Antipsychotics and Violence
Three antipsychotics—Abilify, Geodon and Risperdal — appear on the list compiled by Moore and Glenmullen tracking potential medication-induced violence. These drugs are called second generation antipsychotics, or atypical antipsychotics, to distinguish them from first generation antipsychotics that appeared in the 1950s, drugs like Thorazine, Stelazine and Haldol. Each of these atypical antipsychotics has been tied to incidents of aggression. This may be because akathisia is one of the principal adverse antipsychotic side effects.
In the clinical trials that led to Abilify receiving FDA approval to be used as an adjunct treatment for depression, 25% of the patients taking Abilify suffered from akathisia, versus 4% of those on placebo. 12% on Abilify experienced restlessness, vs. 2% on placebo. By the end of the six-week study, the akathisia had resolved for only half the patients.
In 2013, researchers in Japan and Canada conducted a systematic search of Abilify studies. They found that Abilify was causally related to increases in psychotic symptoms, agitation and aggression. The findings were published in the journal Psychopharmacology.
In one of the most important and well-known studies of the effects of antipsychotics, the 2005 Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, Geodon produced moderate to severe akathisia in 9% of patients, Risperdal in 7%. Medication was discontinued for 74% of CATIE’s 1,432 patients due to “inefficacy or intolerable side effects or for other reasons.”
The FDA approved Geodon drug label lists agitation, hostility, confusion, hyperkinesia (hyperactivity), amnesia, and delirium among the frequent “treatment emergent” adverse reactions reported in the clinical trials that preceded FDA approval of the antipsychotic drug. Frequent means that particular antipsychotic drug side effects were seen in at least one out of every 100 patients. Treatment emergent means the effect occurred for the first time or worsened after the patient began taking the antipsychotic drugs following an initial evaluation. Reactions that are considered to be part of the illness being treated or unlikely to be drug-related are not included.
“First generation” antipsychotics are also associated with extreme akathisia and violence. In a case report published in the American Journal of Forensic Psychiatry in 1985, the authors described five cases in which Haldol was associated with akathisia, homicide and suicide.
In Washington State, a 2007 Tacoma News Tribune investigation into increasing violence at Western State Hospital, a psychiatric facility, tied the increase to a change in prescribing that favored newer antidepressants and atypical antipsychotics. Abilify, Geodon and Risperdal were the three medications on the antipsychotics drugs list cited as contributing to the problem and being “more likely than others in their class to cause agitating side effects such as restlessness, anxiety and insomnia [emphasis added].” Harvard-trained psychiatrist Stephan Kruszewski, quoted in the story, said, “There is a significant relationship between restlessness and agitation induced by medicine and the propensity for violence.”
Opioids and Violence
While prescription opioids like Vicodin and OxyContin are not psychiatric drugs, they deserve mention here. Prescription opioid and analgesic use has reached epidemic levels in America. Aggressive marketing by the pharmaceutical industry has resulted in skyrocketing abuse of opioid prescription drugs. The U.S. Department of Health and Human Services reported that 2.1 million people misused opioid drugs for the first time in 2016.
The tragic results for those who become addicted to these analgesics include severe psychological reactions. Abuse of the opioid hydrocodone has been linked with hallucinations, paranoia, irritability, aggression and violent behavior. Addiction websites warn of mood and behavior changes as one of the opioid side effects of hydrocodone use.
A 2015 study by researchers in Finland, published in the journal World Psychiatry, found that current use of opioid analgesics “was associated with significantly increased risk of offending.”
A 2014 study by University of Michigan researchers, published in the journal Addictive Behaviors, reported that prescription opioids and sedatives were the substances most likely to have been used prior to dating violence among a group of 575 teenagers and young adults.
The list of school shooters under the influence of psychiatric drugs at the time of their rampage is a long one. Among them are:
Columbine High School Shooting, Littleton, Colorado
On April 20, 1999, two senior students, Eric Harris and Dylan Klebold, drove to Columbine High School, parked their cars, and carried two propane bombs into the cafeteria. A bomb summary by the Jefferson County Sheriff stated that 488 students in the cafeteria would have been killed or seriously injured if the bombs had detonated. When Harris and Klebold realized the bombs had failed, they began shooting, ultimately murdering 12 students and one teacher before killing themselves.
Harris had been prescribed the antidepressant drug Luvox. The family of one of Harris’ victims filed an antidepressant lawsuit against the maker of Luvox, Solway pharmaceuticals, and hired psychiatrist Peter Breggin as a medical expert, giving him access to key records in the case. According to Breggin, the school shooter “took Luvox on the day that he did the shootings, or perhaps the night before, because he had a normal, effective level of Luvox in his blood on autopsy. I have seen the data.”
