The Violence-Inducing Effects of Psychiatric Medication

Kelly Brogan, MD, ABIHM
26
3473

On May 17, 2017, we learned that Chris Cornell of Soundgarden had reportedly committed suicide by hanging. His family reports knowing a different Chris than one who would make this fatal decision, and suspect his anti-anxiety prescription in the altered state he was witnessed to be in the night he died. Perhaps an “addict turned psychiatric patient,” like so many, Chris Cornell seemed to have left the frying pan of substance abuse for the fire of psychiatric medication risks.

For reasons that remain mysterious, those under the influence of psychiatric medication often specifically choose to hang themselves in their moment of peak impulsivity. Some, like Kim’s husband Woody who was never depressed a day in his life but prescribed Zoloft by his internist, even verbalize a felt experience of his head coming apart from his body in the days before he was found hanged in his garage.

Then there’s 14 year old Naika, a foster child in Florida who hanged herself on a FB livestream after being treated with 50mg of Vyvanse, a drug treatment for ADHD that leads to a domino effect of diagnoses and psychiatric meds including a 13 fold increase in likelihood of being prescribed an antipsychotic medication and 4 fold increase in antidepressant medications than controls.1

Are these just rare anecdotes? Is this just the cost of treatment that is helpful for most? Are we blaming medication for what might have been severe mental illness that was undertreated and/or undiagnosed?

Informed consent: the premise of ethical medicine

I believe first and foremost in informed consent. If you are informed of the risks, benefits, and alternatives to a given treatment, you will be empowered to make the best decision for yourself based on your personal, family, philosophical, and religious life context. But the truth is that prescribers are not in a position to share the known risks of medications because we learn only of their purported benefits with a short-tagline of dismissively rare risks that are thought to be invariably outweighed by the presenting clinical concern.

But what about serious risks — including impulsive suicide and homicide — surely we are informing patients of that possibility, right?

Wrong.

In fact, the FDA and the pharmaceutical industry have gone to great lengths to conceal multiple signals of harm so we certainly can’t expect your average prescriber to have done the investigative work required to get at the truth.

In fact, from 1999-2013, psychiatric medication prescriptions have increased by a whopping 117% concurrent with a 240% increase in death rates from these medications2. So let’s review some of the evidence that suggests that it may not be in your best interest or the best interest of those around you for you to travel the path of medication-based psychiatry. Because, after all, if we don’t screen for risk factors — if we don’t know who will become the next victim of psych-med-induced violence — then how can we justify a single prescription? Are we at a point in the history of medicine where random acts of personal and public violence are defensible risks of treatment for stress, anxiety, depression, inattention, psychosocial distress, irritable bowel syndrome, chronic fatigue, and even stress incontinence?

Let the science speak

Suicide

Prescribed specifically to “prevent” suicide, antidepressants now come with a black box warning label of suicide risk since 2010. Multi-billion dollar lawsuits like the settlement of Study 3293 have been necessary to unlock the cabinet drawers of an industry that cares more about profit than human lives. A reanalysis of study 3294 which initially served as a landmark study in 2001 supporting the prescription of antidepressants to children, has now demonstrated that these medications are ineffective in this population and play a causal role in suicidal behavior. Concealing and manipulating data that shows this signal of harm, including a doubling of risk of suicide with antidepressant treatment,5 6 7 has generated seeming confusion around this incomprehensibly unacceptable risk profile. In fact, a reanalysis8 of an influential US National Institute of Mental Health 2007 study, revealed a four-fold increase in suicide despite the fact that the initial publication9 claimed no increased risk relative to placebo.

According to available data — 3 large meta-analyses — more psychiatric treatment means more suicide.10 11 12 Well, that might seem a hazard of the field, right? Where blaming medications for suicide would be like saying that umbrellas cause the rain.

That’s why studies in non-suicidal subjects13 and even healthy volunteers who went on to experience suicidality after taking antidepressants are so compelling14.

