SSRIs and violence
Every time there’s a school shooting or any sort of mass violence, the subject of SSRIs comes up from one commenter or another.
Sometimes people also bring up the subject of fatherlessness and mass shooters, which I wrote about at length in this post, the gist of which is that there is no connection although it’s popularly thought that there is.
Now, on to SSRIs. It is notoriously difficult to do research on whether SSRIs trigger more violence, have no effect, or help prevent violence, and if so in what populations. It’s a popular internet meme that they trigger violence, but the evidence is not at all clear that that is so, and as I said it’s very difficult to design a good study. One obvious reason is that such people are often at higher risk for violence in the first place, and drugs are not given randomly. There is almost certainly something already different about the people who get them and those who don’t.
This is one of the better-designed studies, and as you can see if you read it it’s very hard to tell what it all means, if anything. For example:
As is often the case, the authors of the study themselves are rather cautious. While obviously concerned that it is possible that SSRIs may actually cause violent behavior in a small minority of people, they fully recognize that other explanations are possible. These include the possibility that what is driving the violent behavior is medication undertreatment, based on the finding that the risk with violence was only found among individuals who were likely taking subtherapeutic doses. As reported by MedScape, one of the study authors, Seena Fazel, states: “Our own view is that some evidence suggests that it’s a bit more complicated than that, because we found a link with subtherapeutic doses of SSRIs, and that would suggest to us that it may be that it’s actually a lack of treatment [and] it could be residual symptoms that are driving this link.” At the same time, if antidepressants really worked wonders for young people, we should see that therapeutic SSRI usage was associated with a reduced risk of violent behavior, which it wasn’t.
A couple other factors also deserve mention. The idea of comparing periods on and off medication within the same individual is a clever design, because many individual factors that might be related to risk of violence, like one’s socioeconomic status or DNA, are held constant. However, because the period of medication use was not randomized (and couldn’t be), it introduces the very likely complicating issue that individuals were taking medications during times when they were feeling more depressed, anxious, and angry to start with, and thus at higher risk of acting violently. Finally, it is important to note that a statistically significant association certainly does not mean that most people taking antidepressants are out there hurting others. When taking SSRI medications, the conviction rate of violent crimes was at a 1.0% rate compared to 0.6% without medications.
Our study encompassed nationwide data over a 15-year period. In this period, the homicide rate per 100,000 remained fairly constant, with a moderate decline in recent years, leading to an average of 160 homicide victims per year. The suicide rate decreased steadily from 10.26 (approximately 1,500 victims) in 1994 to 8.77 (approximately 1,400 victims) per 100,000 in 2008. The homicide–suicide rate remained relatively stable, averaging at 0.05 per 100,000 (varying from 4 to 14 victims per year, see Fig. 1). In the same period, the rate of total antidepressant use increased considerably, from 3,038.81 in 1994 to 5,650.58 per 100,000 in 2008. A similar increase was observed for the rate of SSRI use alone, which more than doubled from 1,482.25 in 1994 to 3,161.15 per 100,000 in 2008 as well as the rate of SSRI use including venlafaxine, with an increase of 1,486.81 in 1994 to 3,904.20 per 100,000 in 2008. Over the same period, the number of defined daily doses used rose from 59.6 million in 1994 to 245.3 million in 2008: a fourfold increase. This indicates that not only more people used antidepressants, but also that the mean duration or intensity of the treatment grew…
Rates of the use of SSRIs including venlafaxine were also found to be negatively associated with both homicide rates and suicide rates. No significant independent association was found between rates of SSRIs including venlafaxine and homicide–suicide.
Here’s an article about suicide and SSRIs for young people:
The 2004 study examined the clinical trial data that had been collected on two types of medications, selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitors (SNRI). The results of the study prompted the Food and Drug Administration (FDA) to issue a black box warning, the most serious level of warning in prescription drug labeling, for the risk of suicides in children and adolescents being treated with antidepressants in 2004. The warning was extended to young adults ages 18 to 25 years in 2006.
The researchers in the current study performed a meta-analysis of 41 studies, reviewing the data on a total of 9,185 youths, adults, and geriatric patients who were treated with fluoxetine (Prozac is one common brand) and venlafaxine (Effexor) immediate (IR) and extended release (ER) preparations…
In all three age groups, treatment with fluoxetine and with venlafaxine IR and ER resulted in a statistically significant improvement in depressive symptoms when compared to treatment with placebo. The decline in depressive symptoms was also faster for patients treated with medication than control group patients. In the adult and geriatric patients who were treated with fluoxetine or venlafaxine, suicidal thoughts and behaviors decreased over time.
