"I can’t really see a plausible explanation for Lubitz’s ‘kamikaze’ act other than drugs like antidepressants" Psychiatrist David Healy about the involvement of those drugs in rampages
On March 24, 2015, Germanwings co-pilot Andreas Günter Lubitz according to the investigations on his amok flight 4U9525 he crashed the Airbus A320 intentionally against a mountain - an insane act that especially for the victims but also for the relatives was a horror of unimaginable proportions.
Five months later, in the German small town Haltern am See a memorial [1] has been consecrated at the local cemetary a memorial in the presence of the dependants of the deceased.
With this, an important foundation of the mourning has been layed, but in order that the world in future is going to be spared as possible from these kind of catastrophes it would be crucial to determine the underlying cause(s). The renowned psychiatrist David Healy outlines in this interview why medication such as antidepressants can play a decisive role in rampages such as the one of Lubitz or the one of "Batman" shooter James Holmes who has been sentenced to life imprisonment recently in the States.
In this context the German Society of Psychiatry, Psychosomatics and Neurology (DGPPN) says upon request that "the DGPPN has a high interest in an investigation of the Germanwings crash in which the medication aspects are going to be examined as well."1 [2]
"It is almost certain that in some mass killings these drugs in fact do play a part."
Dear Mr. Healy, what did you first think and feel when you heard about the "kamikaze" act of Germanwings co-pilot Andreas Lubitz on March 24 this year that led to the death of all 150 plane occupants?
David Healy: First of all, I was very sad and felt great compassion for the dead and their families. And once it became clear that this was a "kamikaze" act, my first thoughts, as I am sure the first thoughts of many were, was to wonder whether an antidepressant or other psychotropic drug would be involved. Shortly after Lubitz has run amok I have written down some thoughts concerning this matter in my article "Winging it: Antidepressants and Plane Crashes" [3] published on my blog under Davidhealy.org.
Which are your most important arguments for your thesis that antidepressants or drugs with similar side effects may be the main cause for Lubitz’s insane act?
David Healy: Without knowing exactly what Andreas Lubitz was taking and also what his clinical state was in the week or two leading up to the crash, it is difficult to be certain that the drugs he may have been on actually did cause the problem.
But it is clear that drugs like the ones he appears to have been taking can cause people to become homicidal and violent and to contemplate mass killing and there have been so many of these episodes of mass killing in people who have been taking psychotropic drugs of this kind that it is almost certain that in some mass killings these drugs in fact do play a part.
Can you substantiate it with scientific evidence or studies?
David Healy: The FDA has a considerable body of data on the capacity of antidepressants to cause violence. The Canadian regulators, for example, included violence in their warnings for suicide and related behaviors.2 [4] And in 2006, with colleagues I published [5] on just this issue giving controlled trial data on the capacity of antidepressants called Selective Serotonin Re-uptake Inhibitors, in short SSRIs, to cause violence.
In 2013, I have published on my website a list of dozens of drugs that can trigger and cause suicide or homicide, from the most popular antidepressants and antipsychotics via benzodiazepines such as Valium and anti-smoking and anti-asthma drugs and antihistamines through to stimulants such as Ritalin [6].
Are these drugs listed as a matter of personal judgement?
David Healy: No. They are either drugs that companies are obliged to state can cause suicide or for which there is convincing evidence that they have in fact caused suicide. There are likely many more drugs that some government officials and company personnel know cause suicide but about which they keep quiet.
How common is violence as a side effect of SSRI-antidepressants?
David Healy: It is more or less the same as for suicidality: Up to 1 in 10 may have suicidal thoughts and up to 1 in 20 have violent thoughts they would not have had if they had not been taking an antidepressant. But the rate of completed suicide and violent acts is much lower - 1 in 500 or more.
In June, Brice Robin, the state’s attorney from Marseille, reported [7] that Lubitz in the weeks before the crash was under the influence of an overmedication of anti-anxiety drugs, Valium and other psychotropic drugs and, concretely, that he was taking Mirtazapine, an antidepressant, and had even doubled the dosage [8] from 15 to 30 milligrams [9].