Benzodiazepines (like what Cornell was taking) and hypnotics (sleep and anxiety medications) also have a documented potential to increase risk of completed and attempted suicide15 and have been implicated in impulsive self-harm including self-inflicted stab wounds during changes to dosage16. We also find the documented possibility that suicidality could emerge in patients who are treated with this class of medications even when they are not suicidal with recent research stating, “benzodiazepine receptor agonist hypnotics can cause parasomnias, which in rare cases may lead to suicidal ideation or suicidal behavior in persons who were not known to be suicidal”17. And, of course, these medications themselves provide the means and the method with a known lethal poisoning profile18.

Homicide

Clearly murderers are mentally ill, right? What if I told you that the science supports the concern that we are medicating innocent civilians into states of murderous impulsivity?

When Andrew Thibault began to research the safety of a stimulant drug recommended to his son, he entered a rabbit hole he has yet to emerge from. After literally teaching himself code to decrypt the data on the FDA Adverse Event Reporting System website, he was able to cull 2000 pediatric fatalities from psychotropic medications, and 700 homicides. A Freedom of Information Act and a lawsuit later, he continues to struggle with redacted and suppressed information around 24 homicides directly connected to the use of psychotropics including the homicide by a 10 year old treated with Vyvanse of an infant. Another case, ultimately recovered, involved statements from a 35 year old perpetrator/patient, who murdered her own daughter, as directly implicating as “When I took nortriptyline, I immediately wanted to kill myself. I’d never had thoughts like that before.”

To begin to scientifically explore the risk of violence induced by psychotropic medication, a study sample needs to be representative, the reason for taking the drug needs to be taken into consideration, the effect needs to be controlled for, as do any other intoxicants. Professor Jari Tiihonen’s research group analysed the use of prescription drugs of 959 persons convicted of a homicide in Finland and found that pre-crime prescription of benzodiazepines and opiates resulted in the highest risk (223% increase) of committing homicide19.

Relatedly, eleven antidepressants, six sedative/hypnotics and three drugs for attention deficit hyperactivity disorder represented the bulk of 31 medications associated with violence reported to the FDA20. Now an international problem, a Swedish registry study identified a statistically significant increase in violence in males and females under 25 years old prescribed antidepressants21.

Implicated in school shootings, stabbings, and even the Germanwings flight crash, prescribing of psychotropics prior to these incidences has been catalogued on https://ssristories.org/ leading me to suspect psychiatric prescribing as the most likely cause in any and all reports of unusually violent behavior in the public sphere.

Is Association Really Causation?

Beyond the cases where violence to self or others was induced in a non-violent, non-depressed, non-psychotic individual, what other evidence is there that speaks to how this could possibly be happening?

The most seminal paper in this regard, in my opinion, was published in 2011 by Lucire and Crotty22. Ten cases of extreme violence were committed by patients who were prescribed antidepressants — not for major mental illness or even for depression — but for psychosocial distress (ie work stress, dog died, divorce). What these authors identified was that these ten subjects had variants to liver enzymes responsible for drug metabolism exacerbated by co-administration of other drugs and substances including herbs. All returned to their baseline personalities when the antidepressant was discontinued.

Now referred to as akathisia-induced impulsivity23, the genetic risk factors for this Russian Roulette of violence are not screened for prior to psychotropic prescribing. Akathisia is a state of severe restlessness associated with thoughts of suicide and homicide. Many patients describe it as a feeling-less state of apathy — and what I would describe as a disconnection from their own souls, their own experience of human connection, and any measure of self-reflection.

The genetic underpinnings of this kind of medication-induced vulnerability are just beginning to be explored24 with identification of precursor symptoms to violence including severe agitation. In a randomized, placebo-controlled trial, healthy volunteers exhibited an almost 2 fold increased risk of symptoms that can lead to violence25. A 4-5 fold increased risk was noted in patients prescribed a generic version of the antidepressant Cymbalta, off-label, for stress urinary incontinence (a non-psychiatric indication)26.