Breggin reviewed the scientific research linking Luvox and other antidepressants to mania, psychosis, and aggressive behavior in two papers, one published in the International Journal of Risk and Safety in Medicine in 2001 and a second published in the same journal in 2004.
Northern Illinois University Campus Shooting, Dekalb, Illinois
On February 14, 2008, Steven Kazmierczak opened fire with three pistols and a shotgun on the campus of Northern Illinois University, killing 5 students and wounding 17 others before killing himself. He had been taking three psychiatric drugs, the antidepressant Prozac, Xanax, a drug used to treat anxiety, and Ambien, a sleep aid. All three drugs have been linked to acts of violence and homicide. Kazmierczak’s girlfriend of two years said she had never seen him behave violently.
Florida State University Shooting, Tallahassee, Florida
Myron Deshawn May, a former Florida State honor student and successful attorney, shot three people at Florida State University before being killed by police on November 20, 2014. He had been prescribed the antidepressant Wellbutrin and Vyvanse, an amphetamine prescribed for attention deficit hyperactivity disorder (ADHD). May’s autopsy blood test found amphetamine levels indicating he was using amphetamines.
May’s descent into madness under the influence of psychiatric drugs was the subject of the documentary Speed Demons: Dying for Attention.
Did Medication Play a Role in the Marjory Stoneman Douglas School Shooting?
Nineteen-year-old Nikolas Cruz has been accused of carrying a semiautomatic AR-15 rifle into Marjory Stoneman Douglas High School on the afternoon of February 14, 2018, and opening fire, killing 14 students and 3 staff members. As is often the case in school shootings, details of the shooter’s mental health history and the exact medications taken are not clear, but it has been reported that Cruz was treated for ADHD and possibly depression. It also appears Cruz has been in the mental health system for many years and consistently taking his prescription medications.
The New York Times reported that Florida’s Department of Children and Families (DCF) investigated Cruz in September 2016, shortly after he turned 18. A DCF report stated that Cruz was autistic, had depression and attention deficit hyperactivity disorder (ADHD). He was regularly taking medication for ADHD.
A Naples Daily News story noted that a counselor with Henderson Behavioral Health in Broward County told DCF that Cruz was “compliant with taking his medications and keeps all of his appointments.”
A report in the Florida Sun Sentinel said the DCF report noted Cruz was being treated for depression, but it was unclear if that included medication.
The Washington Post reported that Cruz was a behavioral challenge at Westglades Middle School beginning in the 6th grade. His behavior was so disruptive that some teachers banned Cruz from their classrooms and at least one did not want to be alone with him in the classroom.
In 2013, Broward County stopped referring students to police for incidents of bullying, harassment and assault. Instead, they were referred to community social services agencies. School arrests fell 63% and Broward’s system of discipline received national recognition.
Mass Shootings in America
There seems to be an epidemic of mass shootings in America. Mass shootings are, of course, not confined to schools and multiple examples in the list of mass shootings provide evidence of an apparent link to medication.
It is often said that untreated or inadequately treated mental illness is the cause of mass shootings or other cases of extreme violence. Given the perpetrators in a majority of these cases were being treated, that argument rings hollow.
Navy Yard Shooting, Washington, D.C.
On September 16, 2013, Aaron Alexis fatally shot 12 people and wounded three others in a mass shooting at the Washington Navy Yard. Mr. Alexis was prescribed trazodone, a medication used to treat depression and insomnia that has a mechanism of action similar to SSRI antidepressants like Prozac and Paxil. Trazodone can cause mania and violent behavior.
Movie Theater Shooting, Aurora, Colorado
One of the most horrifying mass shootings in American history was the attack that took place at Century movie theater in Aurora, Colorado. On July 20, 2012, 25-year-old James Holmes opened fire in the theater, killing 12 and wounding 70.
Holmes had been prescribed the antidepressant Zoloft (sertraline). David Healy, a psychiatrist and international authority on antidepressants, was hired as an expert witness in the SSRI shooting case. In his opinion, the killings would not have happened had it not been for the medication James Holmes had been prescribed.
The Public’s Right to Know About Medication-Induced Violence
Parents and the public have a right to know what psychiatric drugs do in the brain, the side effects of taking and withdrawing from these medications, and the medical basis—or lack thereof—behind the skyrocketing number of children being prescribed these drugs. This is basic medical ethics and the foundation of informed consent. Failure to warn the public of the dangers of medication-induced violence, and to ensure patients taking the drugs are closely monitored for signs of adverse drug reactions can have disastrous consequences. People have the right to know.
If you or a loved one has been injured in an incident of mass violence that may have been caused by prescription medications, please contact the attorneys at Baum, Hedlund, Aristei & Goldman for a free consultation.