The Effects of Pharmaceutical Drugs on Violence and Mass Shootings.

• Author: Girod, Robert J.

INTRODUCTION

The concept ofpharmaceutical drugs (prescription medication) affecting behavior is not new, but remains controversial in some circles. To be sure, "big pharma" has a vested interest in denying the possible nexus between prescribed drugs and violence of any kind. But even in the academic community, which theoretically questions everything, even proposing to research a possible nexus has been met with some hostility from those who find it easier to proclaim that guns cause violence than to dare to question the conventional wisdom and look for other cause and effect hypotheses. In fact, when I was asked to present a research proposal at one university, I was met with, not only hostility by at least one member of the committee, but almost with physical violence for suggestion a look at whether (or not) prescribed pharmaceutical drugs have a cause and effect nexus to mass shooting violence.

The real question is, "which came first; the chicken or the egg," i.e. a) do prescribed pharmaceutical drugs cause or have an effect on mass shootings and other violence or b) do mass shooters require prescribed pharmaceutical drugs for behavior that leads to violence? Clearly there is some nexus that needs to be researched for clarity of this cause and effect relationship.

THE NEXUS BETWEEN PSYCHOTROPIC DRUGS AND MASS SHOOTING

Some researchers estimate that 20% of youths in the juvenile justice system have serious mental disorders. A much higher percentage have less serious, but still significant, mental health problems. Juvenile offenders who have mental illnesses are often referred to as "emotionally disturbed," but these juveniles are not prone to commit any particular crime over another. While mass killers generally have guns in their hands, another commonality is that they often have psychiatric drugs in their system. The difference is, guns do not exhibit the side effect of "homicidal ideation," where drugs have been found to do so. So there is a strong commonality or a nexus. Are medication side effects a contributing factor or have a cause and effect relationship?

Drugs, whether illegal or prescribed, can cause aggression by altering the neurotransmitters dopamine, gamma-aminobutyric acid (GABA), norepinephrine, and serotonin. Aggression can be either impulsive or predatory aggression. Drugs, in some circumstances, can cause impulsive aggression. A defense in some criminal cases is that the drug caused the violence, i.e. drug-induced insanity. Another strategy is to seek diminished capacity, which aims to obtain a reduction in the severity of the criminal charges. (1) Most psychiatric drugs can cause withdrawal reactions, including life-threatening emotional and physical reactions. So it is not only dangerous to start psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.

CAUSE AND EFFECT

A study by the Institute for Safe Medication Practices, published in the journal PloS One and based on data from the FDA's Adverse Event Reporting System, identified 31 drugs that are disproportionately linked with reports of violent behavior towards others. (2) The top ten include five (5) antidepressants and two (2) drugs used to treat attention-deficit hyperactivity disorder (ADHD).

Violence towards others is a seldom-studied adverse drug event and an atypical one because the risk of injury extends to others. Acts of violence towards others are a genuine and serious adverse drug event associated with a relatively small group of drugs. (3)

In another study, the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) data was used to extract all serious adverse event reports for drugs with 200 or more cases received from 2004 through September 2009. The study identified any case report indicating homicide, homicidal ideation, physical assault, physical abuse or violence related symptoms. "Disproportionality" in reporting was defined as a) five or more violence case reports and b) at least twice the number of reports expected given the volume of overall reports for that drug. (4)

The study identified 1,527 cases of violence "disproportionally" reported for 31 drugs. Varenicline, which increases the availability of dopamine, and antidepressants with serotonergic effects were the most strongly and consistently implicated drugs. Suspect drugs included Varenicline (an aid to smoking cessation), 11 antidepressants, 6 sedative/hypnotics and 3 drugs for attention deficit hyperactivity disorder. The evidence of an association was weaker and mixed for antipsychotic drugs and absent for all but 1 anticonvulsant/mood stabilizer. (5)

1. Varenicline (Chantix) - the anti-smoking medication affects the nicotinic acetylcholine receptor, to help reduce craving for smoking. But it is 18 times more likely to be linked with violence compared to other drugs. (6)

2. Fluoxetine (Prozac) - the first well-known SSRI antidepressant, Prozac is 10.9 times more likely to be linked with violence in comparison with other medications. (7)

3. Paroxetine (Paxil) - an SSRI antidepressant, Paxil is also linked with more severe withdrawal symptoms and a greater risk of birth defects compared to other medications in that class. It is 10.3 times more likely to be linked with violence compared to other drugs. (8)