There is another way

Perhaps it’s as if we are offering the blade edge of a knife to those falling off the cliff of struggle and suffering. Because the idea of managing a chemical imbalance with chemicals seems to make sense. But at what cost? The laundry list of acute and chronic adverse effects is growing, and the unpredictable risk of medication-induced violence should lead to an urgent cessation of all psychotropics. Because it takes 17 years27 for physician practice to reflect published science, we need grassroots level information sharing. We need to inform ourselves before we consent to engage a system that regards you as an impersonal statistic.

We live in a cultural context that makes no room for the relevance, meaning, and significance of symptoms — symptoms are simply bad and scary and they must be managed. We don’t make room for patients to ask why they are not ok.

If you knew that your symptoms were reversible, healable, transformable, you might consider walking that path instead of assuming this level of risk for placebo-level efficacy of psychotropic medication. We would only euthanize a “mental patient” if we felt their condition was lifelong and unremitting. In fact, every woman I have ever tapered off of psychiatric drugs into experiences of total vitality once believed that she would be a medicated psychiatric patient for life. If you knew that radical self-healing potential lies within each and every one of us, if you only knew that was possible, you might start that journey today. It’s side effect free…

Show 27 footnotes

  1. http://journals.sagepub.com/doi/pdf/10.1177/0706743716689055
  2. http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_results.jsp?cboDataYear=All&cboDataTypeY=2%2CHousehold+Event+File&buttonYearandDataType=Search&cboPufNumber=All&SearchTitle=Prescribed+Medicines
  3. http://www.ncbi.nlm.nih.gov/pubmed/11437014
  4. http://www.bmj.com/content/351/bmj.h4320
  5. http://www.bmj.com/content/330/7488/396
  6. http://www.bmj.com/content/352/bmj.i65?etoc=
  7. http://www.ncbi.nlm.nih.gov/pubmed/12601224
  8. http://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs0645
  9. http://archpsyc.jamanetwork.com/article.aspx?articleid=210055
  10. http://www.ncbi.nlm.nih.gov/pubmed/15555028
  11. https://www.researchgate.net/publication/26713983_The_Relationship_Between_General_Population_Suicide_Rates_and_Mental_Health_Funding_Service_Provision_and_National_Policy_a_Cross-National_Study
  12. http://www.sciencedirect.com/science/article/pii/S0160252713000587
  13. https://www.ncbi.nlm.nih.gov/pubmed/2301661/
  14. http://davidhealy.org/articles/#Suicide_Articles
  15. https://www.ncbi.nlm.nih.gov/pubmed/28257172
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2047018/
  17. https://www.ncbi.nlm.nih.gov/pubmed/27609243
  18. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303061
  19. https://www.eurekalert.org/pub_releases/2015-06/uoef-fsa052515.php
  20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002271/
  21. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001875
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513220/
  23. https://www.ncbi.nlm.nih.gov/pubmed/27138119
  24. https://www.ncbi.nlm.nih.gov/pubmed/27324805
  25. http://journals.sagepub.com/doi/full/10.1177/0141076816666805
  26. http://www.cmaj.ca/content/189/5/E194
  27. https://www.ncbi.nlm.nih.gov/pubmed/22179294

Support MIA

MIA relies on the support of its readers to exist. Please consider a donation to help us provide news, essays, podcasts and continuing education courses that explore alternatives to the current paradigm of psychiatric care. Your tax-deductible donation will help build a community devoted to creating such change.

