Seite 3: Antidepressant violence? Proofs?

In the USA, for example, by now around 25 percent of the population, or almost 80 million people, are taking psychiatric drugs, and round about 13 percent or 41 million Americans are taking antidepressants. In other industrialized countries the development goes in the same direction. Considering these strikingly high numbers, shouldn’t there be more people running amok if medication may play a causal role in the context of mass killings?

David Healy: The rate at which people engage in mass killings now appears much greater than decades ago. In fact, we virtually haven’t seen phenomena such as "weak-willed" shootings in schools, universities or military facilities lacking concrete criminal background before the 1980s, at least by no means in the frequency of the last 20 to 30 Years. So there must be one or several triggering factors for these "modern" rampages. Also, death by suicide is at record levels in the armed services. Simultaneously the use of antidepressant drugs is also at record levels, including brand names like Prozac, Zoloft, Paxil, Celexa and Lexapro.

In which patients can we observe these problems with violence?

David Healy: It is important to take into account that the people who contribute most to these currently high figures of people on antidepressants are people hooked to them. At present not less than 9 out of 10 people on antidepressants in any one year are dependent on them. And the increase of people being on antidepressants during the recent one or two decades especially in the U.S. come from people who at the end of each year remain on treatment - mostly because they are "hooked" to it.

But these are people who have problems with the pills - and they are not the same group who have homicidal or suicidal thoughts. In fact, antidepressant violence is a problem on starting or withdrawing from treatment. So you don’t need to look at how common these killings or mass killings are against a background of the number of people who are on these drugs each year, but against the number of people starting these drugs or suffering withdrawal symptoms each year.

And while today the number of people starting these drugs is not much greater than it was in the mid-1990s, there was a significant increase somewhere in the 1980s, first of all in the States - and this increase corresponds to the remarkable rise in mass killings with no specific criminal background such as school or movie theater shootings in this country the 1980s. And afterwards the number of these mass killings remains more or less steady.

Is this kind of parallel also true for plane crashes?

David Healy: The problem for Lubitz appears to have been that he was trapped into continuing with treatment for fear that he would lose his job otherwise. It is when people get trapped by their doctors into continuing their treatment or trapped by circumstances into continuing a treatment that doesn’t suit them have the potential for problems to escalate.

And there is good evidence that in a significant number of plane crashes where pilots were on antidepressants, American crash investigators attributed some causality to the antidepressants - before 2010. In 2010 these drugs were approved for use by pilots. Since then, we do not hear of plane crashes happening where the antidepressants are thought to play a role.

But psychiatrist Rainer Holm-Hadulla from the University of Heidelberg, for example, says upon request that "there is no proof and it is made likely by anything that antidepressants clearly favor violent behavior." And he adds6 that "it is highly unlikely that massive acts of violence [such as the one of Lubitz] are induced by such kind of drugs."

David Healy: If the media had put out the story that Andreas Lubitz had been taking "street" drugs such as Amphetamines, Cocaine, or LSD before getting on the flight or perhaps even drinking alcohol heavily, many people, including doctors would have happily believed that these drugs caused the problem or significantly contributed to it.

That is to say, it is primarily because the suggestions we have are that he was on prescription drugs only that doctors and others are reluctant to believe that the drugs he was on could have caused the problem - even though they are close to identical drugs to the street drugs that were banned during the 1960s, largely because they could cause aggression and violence and other problematic behaviors.

However, psychiatrist Henning Saß who acts as chairman of the advisory board of the German Society of Psychiatry, Psychosomatics and Neurology (DGPPN) says that during his "decades of experience as clinician side-effects of antidepressants in the form of acts of violence has not known to him."7

David Healy: This sounds odd. Let’s take the example of BBC’s premier investigative programme, Panorama, that ran four programmes on the topic of SSRI antidepressants and violence and suicide and company efforts to hide the problems. The response to this report entitled "The Secrets of Seroxat", also known as Paxil, was tremendous.

In which way?

David Healy: They received not less than 1,374 e-mails from viewers, mostly patients. And one of my research colleagues, Andrew Herxheimer, was able to analyze the full set of these responses. Many linked emotional storms and thoughts and acts of violence or self-harm to the antidepressant paroxetine, known by the trade name Paxil or Seroxat, both to starting drug treatment and to dosage change.

These were not simple anecdotal reports, in that the analysis clearly pointed to a linkage with dosage. In addition, they were self-reports of violence from patients with no apparent background of violent behavior.

And moreover, the analysis was consistent with an analysis of reports of thoughts and acts of violence or self-harm on paroxetine that doctors had sent to the British Medicines and Healthcare products Regulatory Agency about other patients between 1991 and 2002.