, Thomas Moore and his colleagues (2010) reviewed all adverse reports sent to the FDA from 2004-2009.  Their reviewed showed that the vast majority of drugs (84.7%) have two of fewer reports of violence.  By contrast, a few drug classes — antidepressants, stimulants, benzodiazepines, and atypical antipsychotics — have a disproportionately larger number.  The differences remain when the number of prescriptions are factored into the statistical analyses (p<0.01).

It’s not the patient’s “mental illness” that causes violence, it’s the drugs.  Six of the 31 drugs associated with violence in Tom Moore’s study are not routinely prescribed for psychiatric disorders.  Remarkably, by far the most dangerous drug for causing violence is Chantix (varenicline), an aid for stopping smoking.  Similarly, the fifth drug is Lariam (mefloquine), an antimalarial drug, made infamous because it was taken by U.S. Army Staff Sgt. Robert Bales when he massacred Afghan noncombatants.  The FDA label for Lariam states, “Mefloquine may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior.”   Not all psychiatric drugs are associated with violence and several non-psychiatric drugs are highly associated with violence. The data proves that the violence is associated with the class of drug and not the condition of the patient.

Closing Thoughts

Four of five of these murders—Harris, Holmes, Wesbecker, and C.P.Z.—had extensive contact with the mental health system.  Clinics and doctors, including psychiatrists, failed to detect and/or to prevent their violent behavior. Instead, the doctors gave drugs that caused violence or amplified any pre-existing violent tendencies.  We can conclude that psychiatric treatment, at least in these cases, was no help in identifying or controlling violence.  My experience teaches that this is a general principle: we cannot rely upon the mental health system to identify and to treat violence.  Instead, it contributes to and causes violence.

Curtailing or stopping the use of SSRIs and other antidepressants would vastly diminish an infinite number of aggressive and violent acts committed by individuals taking these drugs, including the more mundane, everyday acts of ordinary people described earlier.  As I pointed out decades ago in Talking Back to Prozac, and in many books and articles since then, careful scrutiny of the FDA testing for drug approval shows that antidepressants do not work any better than placebo, but that they do make many people very mentally disturbed and increase the rate of suicide and violence.  My observations on the lack of effectiveness of antidepressants has now be confirmed by a series of studies by multiple researchers, most notably Irving Kirsch, the author of The Emperor’s New Drugs. A class of drugs with no proven efficacy that has a vast array of demonstrable adverse reactions, some of which are potentially lethal?   Why should such drugs be on the market?   The continued availability of antidepressants and their growing numbers reflect an avaricious pharmaceutical industry, a collaborative medical and psychiatric profession, and a corrupt FDA.

In 2013, shaken by Adam Lanza’s horrendous Sandy Hook slaughter in Connecticut, Sanjay Gupta, MD on CNN and Tom Ridge, former Homeland Security director on Fox News, briefly spoke the truth.  They admitted that psychiatric drugs can cause violence and deserve consideration as a potential cause of Lanza’s mass murder.  Thankfully, I captured their comments, because they never uttered them again; and we still do not have Lanza’s medical record.

When AbleChild forced a Freedom of Information (FOIA) hearing from Connecticut officials, the state refused to reveal Lanza’s medical record.  At the hearing, Assistant Attorney General Patrick Kwanashie argued that it would not be legitimate to conclude that Lanza’s taking antidepressants had anything to do with his violence. The attorney general refused to divulge the records or the information because it had no legitimate purpose and would “cause a lot of people to stop taking their medications.”

Congress and state legislatures must pass legislation requiring the divulgence of the medical records of mass murderers.  Only then will we be able to bypass the lock that the pharmaceutical industry has put on all such critical information. Meanwhile, the evidence, presented in this report and in more detail in my book Medication Madness, cannot be denied—antidepressants can and do cause violence on every level from people who feel more irritable or less loving toward their families to people who commit domestic violence or carry out mass murders.