As the patients became less depressed, they had fewer suicidal thoughts and attempts. Although the youths who were treated with medication showed the same statistically significant decrease in depressive symptoms as the older populations, they did not show a decrease in suicidal ideation and actions.
“In kids, we don’t see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide,” said the study’s lead author…
The newest analysis did not support the idea that there was an increased risk of suicide in children and adolescents taking fluoxetine, an SSRI. In explaining the difference in their findings, the researchers note that these original meta-analyses included fewer studies and the studies were of shorter term than the longitudinal data they analyzed.
There probably will be a number of readers here who say something like this: “It’s all lies promulgated to cover up the damage drug companies do and to preserve their profits.” You’re welcome to that point of view, and certainly during the COVID years the CDC and many other official entities have earned our distrust. But if you throw out all research, including older studies such as these, you are left with internet memes and paranoia. That’s not science, either. I believe that most of these studies are attempts at valid research on a subject that is inherently difficult to study, and that the bulk of the evidence indicates that SSRIs do not increase violent behavior.
Early on, we see a doubling–0.5% to 1%. Small but double is twice as much.
If we use SSRI as a signal that the person we’re looking at has problems–irrespective of their origin or likely statistical result–we’d be getting some place, if only by reversing chicken and egg.
So, let’s say SSRI NEVER EVER causes school shootings. But underlying issues treated with SSRI do. Would it be fair to look more carefully at someone prescribed SSRI? Somebody, presumably a professional, thought he had something going on requiring SSRI.
Richard Aubrey:
Therapists are always supposed to monitor for suicidal and/or other violent impulses in patients, and particularly in those taking SSRIs but also in all patients. Problem is, it’s not easy to do, because some patients will hide such ideation and lie about plans.
I don’t know that we will ever have solid, understandable answers on why some people commit these atrocities.
There are definitely people with mental illnesses who can be helped by pharmaceuticals. However, I believe that number is far less than the number of people seeking and/or receiving help from pharmaceuticals.
Living life on planet Earth as a human is not a circumstance that generates human happiness. It is a major flaw in most first world countries that people use personal happiness as a gauge of their well being. Because they use this false gauge when they ask themselves “am I happy?” and the answer often comes back, “no,” people seek shortcuts from pharmaceuticals; or food, or social media, or alcohol, or recreational drugs or…
Humans are capable of having fulfilling lives. Rewarding lives. Joyful lives. Beneficial lives. All of those are much greater than “happy” lives, and none can be attained without struggle, failure and unhappiness.
Regarding the benefit or harm of pharmaceuticals on the human brain and thinking…
The human brain is the ultimate “black box.” The physical complexity alone is nearly incomprehensible. Depending on age, the number of synaptic connections is in the neighborhood of 600 trillion to 1 quadrillion. How can you do a controlled study on a system with that many variables? And even if you could have two, genetically identical brains, we are strongly shaped by our environments and experience.
The only psychotropic drug I have any real experience with is alcohol. There are days I can drink the same, identical drinks and feel and act completely sober. Another day those same drinks will impair my thinking and alter my personality. Alcohol makes some people happy, others sad, others violent, others tired, others energetic. And the chemistry of alcohol and how it is processed in the brain is well known and fairly easy to understand. We still have no chemical idea how or why many of these psychotropic drugs work in the human brain.
Humans are capable of having fulfilling lives. Rewarding lives. Joyful lives. Beneficial lives. All of those are much greater than “happy” lives, and none can be attained without struggle, failure and unhappiness.
Rufus:
Calling Dr. Peterson, Dr. Jordan Peterson…
Related:
” ‘I Felt Bullied’: Mother of Child Treated at Transgender Center Speaks Out;
“She was told medical intervention would help relieve her 14-year-old’s psychological distress. That’s not what happened.”—
https://www.thefp.com/p/i-felt-bullied-mother-of-child-treated
H/T Powerline blog.
What they’re telling you.
And what they’re not.
And why.
My mother was driven first into psychosis by prescription amphetamines, then into permanent brain damage (tardive dyskinesia) by prescription thorazine. To be fair, she was a mess and I grant her doctors were trying to help her.
So I was prepared to believe the worst about SSRIs after they had been out a while and a backlash emerged. Plus I had my therapist and everyone pushing me to get me on SSRIs when I was clinically depressed.
I admit I took Zoloft for a week from a physician-friend who considered SSRIs to be like vitamins or insulin. I had the worst manic episode of my life. I finally managed to get to sleep around 4am after hiking up and down the hills of San Francisco for several hours.