$
Select Payment Method
Loading...
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Donation Total: $20.00

26 COMMENTS

  1. Beautifully written. When I heard that Chris Cornell had died unexpectedly at 52, the very first thing I thought was “wonder which psych meds he’s on.” I’m a primary care NP at a (so-called) mental health clinic and it’s incredibly frustrating to see how many of the patients’ problems both mental and physical are exacerbated by their psych meds. But it’s hard to advocate for the pts with their psychiatric prescribers in a way that doesn’t make the prescribers defensive – after all, they have so few tools in their toolkit (basically only one: meds. Some of the social workers, on the other hand, are wonderful, being supportive in countless practical ways). Some patients who’ve been stable for years have told me they’d like to decrease or d/c their psych meds, and of course I’m supportive – but it’s wrenching to see them completely squelched by their psych prescribers when they bring up this possibility with them. “You’ll just go back to how you were – is that what you want??” (paraphrased). It’s so sad. The light just goes out of them. One patient who’d done great for years (hears a number of voices but lived fairly peaceably with them) was recently moved into a new board & care and she decompensated in the same way that an elderly person might due to a stressful new environment & loss of familiar routines. Would you drug your grandmother in a situation like this? Yet the response of her psych prescriber was, “She’s paranoid, I’ll up her clozapine.” It’s really hard to see.

  2. Thank you so much for the solid information and links. I advocate daily against medication and for therapy because it works and doesn’t have side effects! I focus on interventions to improve self-acceptance and shame tolerance through mindful self-compassion training as it directly addresses the REAL causes of emotional problems, which is low self-worth due to trauma and attachment insecurity.

  3. Fantastic article, Kelly! I once handled a crisis call from a woman who was frantic about her ongoing depression and anxiety. She told me a list of at least 4-5 antidepressants she’d been on and nothing had changed and she was worried that she’d ALWAYS feel this bad and it was driving her crazy! That’s kind of how she talked. So I asked her one question: did anyone ever tell you there are other things you can do for depression and anxiety besides drugs? She stopped cold for a moment. Calmly said, “No.” I said, “Well, there are.” She said, “Oh. Well that’s good!” She instantly felt better knowing there was something she could do herself, but had been seeing mental health professionals for A WHOLE YEAR and no one had told her there was more she could do.

    I’ve worked for years with foster youth who are put on these drugs sometimes in elementary school, despite the data saying they don’t work, and I can’t think of one who was told that s/he might become aggressive or suicidal on these drugs, nor were their parents or even their caseworkers informed. I ended up being the one who shared these facts. It is a very disturbing reality when people are given drugs that don’t work, not told of potentially dangerous or deadly side effects, and not given any alternative that might actually help them out. Not saying some people don’t feel good about their antidepressant use, but informed consent basically doesn’t exist for these drugs!

  4. So many of you are aging. Medication is not the first choice for young people experiencing mental health challenges or choice of parents. Read below and perhaps you can get a sense of why the same people comment on this site over and over with no new people.

    If you know someone who has depression it is possible to get better.

    “It can be therapied away, can be loved away, and if needed medicated away.” – John B Wells. (Hope I quoted John B accurately.)

  5. Dr. Kelly Brogan:
    Relax, I’m far more on your side, than not. And yeah, I kinda’ sorta’ get what you mean when you describe akathisia as a “disconnection from one’s soul”. *BUT*, given what we know about the mechanism of action of psych drugs – their physical effects on the CNS, and all 4 nervous systems, – I think you’re doing a grave dis-service to akathisia sufferers, and minimizing their suffering. I myself had akathisia from heavy neuroleptics, including thorazine, mellaril, haldol, stellazine, etc. Yeah, I was “disconnected from my soul”, but that was far from the worst of it. This is only a minor point, really, because the REST of your message, and the many ways to use diet, exercise, and mindfulness, etc., are call generally EXCELLENT. KEEP UP THE GOOD WORK, Kelly! But please re-think your views on akathisia. Akathisia is living hell, and NOBODY’s soul would lead them into that hell, nor abandon them to that living hell….
    ~Bill./

