The Infinite Mind is a long-running weekly public radio show about health issues, psychology and the mind in society, produced by Lichtenstein Creative Media and hosted by Dr. Fred Goodwin. Dr. Fred Goodwin is a Professor of Psychiatry and Director of The Center on Neuroscience, Medical Progress, and Society at The George Washington University Medical Center. He is a physician-scientist specializing in psychiatry and psychopharmacology, and is the former Director of the National Institute of Mental Health (NIMH). (Full disclosure: I produced LCM’s first website back in the late 1990s, but quit doing so in 2000.) The Infinite Mind is an established, well-respected program, with a mix of news updates and interviews with leading experts.
Furious Seasons has an angry response to a recent show about the connection between Prozac and the NIU tragedy. We discussed the possible link to Prozac and violence a few days after the tragedy here and didn’t find strong evidence connecting the two. Especially in light of the fact that the NIU murderer, Steven Kazmierczak, had apparently discontinued use of Prozac 3 weeks prior to the killings.
We agree that while there seems to be increased risk of suicidal thoughts and behaviors in people who take SSRI antidepressants, there has been no associated risk in regards to violent behavior toward others. The two are completely different behaviors and have virtually no connection to one another (except suicide can be, but is not necessarily, a “violent” act).
One of the things I get worked up about is when people associate mental health concerns (or mental health treatments) with an increased risk for violence. Unless substance use is involved, the research is clear that there is little to no increased risk of violent behavior amongst those who are mentally ill.
The same appears to be with drug treatments (ironically, often the same drug treatments used in the hopes of quelling violence in some patients, see for example Goedhard, et. al., 2006 or Janowsky, et. al. 2005). Walsh et. al.’s (2001) meta-analysis of studies published up to that date could find no connection between SSRI antidepressants and an increased risk of violence. Fazel, et. al. (2007) actually showed a lowered risk for violent suicide (as compared to non-violent suicide) completers in those taking an SSRI antidepressant.
SSRI antidepressants have been shown to have an increased associated risk of suicidal thoughts and behaviors. Period. On this point, I don’t think there’s any widespread disagreement amongst unbiased professionals. Using the NIU incident to get into a wider discussion about antidepressant use, suicidal behavior, and the connection between the two seems like a bit of a leap. The discussants would likely have been better off not to even bring up the NIU case, since it seems to have little to do with antidepressants or suicidal behavior.
Finally, we’re in agreement that there was indeed sufficient reason for the FDA black box warning on antidepressants, and we stand by their requirement of the warning to provide people with the most up-to-date and accurate information on this topic. So in that regard, the discussants on the program did a public disservice by suggesting that the warning — e.g., greater information — led to an increase in suicides. As Philip at Furious Seasons rightfully points out, there was no long-term trend that supported that theory.
Fazel S, Grann M, Ahlner J, Goodwin G. (2007). Suicides by violent means in individuals taking SSRIs and other antidepressants: a postmortem study in Sweden, 1992-2004. J Clin Psychopharmacol. 27(5):503-6.
Goedhard LE, Stolker JJ, Heerdink ER, Nijman HL, Olivier B, Egberts TC. (2006). Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review. J Clin Psychiatry, 67(7):1013-24.
Janowsky DS, Shetty M, Barnhill J, Elamir B, Davis JM. (2005). Serotonergic antidepressant effects on aggressive, self-injurious and destructive/disruptive behaviours in intellectually disabled adults: a retrospective, open-label, naturalistic trial. Int J Neuropsychopharmacol. 8(1):37-48.