But in the product description of Mirtazapine it says "short term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond the age of 24 years", and Lubitz was 27 [10] when doing his "kamikaze" crash.
David Healy: There is convincing evidence that Mirtazapine increases the risk of suicidality in clinical trials, compared to Placebo. This is not age-specific evidence, it is across-the-board evidence with the date for people in their 40s, 50s and early 60s, for instance, looking identical to the data in under 25s.
And how is the product description of Mirtazapine then to explain?
David Healy: Companies take great care in their product descriptions to word things in a manner that deflects attention for their product. This rather than informing doctors or patients often appears to be their primary aim. Companies will often claim there is no need to enter data unless the data is statistically significant but this means they leave out figures showing a very clear increase in the risk of suicide - as the figures for mirtazapine show.
An objection against the thesis that antidepressants such as SSRIs or drugs with similar side effects may cause acts of violence is that they cannot be made responsible for insane acts such as the one of Lubitz because these drugs only cause acts of violence "on impulse" and not ones that have been planned long(er) beforehand, as Lubitz did it [11].
David Healy: SSRIs are by far not only linked to impulsive acts, but to planned acts of violence or harm. It is generally accepted that they cause emotional blunting and this makes it possible to contemplate things like homicide that someone would normally be too anxious to consider.
The Case of the "Batman" shooter in Aurora, James Holmes
But isn’t Lubitz an exception of a person running amok who has planned his insane act in advance while being heavily sedated with medication with considerable side-effects such as SSRI-antidepressants?
David Healy: Many public shootings bear witness to it. In the final report about Adam Lanza, for example, who shot on December 14, 2012, in Newtown, Connecticut, his mother, 20 children and 6 adult staff members and finally himself, it says that the evidence clearly shows that the shooter planned his actions, including the taking of his own life [12].
Or let’s take David Carmichael who reports about the killing of his own son that a few days after he started taking the antidepressant Paxil again, he was having suicidal thoughts. Three days later, he planned his suicide. But then he went from planning his suicide to planning a murder-suicide to planning a murder. On July 31, 2004, he finally killed his 11-year-old son Ian [13].
Does this also hold for the spree killer James Holmes who was sentenced to life in prison on August 7 this year without the possibility of parole?
David Healy: The information compiled from multiple sources about Holmes who became known as "Batman" shooter, because he killed 12 people and injured 70 others at a Century movie theater in Aurora, Colorado, on July 20, 2012, at the premiere of the Batman movie "The Dark Night Rises", shows the planning for his rampage was methodical, went back months [14].
But the picture about Holmes is not the way it happened. He had no plans to kill anyone until he went on the SSRI-antidepressant Zoloft which his doctor prescribed on March 21, 2012 - four months before he committed the mass shooting. In this period his dose of Zoloft was being increased in steps from 50mg to 100mg to 150mg per day. And Holmes not only got worse every time he changed dose. It also appears that specific plans of harming others began to crystallize out as the dose of Zoloft was increased.
How did James Holmes deal with the situation?
David Healy: While being on drugs such as Zoloft, he attempted to alert others about his specific plans of harming others in so far as he could - but no-one registered the changes in him. He describes himself as developing a state of Manic Dysphoria3 [15] which is a good description of Zoloft induced akathisia. He also describes clear emotional blunting - that endured after he stopped the treatment - which is a well-recognized phenomenon.
When did he stop taking Zoloft?
David Healy: Somewhere around June 30, 2012, about 3 weeks before his killing. And when he stopped Zoloft, he did so abruptly from quite a high dose of 150mg. And he was unaware Zoloft could produce dependence and a withdrawal syndrome.
He became confused on withdrawal - being both more and less depressed. He became emotionally labile - dysphoric mania as he described [16] it.
The reduction in fear he experienced while on Zoloft continued after he had stopped. Lots of people have continued emotional blunting or depersonalization - detachment from your thoughts or feelings - for months after stopping treatment with SSRIs.
