Akathisia: The number-one cause of suicide?
If Peanut the squirrel could cause Kamala Harris to lose the election, perhaps Bruno the dog could cause psychiatry to lose the trust of the American people?
That’s unlikely, because it's been almost 50 years since Bruno was almost killed by his owner in a fit of drug-induced violence, and yet there are still doctors, possibly even a majority of them, who are unaware or refuse to entertain the idea that psychiatric drugs can cause the extreme discomfort labeled akathisia and lead to severe, almost uncontrollable violent impulses that can result in suicide or even homicide.
'Just take this and you'll feel better'
Bruno featured in a case study published in 1978, which describes a man with a problematic history who was given haloperidol (Haldol) in order to help him with his impulsiveness:
The patient ... reported a great decrease in his level of hostility, agitation, and thought disorganization ... One week later, the patient reported that he was more agitated at night. Since it was not known at that time that akathisia was beginning, haloperidol treatment was increased ... he became uncontrollably agitated, could not sit still, and paced for several hours.
He complained of a tightness in his muscles, rigidity, a jumpy feeling inside, and violent urges to assault anyone near him. This culminated in an assault on his dog with an intent to kill.
He became frightened over his loss of control and came to the emergency room ... Three days after drug treatment was discontinued, all of these symptoms had ceased...
Dr. Walter A. Keckich, the author of this case study, noted that “this person had a characterological and social predisposition to violence” which likely contributed to the way in which he responded to his drug-induced akathisia. Bruno was lucky; he survived the assault. But his owner is not the only person in the world with a “predisposition to violence” and millions of people take drugs that can cause akathisia. How many other victims of drug-induced homicide have there been?
The number-one cause of suicide
According to Dr. David Healy, a professor of psychiatry who founded the rxisk.org website,
Akathisia is such an uncomfortable state that it is the leading cause of death by suicide and a common trigger to homicides and aggression.
He founded RxISK “to empower you to have better conversations about your medications with your doctor,” stressing that, “no one knows more about the effects of a drug than the person taking it."
When it comes to akathisia, doctors often refuse to believe their patients, finding it too cognitively dissonant to admit that drugs they have prescribed may be making their patients worse when all the neurological tests they run come back showing normal results.
In our previous article in this series on akathisia, The Gold Report reported on the case of a Canadian woman denied access to doctor-assisted suicide, after two “experts” and a judge decided that her akathisia was “treatable.” The woman describes what she is enduring as “the horrors” and has been suffering immensely for around six years. Her husband, who understandably and rightly wants her to continue to live, is among many relatives of drug side-effect victims who say they cannot fathom what they are going through. So far, he has managed to save her, but many others have, in desperation, ended their lives in an agony that can appear invisible to outsiders.
Six days to disaster
Missd.co was founded by Wendy Dolin after her husband committed suicide due to drug-induced akathisia. Steward Dolin was just 57 when he jumped onto train tracks and ended his life.
Stewart Dolin had the perfect life. He was married to his high school sweetheart for 36 years. He was the father of two grown children with whom he had a very close and meaningful relationship. He was a senior partner of a large international law firm, managing hundreds of corporate lawyers. He enjoyed his work and derived satisfaction from cultivating relationships with his clients, as well as helping them achieve the results they desired. He enjoyed travel, skiing, dining, joking around with his family and friends and an occasional cigar. He was 57 years old, and high on life.
Everything changed, Wendy Dolin relates, after Paxil:
In the summer of 2010, Stewart developed some anxiety regarding work. He was prescribed Paxil (paroxetine), a selective serotonin reuptake inhibitor (“SSRI”) ... Within days, Stewart's anxiety became worse. He felt restless, had trouble sleeping ... and kept saying, “I still feel so anxious.”
On July 15, 2010, (six days after beginning the medication), following a regular lunch with a business associate, Stewart left his office and walked to a nearby train platform. A registered nurse who was also on the platform later reported seeing Stewart pacing back and forth and looking very agitated. As a train approached, Stewart took his own life.