    • I’ll second this. Akathisia might includes separation from one’s soul, but “a feeling-less state of apathy” doesn’t sound right at all. It’s non-okayness so profound and enveloping that your entire existence is taken over by it. It’s a desperate feeling that something must be done to help you NOW accompanied by the sure knowledge that you are utterly incapable of doing it. Oh, and you cannot remain still. Can’t sit, can’t lie down. There might be twenty people you could call for help but the impossibility of explaining yourself even if you understood what was going on makes it seem pointless. It is typical of akathisia sufferers to say “I can’t take another minute of this.” And yet it’s relentless and many, many more minutes are queued up, measured in days and weeks, or months and years in the worst cases. A lot of sufferers say they want to die immediately, while completely disavowing any desire to kill themselves. It only seems contradictory to those who don’t listen to the exact words spoken. Abilify is a top offender in causing this syndrome, and woe be to those prescribed Abilify for anti-depressant-induced mania that was mistaken for so-called “bipolar disorder.” The worsening will be misunderstood as worsening of mania and dose increase of the Abilify is likely.

  6. Dear Dr Kelly,

    Thanks for the well written Article.

    I support the description of drug induced suicidal reaction as “drug induced Violence” because I think the description is appropriate.

    I’ve had two suicide attempts, several hospitalizations and several years of taxpayer funded disability which can be directly traced to Psychiatric “medications”.

    Many years ago when I came to the UK I wrote an Adverse Drug Reaction Warning Request letter to my previous psychiatric carers in Ireland. In reply, they sent a “history” of me over to the UK – but without any Adverse Drug Reaction Warning.

    At the time the President of the British Association of Psychopharmacologists came from the Irish University that managed the Psychiatric Unit where I had been treated.

  7. This news was particularly distressing to me because Cornell was taking the same prescription my doctors have prescribed to me for the last two years for my tremor disorder. I’ve long been opposed to the flippant use of antidepressants after suffering through regular suicidal and homicidal episodes triggered by bupropion, but for whatever reason I didn’t think to question my doctors about how exactly lorazepam was working (I was just told “this is a tremor/seizure medication,” so I suppose the alarm bells I associate with “anti-anxiety/antidepressant” just didn’t go off). About a year ago, when I finally did start to think “exactly how IS this stuff working?” I googled and couldn’t find anything that told me much of anything. Does prolonged use of lorazepam have permanent effects on the brain, as antidepressants do? I’ve never had any suicidal or homicidal tendencies on the stuff, as Cornell did, and I’ve tapered down from several times a day to once every three or four months — but I would certainly prefer to find an alternative altogether for the (now rare) times I’m overtaken by my tremors, if lorazepam could have any permanent effects that I’m simply not conscious of.

  8. First problem is, that majority of MH experts, consider each killer, as *mentally* *ill*. As *undiagnosed* one.
    Listen. I read mainstream Psychologists and Psychiatrists posts on few websites and in their’s eyes, *crazies* are big danger to entire society. *Medicated* or *unmedicated*. Doesn’t make a difference for them. Control over you is all, what MH experts wants to have. And this isn’t some MH System *agenda*, on it’s own. It’s NWO *bidding*. They never say, lone wolf was, or wasn’t on *meds* ! But they always say, he had *mental* health *issues* ! Majority of people on meds, will easily commited a murder, because they don’t have any emotions at all. Yes some people are more violent on *meds*, some aren’t. It’s like a alcohol at best! Indeed MH experts won’t ever take any responbility, if they *created* with *meds* , a killing *machine* ! More then meds alone, are *events* in Mental Institutions one, which will *turn* person into a *killer*. Anyway we *crazies* *commited* one *crime* already – we are born different. And *intolerance* towards our difference, is coming from two Abrahamic religions, Islam is excluded! Please people face this fact! Psychologists will *stone* you, Psychiatrists will *burn* you!!!

  9. Ativan made me very, very ill, taken as prescibed for menopausal anxiety and insomnia. How can we all help spread the word so no more lives are lost? I became suicidal, yet through a SLOW taper, daily yoga, meditation, healthy food, fresh air, etc. I am very well after 3 years off. Grateful for Kelly Brogan and Mad in America. Sick and sad about Chris Cornell and those who still suffer.