But in an Associated Press article [17] from August 8 it is being claimed that "Holmes told one [psychiatrist] that he had been secretly obsessed with thoughts of killing since he was 10." This conveys the impression that the potential to be a "killer machine" was already part of him at an early age.
David Healy: It is not true that Holmes was "obsessed" with thoughts of killing when he was 10. He didn’t have a nervous disorder till shortly before he went to the clinic in March 2012, a few months before he committed his mass killing at the age of 24 in Aurora, Colorado.
It was only when he was put on Zoloft in March 2012, he developed new thoughts centering on the possibility of specific homicidal acts - and these were not the same as his former vague ideas of killing people, as I also outline in my comment "The Man who thinks he is a Monster: Sertraline [= Zoloft] and Violence" [18], published on August 15, 2015.
Against this background one may ask why the attorney team of James Holmes didn’t use the Zoloft/medication argument during the court case, especially as there are court cases in which a certain psychotropic drug such as an antidepressant has been named "guilty" for suicide or murder (see here [19], here [20] and here [21]).
But Brian N. Connors, Chief Deputy State Public Defender at the Office of the State Public Defender in Denver, Colorado, said upon request that "Neither Mr. Holmes nor any of his lawyers will be speaking with journalists concerning the case."4 [22] What do you think may be the reason why the attorney team of James Holmes didn’t use the Zoloft/medication argument?
David Healy: The law is not clear on drug related issues - and lawyers are even more uncertain. They find it difficult to distinguish between mental illness and medication related issues and don’t know how to explain these things to juries.
The attorney team insisted that James Holmes' crimes were caused by his psychotic breakdown of a mentally ill person [23]. With the final result that Holmes escaped the death penalty and was sentenced to life imprisonment. Do you think the attorney team could have reached more for James Holmes if they had argued that the SSRI-antidepressant Zoloft did play a vital or important role in the formation of his insane act?
David Healy: James Holmes had a good medication defense but neither the law not the legal system are comfortable with these issues.
In the mentioned Associated Press article it also says, "As in previous proceedings, Holmes who is on anti-psychotic medication that dulls his responses, showed no reaction." How could it be that Holmes has been given antipsychotics that have a brain damaging effect [24] (also here [25]) and that "dulls his responses," though one should assume that an accused person shouldn’t have an additionally "befogged" mind being able to speak in a manner that helps elucidating the circumstances of the massacre?
David Healy: The problem here is it’s the doctor treating him who decides on this one - the lawyers have little input. I saw no clinical reason for continuing treatment with these meds.
But if medication such as SSRI-antidepressants can bring people to commit suicide or even a massacre, why has anyone noticed something in advance?
David Healy: In contrast to alcohol or street drugs such as LSD, with antidepressants you do not become necessarily "maladjusted." In fact, many of the people being given antidepressants can seem essentially normal. They will show up as "normal" on profiling. Let’s take the example of Tim Kretschmer who killed 15 people and finally himself in 2009 in Winnenden near Stuttgart.
Kretschmer had been suffering from depression, even attending a clinic and receiving medication for the condition.5 [26] But according to media reports [27] even school psychologists didn’t noticed anything, they just concluded "that Tim was a ‘normal scholar' for his age."
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 [28]. 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 [29].
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 [30] 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 [31]
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 [32]. 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 [33]. 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 [34].
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 [35].
Media are to slow?
But why do even important media such as the New York Times, the British Guardian or the German Spiegel that consider themselves as investigative not follow this antidepressant/amok track in the context of Lubitz and other cases where people have run amok?
David Healy: This is a very important question that needs answers. First, I would broadly point out that investigative journalism is slow to question the corporate establishment - on issues from lead poisoning to the food industry etc. The case has to be very compelling before some journalists will attempt to take the task on.
This holds especially for medical topics, not least journalists themselves are just ordinary people, and most ordinary people in today’s times have internalized the idea of drugs being a kind of "magic bullets", as Harvard scientist Allan Brandt outlined in his book "No Magic Bullet" [36].
Is the mentioned BBC report about Paxil or Seroxat, respectively, to your knowledge the only of its kind from a major media?