So I refused the SSRI route and found my way out with weight-lifting, therapy, ballroom dancing and Tony Robbins. I credit Tony most of all.
Since then I’ve kept a wary eye on SSRIs. But the really serious side-effects I feared have not come to pass, as neo has written. There may be a long-term link to strokes, but that’s about all I’ve found.
My bottom line on SSRIs is that they do have other milder, though still undesirable, side-effects like libido reduction and weight gain.
Furthermore, it’s hard for many people to get off SSRIs. I know people who have been on SSRIs since the 90s and they don’t expect ever to stop taking them. This strikes me as less than ideal.
I don’t believe 10% of Americans need to be on a psychiatric drug. Something’s wrong with this picture.
https://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624
It may be that mass killers are already so mentally disturbed that their medications make little difference in their actions. It’s very hard to say.
huxley, I strongly favor exercise and therapy to drugs whenever possible.
“Calling Dr. Peterson, Dr. Jordan Peterson…”
Umm…he’s a decent guy, but temporal at best.
Human maladies require a more eternal solution…like say what transpired at the end of this week.
Years ago I had a short run with Zoloft. I found it very unpleasant. Did little for the blues; just left everything neutral beige. It had the peculiar side effect of shutting down my inner dialogue, and replacing it with earworms. Whatever last thing I heard would stick in my head in an endless loop. God forbid I should hear some obnoxious commercial jingle on the radio. I stopped very soon.
The drug that I wonder about in these psycho shootings is Ambien. A few years back I had a run of ferocious insomnia. I tried the ambien, and it didn’t work well for sleep. Within two days I was hearing voices, believing that I was on a chosen mission from God, and that there was a satanic conspiracy trying to thwart me. I was seeing mouse turds on the floor everywhere. I went off on an old friend, and generally behaved like a lunatic. Oddly enough, it was a couple of CBD capsules that brought me to my senses.
I did a little asking around about the Ambien. In no time I heard stories of people doing things in a total blackout- sleepwalking, gorging on food, even driving the car and getting into accidents. No recollection. I found a ton of horror stories on line as well.
JWM
jwm:
Any of these drugs can cause bad reactions in a certain small percentage of people, but since so many people take them the numbers can add up.
The Nashville police still haven’t released the shooter’s writings, but they said on Monday that she had planned the shooting for months. That doesn’t sound like a drug-induced “snap.”
huxley, sorry about your mother. That had to be very difficult.
jwm, that’s an amazing story. Yikes!
For as long as I remember I have been very hesitant to take any medication (I do take vitamins). I don’t know where it came from, but my thought has always been: symptoms are the body and mind’s way of telling one something is wrong. Masking them is likely not the optimal solution, and may delay one’s investigation into the root cause.
Every time there is a school shooting the discussion quickly turns to why the shooter did what he did, how he got into the school, what kind of gun(s) were used, what was the police reaction, and now, if you can F’n believe it or not, what is the “proper” noun to describe the gender of the killer (as if anyone with a modicum of humanity and empathy for the REAL VICTIMS could give a sh*t).
Little to no discussion at all as to the best way to place armed guards or other armed individuals in every school which certainly would minimize (and maybe even prevent) school shootings.
How often do you hear of a shooter – even one seeking “suicide by cop” – enter a police station and begin shooting up the place?
Mass killers ALWAYS choose places where there is little to no chance of encountering an armed guard. I don’t think this is a coincidence.
And the mental state of the shooter seems to not be an impediment in the shooter’s ability to obtain any/all weapons he needs.
Yep, the shooter has mental problems – which caused him to shoot up a school – but his mental / thinking skills work just fine in finding a way to obtain the guns he will use to murder school kids. (Recall the nut-job who shot up a movie theater in Colorado some years back.)
As for those claiming that outlawing guns (or certain types of guns) would solve the problem, I refer you to existing drug laws.
For those interested, here is a chart of drug overdose death rates from 1999 to 2019 see here:
https://www.cdc.gov/nchs/products/databriefs/db394.htm
People will have all sorts of reasons to engage in school shootings and talking about their causes is a waste of time.
The only solution is to have armed guards / personnel at every school and how best to achieve and implement this should be the main point of discussion.
I am simply baffled why this is not the case.
Tennessee is taking steps to put an armed officer in every public school, and to provide funding for private schools to hire guards as well, at their option. The Nashville shooter, the police say, chose this Christian school because a couple of other targets she considered had too much security, that is, someone who could shoot back.
We keep talking about biology and brain science, probably because those usually give us answers in other areas, like medicine, which is extending life, which we value.