4. Amphetamines: (Various) - used to treat attention-deficit hyperactivity disorder (ADHD) and affect the brain's dopamine and noradrenaline systems. They are 9.6 times more likely to be linked to violence, compared to other drugs. (9)

5. Mefoquine (Lariam) - a treatment for malaria, Lariam has for a long time been linked with reports of bizarre behavior. It is 9.5 times more likely to be linked with violence than other drugs. (10)

6. Atomoxetine (Strattera) - used to treat attention-deficit hyperactivity disorder (ADHD), Strattera affects the neurotransmitter noradrenaline and is 9 times more likely to be linked with violence compared to the average medication. (11)

7. Triazolam (Halcion) - a benzodiazepine, which can be addictive, and is used to treat insomnia. Halcion is 8.7 times more likely to be linked with violence than other drugs. (12)

8. Fluvoxamine (Luvox) - an antidepressant that affects serotonin (SSRI), Luvox is 8.4 times more likely than other medications to be linked with violence. (13)

9. Venlafaxine (Effexor) - a drug (related to Pristiq) in the same class of antidepressants, both are also used to treat anxiety disorders. Effexor is 8.3 times more likely than other drugs to be related to violent behavior. (14)

10. Desvenlafaxine (Pristiq) - an antidepressant, which affects both serotonin and noradrenaline, is 7.9 times more likely to be associated with violence than other drugs. (15)

STUDY FINDINGS

The study of the FDA reports found the following drugs associated with violence and the number of adverse violent incidents. (16)

Drug Name Violence Cases VARENICLINE 408 FLUOXETINE 72 PAROXETINE 177 AMPHETAMINES 31 MEFLOQUINE 10 ATOMOXETINE 50 TRIAZOLAM 7 FLUVOXAMINE 5 VENLAFAXINE 85 DESVENLAFAXINE 8 MONTELUKAST 53 SERTRALINE 64 ZOLPIDEM 48 ESCITALOPRAM 31 SODIUM OXYBATE 6 CITALOPRAM 34 ARIPIPRAZOLE 23 OXYCODONE 46 BUPROPION 35 ZIPRASIDONE 19 METHYLPHENIDATE 27 MIRTAZAPINE 15 GABAPENTIN 35 LEVETIRACETAM 21 DIAZEPAM 11 ALPRAZOLAM 15 DULOXETINE 45 CLONAZEPAM 10 INTERFERON ALFA 54 RISPERIDONE 29 QUETIAPINE 53 PROZAC LAWSUITS: RISK OF SUICIDE AND SEROTONIN SYNDROME

Prozac (fluoxetine) is a well-known antidepressant drug produced by Eli Lilly and Company and was approved by the Food and Drug Administration (FDA) in 1987. Prozac was the first of many antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) that reached the market in the 1990s. Antidepressants, like Prozac, have since become the third most prescribed medication in the U.S. Researchers estimate that more than one in ten Americans takes antidepressant medication. Pharmaceutical companies annually earned billions of dollars a year in antidepressant sales before generic versions of the drugs became available. (17)

The most common side effects include headaches, loss of appetite, nausea, diarrhea, sinus infections, indigestion, dry mouth, dizziness, drowsiness, excessive sweating, rashes, and anxiousness. Some patients have reported experiencing sleep problems and sexual problems. Prozac carries an FDA black box warning cautioning patients about an increased risk of suicide among young people. The FDA first issued this warning for children and adolescents in 2005. The warning was expanded to cover young adults ranging in age from 18 through 24 in May 2007. Some patients in these age groups who took Prozac have reported experiencing suicidal thoughts and behavior and there have been some reports of actual suicide among Prozac patients. The families of some patients who took Prozac later committed suicide or developed suicidal behavior and some patients who developed serotonin syndrome after taking Prozac have sued for damages. (18)

Patients who take Prozac are at risk of developing serotonin syndrome. SSRI antidepressants are designed to boost a patient's mood by blocking the absorption of a chemical called serotonin in the brain. When patients develop excessive serotonin levels, they can experience symptoms such as agitation or restlessness, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle twitches, and headaches. These effects are similar to the symptoms of people under the influence of methamphetamine. (19)

MURDER AND CIVIL LITIGATION

Pharmaceutical manufacturers, such as Eli Lilly, have faced a number of lawsuits for multiple products, some of which have resulted in settlements of thousands of dollars for the victims. Actos (pioglitazone), produced by the Japanese pharmaceutical company Takeda and co-marketed by Eli Lilly from 1999 to 2009 in the US, resulted in injuries such as congestive heart failure and...