My October 3, 2011 blog on The Huffington Post described a recent precedent-setting criminal case in which a Winnipeg, Manitoba judge confirmed my written opinion and courtroom testimony that Prozac adverse drug effects drove a 16-year-old boy to stab a friend to death. I have now made the judge's opinion available online and also as a part of my more extensive report on the case on my website.
In the case of "C.J.P," Judge Robert Heinrichs concluded, "Dr. Breggin's explanation of the effect Prozac was having on C.J.P.'s behavior both before that day and in committing an impulsive, inexplicable violent act that day corresponds with the evidence" (p. 18). My written report in the case stated, "At the time of the assault, [C.J.P] was suffering from a Prozac-Induced Mood Disorder (292.84) with manic features (especially extreme irritability) caused by Prozac. I want to emphasize that, within a reasonable degree of medical certainty, he would not have become violent without the exposure to Prozac, and he will not become violent again."
Judge Heinrichs also found, "There is clear medical and collateral evidence that the Prozac affected his behavior and judgment, thereby reducing his moral culpability" (p. 20). In my report I observed that C.J.P.'s adverse reactions to Prozac exactly paralleled the description of adverse drug reactions contained in the FDA-approved label for Prozac, including the "emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down" (p. 8). C.J.P. had deteriorated emotionally over a three month period on Prozac, including an increase in dosage 17 days prior to the assault.
The case of C.J.P. and its violent outcome can be compared to a similar case that I describe in "Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime." A very gentle teenage girl whom I called Emily Ashton developed a sudden urge to thrust a knife into her mother's back during her second week of taking Prozac. Like C. J. P., she was 16 years old; but unlike him, she showed no outward signs of a worsening mental condition and displayed no anger at all until the sudden compulsive urge to stab her mother began to overtake her. At the time, there were no angry conflicts in the family. Fortunately, Emily told her mother about the bizarre and violent compulsion. As in C.J.P.'s case, Emily's mother knew that violence was wholly out of character for her daughter and she suspected the Prozac.
Again as in C.J.P.'s case, Emily's mother took her back to her prescribing family doctor who then referred her to a psychiatrist. There the comparison ends. Unlike C.J.P.'s tragic case, the consultant psychiatrist recognized the problem as Prozac-induced and immediately stopped the anti-depressant, after which the compulsion gradually subsided. Emily went on to live a normal, productive adult life and to raise a family. Nonetheless, she continued to feel guilty about her violent impulse that overcame her at the age of 16. She felt relieved many years later when we talked and I was able to reassure her that the impulse had been chemically-driven by the drug.
All of the newer anti-depressants carry the same warnings as Prozac concerning "anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression and suicidal ideation." These drugs include Celexa, Lexapro, Luvox, Prozac or Serafem, Paxil, Cymbalta, Effexor, Wellbutrin or Zyban, and Pristiq.
Many tragic acts of suicide and violence could be averted by reducing or stopping the use of anti-depressant drugs, by greater professional and public awareness of the dangers associated with these drugs, by withdrawal from the drugs at the earliest sign of mental and behavioral deterioration, and by greater reliance on individual and family psychotherapy.
The effectiveness of anti-depressants has been increasingly called into question. At the same, the risk of withdrawing from them has become more obvious, and cutting back or stopping them requires experienced clinical supervision and a slow, cautious taper. Many psychotherapists successfully treat depressed patients without resort to these drugs.
Peter R. Breggin, M.D. is a Harvard-trained psychiatrist and former full-time consultant with NIMH who is in private practice in Ithaca, New York. Dr. Breggin is the author of more than twenty books including the bestseller Talking Back to Prozac and the medical book Brain-Disabling Treatments in Psychiatry, Second Edition. His most recent book is Medication Madness, the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime. He is also the author of dozens of peer-reviewed scientific articles, many in the field of psychopharmacology. On April 13-15, 2012 in Syracuse, New York, the annual conference of Dr. Breggin's international organization, The Center for the Study of Empathic Therapy, will present a panel of lawyers, experts, survivors and families concerning antidepressant-induced violence and crime. Conference information is available on www.EmpathicTherapy.org.