David Healy: No. Just recently, on July 14, the German FAZ reported [37] about the fact that most young men running amok in America, among them the mentioned "Batman" shooter James Holmes, have been under the influence of medications that can go along with severe side-effects such as antidepressants.
Another known example is the report of US neurosurgeon Sanjay Gupta in his capacity as CNN's Chief Medical Correspondent about Adam Lanza’s school shooting in 2012 with 28 being killed altogether. Gupta said [38]:
There is something else to consider. What medication if any Adam Lanza was on? We are specifically talking about antidepressants. If you are looking at the studies and other shootings like this that have happened, medications like this were a common factor... [They] could lead to increased impulsivity, decreased judgment, making someone out of touch."
But in the context of shootings such as the one of Adam Lanza it is being argued that access to guns is the main problem. Doesn’t this sound plausible?
David Healy: Mass shootings are easier with a gun but antidepressants are also linked to some horrific murders with knives and other means. Apart from this, the number of gun homicides in the US at the beginning of the 1970s was the same as 2004 [39], whereas at the beginning of the 1970s the US population was around 200 million and in 2010 about 300 million.
So finally, decades ago there have been even more gun homicides relative to today's times, but virtually no mass shootings. In this context, a 2013 study by the Pew Research Center showed that gun homicides and violence in the United States went down sharply in the past 20 years. But especially in the past 20 years the number of mass shootings without criminal background has risen sharply [40]in America [41].
The U.S. Food and Drug Administration (FDA), though it has determined that antidepressants could cause suicide and as a consequence has issued a so-called black box warning that appears on the package insert of a prescription drug in 2004,8 [42], hasn't enacted such black box warning for violence or homicide yet. And upon my request the FDA said they "have no such data for violence, or homicide, or aggression." Doesn’t this counter your view?
David Healy: Undoubtedly, the evidence is there.
But then, how is the missing FDA black box warning for violence or homicide to explain?
David Healy: The FDA probably concluded that it is politically impossible in the United States to hold a hearing on this risk. Apart from the clinical trial data, not least the FDA’s own voluntary reporting system for adverse events, the so-called MedWatch database, delivers solid evidence.
In which way?
David Healy: There are a large number of case reports of SSRI-associated violence that have been submitted to the FDA's own MedWatch program. In a review of that MedWatch data, Harvard psychiatrist Joseph Glenmullen and other researchers identified 31 drugs associated with case reports of violence towards other, which included 387 reports of homicides. Twenty-five of the 31 suspect drugs were psychiatric drugs, and 11 of the 31 were antidepressants.
The second most problematic drug on the list was the fluoxetine, known by the trade name Prozac. And paroxetine, known as Paxil, another SSRI, was number three. As a class, antidepressants were the most problematic drugs in the MedWatch data base [43] So if the FDA would look at its own data, it would find a compelling scientific reason to issue a black box warning.
In this context, experts call attention to the fact that the FDA estimates [44] that less than 1 percent of all serious events are ever reported to it. So can we seriously conclude from this that the real figures of violence and homicides associated with drugs such as SSRIs are in fact a hundred times or at least much higher than the statistics are indicating?
David Healy: It is true that the overwhelming majority of problems on drugs are not reported and it is also true that problems linked to violence and antisocial behavior may be even less likely to be reported because doctors do not make the link but it is not possible to say how much greater the problem in fact is in comparison with how it is reported.
But then, how can it be explained that recently experts even suggested to remove the FDA’s black box warning from 2004, saying [45] that it is "extremely questionable and virtually meaningless"?
David Healy: The aggressive campaign to attempt to remove the black box warning from antidepressant drugs, determining that they could induce suicide, are reminiscent of the hazards of substances such as of lead, asbestos and tobacco that have been negated over decades by politicians and powerful scientists. In the case of asbestos [46] , there have been first indications of its heavily sick-making or deadly potential [47] already around 1900 [48], but the carcinogenic silicate mineral - long celebrated as "miracle fiber" - has only been prohibited in Europe approximately 90 years later. The public will have to make their own mind up as to what is going on here.
How effective are SSRIs?
