THE ELEPHANT IN THE MORGUE

SAM SMITH, PROGRESSIVE REVIEW - In coverage of school shootings there has been one topic that has been kept off the table: the consistent use of anti-depressants by the murderers and the possible connection between the drugs and the deaths.

In an exception to this trend, Julie Deardoff wrote for the Chicago Tribune: "Investigators believe that Cho Seung Hui, the Virginia Tech murderer, had been taking anti-depressant medication at some point before the shootings, according to The Chicago Tribune. Perhaps it's just a terrible coincidence, but Columbine shooters Eric Harris and Dylan Klebold, and Kip Kinkel, the 15-year-old Oregon youth who killed his parents before opening fire on his classmates, were also taking drugs for depression.

"It's not yet clear what, if anything, Cho was on. But anti-depressants are a leading suspect because they've been shown to pose a suicide risk for children; the drugs come with a federal 'black box' warning. And a recent federal analysis of clinical trials showed for the first time that it can also trigger suicidal behavior among patients older than 18. . .

Russell Blaylock, writing in Newsmax, notes:

"Of special concern is whether [Cho] was on selective serotonin re-uptake inhibitor psychotropic medications, such as the fluorinated SSRI antidepressants (Paxil, Prozac). You may recall that these same antidepressants appeared in most of the other cases of school shootings. There is growing evidence that the SSRI medications, as well as other fluorinated medications, are resulting in increased acts of violence , either suicide, homicide or both.

"The first link to SSRI medications came in 1989 when Joseph Wesbecker shot and killed eight people and wounded 12 others before killing himself. The ensuing lawsuit charged that Wesbecker, had just started on an SSRI anti-depressant and that the maker, Eli Lilly, knew that violent behavior was a complication of their medication. Today, both the FDA and the Canadian regulatory agencies recognize that the SSRI medications can induce some people to harm themselves or others. Glaxo Smith Kline, maker of Paxil (paraoxetine), admits "hostile episodes" as a complication.

"In fact, in their own clinical trials they found homicides, homicidal acts, homicidal ideation and aggressive behavior to be a side effect of the medication. In addition, it was found that children with obsessive-compulsive disorder taking the medication experienced hostility episodes 17-times more often than depressed patients. Of particular concern was the finding that 1.1% of healthy, psychiatrically normal people who took an SSRI anti-depressant experienced one or more hostile episodes, while none taking the placebo had such an event.

"A number of studies have shown that the most common reason people stop the drug is aggression, agitation and akathisia. Of particular concern is the latter of these. The pharmaceutical companies refer to this by using a code word "hyperkinesis", which sounds less ominous to prescribing physicians.

"Akathisia is a psychiatric term that means a feeling of tenseness, restlessness and feeling very uncomfortable-like wanting to jump out of your skin. It is also associated with a loss of emotional control, emotional blunting and even psychotic reactions. It has been linked in a number of studies to homicides and suicides. Emotional blunting was described in Chu's psychiatric evaluation and those who witnessed his attack described him as detached and without emotion.

"It has been estimated that such side effects with these anti-depressant medications, as well as other fluorinated medications, is grossly underreported to the regulatory agencies. One study estimated only 1 to 10% of cases are ever reported. In 2002 a story aired on the BBC concerning Paxil (paraoxetine). They were inundated with thousands of e-mails from patients on the medication describing 'emotional storms,' thoughts of violent acts and self-harm, when no such events occurred prior to the medication."

According to the federal Agency for Healthcare Research and Quality, "In 2004, total expenditures on prescribed psychotherapeutic agents was at least 2.5 times as high as in 1997, rising from $7.9 billion to $20.0 billion. In the same time span, the total number of purchases of psychotherapeutic agents increased substantially from 141.9 million purchases to 244.3 million purchases. . . The total number of purchases of antidepressants rose from 88.3 million purchases to 161.2 million purchases and the total number of persons reporting purchasing an antidepressant increased from 15.3 million people to 24.8 million people in the same time span."

Some have argued that the worth of anti-depressants is greatly overrated. For example, an article in Psychiatric Times in 2002 reported that "More than half of the clinical trials sponsored by the pharmaceutical companies failed to find significant drug/placebo difference, and there were no advantages to higher doses of antidepressants. The small difference between antidepressant and placebo has been referred to as a 'dirty little secret' by clinical trial researchers. . ."

But let us assume that for the vast majority of patients these drugs do help and even reduce the overall suicide rate. That still leaves us with a serious problem.

Let's say that of the 24.8 million people using anti-depressants, only one one hundredth of one percent have violent reactions. According to the drug industry and the media, the risk therefore is infinitesimal. But because of the huge number of users, percentages don't really matter - you still have 2,480 potential mass murderers roaming the land.

This doesn't mean you ban use of the drugs, but it certainly means the government and the media stop covering up the problem and face it honestly. We might, for example, find that for those of Cho's dramatic and previously professionally noted symptoms, the violence or suicide rate is not one one hundredth of one percent but 20% - in which case speaking of "minimal risk" would be a lie. And you stop giving such patients anti-depressants.

The media has been complicit in failing to deal with the issue, perhaps because of its consistent acceptance of pharmaceutical industry spin and perhaps because of a discomfort with science and math. In any case, it is time to stop milking the story and start looking into an issue too many have wished to ignore.

AHRQ
NEWSMAX
CHICAGO TRIBUNE