The problem with mass shooters is most people consider their actions inexplicable, so we fall back on the things which provide us understanding, but those things still can’t make us understand.
The ultimate simple reason why mass shooters do what they do is: they want to kill people and they no longer care if their spree ends with their death.
But where does that come from? Well, for whatever reason (traumatic childhood, broken family, lack of discipline or care from parents, bullying, or an inability to cope with the usual slings and arrows of life), these people first hate themselves, but unlike most people who hate themselves, they also take the next step of hating existence. They wish they had never been born. And when they see other people getting by, doing well, enjoying their existence, the hate becomes focused outward, too. How dare other people like the thing causing me so much pain. The resentment leads to the plan to punish the love of existence, and what’s the best way to do that? Not just to kill yourself, but to kill other people as well, as many as you can, to cause as much pain to others as you feel yourself, to make them see how terrible existence is. And what kind of killing maximizes other people’s pain? Killing children. Not only do you destroy the happiness of their entire family, but you also hurt everybody who values the lives of children. It’s a psychic wound to society when children are murdered, because they’re innocent.
Their innocence is the point of murdering them. It maximizes the pain the shooter can cause. It maximizes disillusionment and anguish, which is what they want to do. If they die only minutes later, they have those few minutes of knowing how much pain they’ve caused.
Mass shootings are a not a strike by the perpetrators at individual lives, but at life itself, at existence. Brain chemistry will never explain it, why some choose to hate existence and then act on that hatred.
“For as long as I remember I have been very hesitant to take any medication (I do take vitamins). I don’t know where it came from, but my thought has always been: symptoms are the body and mind’s way of telling one something is wrong. Masking them is likely not the optimal solution, and may delay one’s investigation into the root cause.”
Me too. I grew up in a family of 5. The aspirin bottle was routinely discarded for expiration with almost all the aspirins in it. This was carried into my adulthood. I never gave my children anything for an upset stomach except chamomile tea. I still use it and make sure I have it in my travel bag, just in case.
It is not just “an internet meme”–it’s been well known in the medical community since the day SSRIs were cleared by FDA–?forty years ago now?– that SSRIs cause violent ideation. (I assumed there was a black box warning.)
Patients are to be carefully monitored when the drugs are begun, particularly for self-violence.
https://www.peoplespharmacy.com/articles/antidepressants-and-thoughts-of-suicide-were-your-warned
There is a study where SSRIs were given non-psych patients (students) , and the violent ideation occurs in them as well.
NO psychotropic drugs have ever been tested for long term use—
and it’s starting to be noticed that it appears they “rot your brain” when used for extended periods of time–early dementia.
Far more effective in treating depression than ANY drug—moving outdoors.
Early in the day, even better. Push yourself if getting up is a problem.
https://amidwesterndoctor.substack.com/p/the-decades-of-evidence-that-antidepressants
https://amidwesterndoctor.substack.com/p/the-evidence-for-antidepressants
https://amidwesterndoctor.substack.com/p/how-the-fda-buried-the-dangers-of?utm_source=substack&utm_campaign=post_embed&utm_medium=web
Shock, chamomile tea contains “chemicals and molecules” as do drugs.
The dose makes the poison.
And of course there are diseases and afflictions that have no obvious symotoms (that old body not telling you anything is agley) such as glaucoma, the low intraoccular pressure variety.
The dose makes the poison.
Lee:
The later research – links and excerpts in my post – strongly indicates that there is no effect of SSRIs on actual violent acts by young people, and there is a decrease in older people.
There is an overlooked aspect to some of the mass shootings: autism. In fact, there was a scholarly piece by researchers in Sweden and Scotland a few years ago highlighting this linkage (https://psycnet.apa.org/record/2016-61678-005; also see https://www.intechopen.com/chapters/47518). The researchers in the first paper used the Mother Jones data base of mass shootings to do their analysis.
Think of Anders Breivik (Norway), Adam Lanza (Sandy Hook), Dylan Roof (Charleston), Seung-Hui-Cho (Virginia Tech), Nikolas Cruz (Marjory Stoneman), Dylan Klebold and Erik Harris (Columbine). All diagnosed with autism or strongly suspected of being on the spectrum. And, now Audrey Hale.
There is an interesting link between autism and transgenderism, too. Even NPR did a piece on this: https://www.npr.org/2023/01/15.
MAH:
Those articles over-define and over-diagnose autism. Most of these people have some social problems, and some are psychopaths, but neither thing is autism. The Sandy Hook killer was apparently autistic (Asperger’s), but most of the other diagnoses are very iffy.