But there is a strong belief that SSRIs are effective and, for example, increase the extracellular level of the neurotransmitter serotonin resulting in feelings of well-being and happiness.
David Healy: The evidence that SSRIs are effective does not stem from controlled trials, but from a situation in which the negative trials remain unpublished and the published studies are almost universally ghostwritten. There is in fact no trial that demonstrates effectiveness of SSRIs.
The impression people have that these drugs are effective comes from persistent reporting to this effect in the media. And as to regards what SSRIs do to extra-cellular Serotonin, this is unknown, as I have outlined in my article being published recently in the journal BMJ about serotonin and depression [49].
But, for example, in a recent article published in the TIME magazine about your BMJ study Dr. Victor I. Reus, a professor in the department of psychiatry at the University of California, San Francisco, has been quoted. According to him SSRIs "are in many cases remarkably successful." [50]
David Healy: There is in fact no trial in which an SSRI has been shown to be effective. There are trials where they show some benefits on a rating scale9 [51] but this is not the same thing. There are no trials showing they get people back to work or even save lives. Finding that some people report feeling better on an SSRI is little different to the fact that some people report the same thing for alcohol or for amphetamines.
Established psychiatrists still tend to play the personality card when it comes rampages such as school shootings and Lubitz’s "kamikaze" act. Psychiatrist Holm-Hadulla, for example, wrote in an article for the Frankfurter Allgemeine Zeitung (FAZ), one of Germany’s leading daily newspapers, that Lubitz may have suffered from a narcissistic personality disorder and that this may have generated a cold hate in him resulting finally in his rampage "that is comparable with a terroristic act." [52]. Upon request10 [53] he conceded that it is only a "more or less plausible speculation," but isn’t it worth being taken into account?
David Healy: At first, my problem is that here again the hard facts about the potential role of medication are not being taken into account, while the media and experts do not seem to have problems with pouring into speculation about mental disorders being the culprit.
Particularly as according to the information available to me, Lubitz did not suffer from a narcissistic personality disorder because he did not seem to have the typical attitudes that are going along with such a condition, for example being inordinately preoccupied with impressing others, to raise their admiration.
What about alcohol or illegal drugs?
David Healy: Lubitz didn’t seem to be under the influence of alcohol or street drugs such as LSD or crack, and investigations over the past months have not mentioned such drugs or alcohol as potential factors in the Germanwings crash [54].
But of course, also in a case of Lubitz, all theories need to be taken into account. But without having the full medical details of Lubitz’s case showing what kind of mental illness the co-pilot was exactly suffering from, it is impossible to answer this question.
Are there at all solid studies showing that a mental illness such as narcissistic personality disorder, depression or bipolar disorder can be the major triggering factor for such a kamikaze act or school shooting?
David Healy: There are no studies of this sort. And narcissistic personality disorders, for example, don't do this.
So analyzing the available facts, can you at all see a plausible explanation for Lubitz's act of madness other than SSRIs or other drugs with similar side effects?
David Healy: Not really.
Critics say psychiatry is saddled with conflicts of interests, i.e. with connections to the pharmaceutical industry [55]. How strong is this problem - und does it hinder psychiatrists from eyeing the "medication card" in the context of insane acts such as the one of Lubitz?
David Healy: This is a factor, and in fact psychiatry does have a problem with its link to industry. Just think of the fact that the pensions of most doctors likely depend on the performance of pharmaceutical company shares, so causing trouble for pharmaceutical companies is not in their interest. In particular we need doctors who want to provide good medical care instead of just following the guidelines of healthcare managers by being advocates for possible non-consumption of drugs [56].
In your recent article about Lubitz mentioned at the beginning of this interview - "Winging it: Antidepressants and Plane Crashes" [57] - you state that many people in the pharmaceutical industry have known for a long time that something like Lubitz’s insane act can happen [58]. Why didn’t the firms took action then?
David Healy: The pharmaceutical industry has known for a long time that antidepressants and other drugs can cause a range of problems from suicide to homicide to birth defects to withdrawal problems. They have put a range of mechanisms in place to ensure safety - the safety of the company.
They are in the business of minimizing the risks that these problems might pose to the well-being of the company. These safety policies are at odds with the safety of patients being treated with these drugs or the innocent people who may become the victims of a person being treated with the drugs.
You also criticize that many people in the pharmaceutical industry have done nothing to put in place systems to manage the risk of "kamikaze" plane crashes or school shooting or to dismantle the system that gives rise to risks like this at a much greater rate than we should have to tolerate. What kind of system would you put in place?
David Healy: In terms of managing the safety to the company, the industry have perfected the art to an extraordinary degree making it very difficult to link any of their drugs to any problems likely to cause them money or embarrassment. Using the techniques that industry now use to safeguard products, it is possible to successfully deny the link between drugs and insane acts with all their dramatic consequences.
Techniques of an Industry
Can you please specify to what kind of techniques that industry is now using to safeguard products you are referring to?
David Healy: In the public domain, companies long ago learnt that if they shell a building housing children, simply denying it was anything to do with them often works wonders - do we know the children weren’t playing with explosives? They have this down to a fine art. Chemie Grünenthal’s handling of thalidomide, marketed as Contergan, makes it clear even Holocaust Denialism is not beyond them [59]. I give lectures on this topic to specialist groups and typically include details of what industry do under the heading of Holocaust Denialism.
In some cases, even in today’s times the system seems to work to the benefit of the end consumer. As mentioned before, there have been already court cases in which a certain psychotropic drug has been named "guilty".11 [60] What were the decisive factors that led to the case that a certain drug has been found guilty?
David Healy: Chance and the will to get to the bottom of things. Let us take the case of a 60-year-old man with a history of five prior anxiety/depressive episodes. These did not involve suicidality, aggressive behaviour, or other serious disturbance. But then his doctor started to give the SSRI-antidepressant fluoxetine, also known as Prozac.
Afterwards, he had a clear adverse reaction to fluoxetine involving agitation, restlessness and possible hallucinations, which worsened over a three-week period despite treatment with trazodone and propranolol that might have been expected to minimize the severity of such a reaction.
But didn’t the doctors discontinue the psychiatric drugs?
David Healy: Some years later, a new family doctor, unaware of this adverse reaction to fluoxetine, prescribed paroxetine, also known as Paxil. Two days later the man used a gun putting three bullets each through the heads of his wife, his daughter who was visiting, and his nine-month-old granddaughter before killing himself. Three years later, at jury trial in Wyoming instigated by the surviving son-in-law of this man a jury found that paroxetine "can cause some people to become homicidal and/or suicidal."12 [61]
What about the maker of Paxil?
David Healy: SmithKline Beecham, now GlaxoSmithKline, was deemed 80 percent responsible for the ensuing events.13 [62] The documentary evidence included an unpublished company study of incidents of serious aggression in 80 patients, 25 of which involved homicide.
In the context of the insane act of Germanwings co-pilot Andreas Lubitz, the European Aviation Safety Agency, in short EASA, said on July 17 that psychological evaluation should be in place for all pilots during training or before they start the job [63]. And airlines should not only check the blood of pilots for illicit drugs and alcohol but also for signs of psychiatric drugs such as antidepressants [64]. Do you think this is target-aimed?
David Healy: I think this testing is irrelevant. Many of the people being given antidepressants are essentially normal. They will show up as "normal" on profiling. Unless there is an acceptance that treatment can cause problems with specific questions aimed at establishing whether the treatment is in fact helping or could be causing problems then generic profiling is not going to help.
Relatives of those who dies in the Germanwings crash reject the offer of the Lufthansa in the amount of 25,000 € per victim and demand - along with personal commiseration and an apology [65] - 200,000 € for each dead person [66]. And now they even want to go to court in the United States where the surviving dependants get ten times the amount they receive in Germany [67] Do you think it could be worth for the surviving dependents to put into play the possible role of the drugs under whose influence Lubitz has been?
David Healy: If I were a relative and thought a drug company had been withholding data on a risk like this - I would be absolutely furious.
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