'With everything to live for, I wanted to die'
Missd.co is dedicated to raising awareness of akathisia. Among their projects has been placing advertisements in subway stations, to educate the public on the side effects of drugs that so many millions take on a daily basis.
Stewart Dolin is one victim. Many others took their lives. Some took the lives of loved ones and then their own. Still others continue to struggle to live with unimaginable suffering which can last weeks, months, or years.
J.A. Carter-Winward describes how:
I was medicated with an SSRI after a traumatic brain injury in 1997, and after experiencing drug-induced akathisia, my diagnosis was “upgraded” to bipolar disorder II. It was then I was placed on the polydrug carousel that came to characterize and inform the remainder of my adult life...
During the years following all this, I experienced increasing levels of suffering due to akathisia. While not the sole consequence of these drugs, akathisia was easily the worst and after my first bout with it, it never fully subsided.
It became my baseline, but nineteen years later, in 2016, I had reached the brink of what I could tolerate. With everything to live for, I wanted to die. The medications they gave me to help me walk, speak, and sleep did nothing to quell the akathisia stubbornly grinding its way through my resolve. There were days I could barely breathe, barely move because I felt frozen in terror — but the compulsion to move overwhelmed me.
After years of suffering, Carter-Winward found a path toward healing which will be described in the third part of this series.
Springsteen: 'I just wanted OUT'
What virtually all victims describe is the paralyzing fear that accompanies the compulsive need to move, and the virtual impossibility of countering it:
I had akathisia for 18 months, four of which were incredibly severe. At that stage it is accompanied by an awful sense of dread and doom. I remember getting through each breath was torture, minutes seemed like hours. It is completely alien to normal experience, the mindset of suffering is just off the charts, indescribable.
One high-profile victim is Bruce Springsteen, who recounted his experience in his book “Born to Run.” After a bout with medication that led to melancholia came something else entirely:
I had an attack of what was called an ‘agitated depression.’ During this period, I was so profoundly uncomfortable in my own skin that I just wanted OUT. It feels dangerous and brings plenty of unwanted thoughts. I was uncomfortable doing anything. Standing…walking…sitting down…everything brought waves of an agitated anxiety that I’d spend every waking minute trying to dispel.
Demise and foreboding were all that awaited and sleep was the only respite. During waking hours, I’d spend the day trying to find a position I would feel all right in for the next few minutes ... but really all I wanted was ... unconsciousness. I spent good portions of the day with the covers up to my nose waiting for it to stop...
Springsteen eloquently describes the feelings of desperation:
I felt myself dangerously slipping away. I became a stranger in a borrowed and disagreeable body and mind. This lasted for six weeks...
I couldn’t live like this, not forever. For the first time, I felt I understood what drives people toward the abyss. The fact that I understood this, that I could feel this, emptied my heart out and left me in a cold fright. There was no life here, just an endless irritating existential angst embedded in my bones.
40 years of 'inexplicable' suicides...
While it is by now widely known that antidepressant drugs can cause suicidal ideation, suicide, and even homicide, what is less known is that the suicidal thoughts are thought to be more often than not linked to akathisia and the agonizing feeling that one simply cannot go on living in such a state.
Multiple studies have described this theory:
The term “suicidal ideation” to describe the apparent suicidality associated with akathisia is misleading as the “suicidal ideation” reported in patients receiving fluoxetine [Prozac] was a reaction to the side-effect of akathisia (i.e., unbearable discomfort and restlessness) and not true suicidal ideation as is typically described by depressed patients experiencing suicidal ideation. (Hamilton and Opler, 1992)
SSRI-induced akathisia may represent a form of serotonergic overstimulation or serotonin toxicity ... [which] includes changes in mental status and behavior, neuromuscular system changes and autonomic instability. (Lane and Baldwin, 1997).
As far back as 1983, research papers were being published describing the tragic consequences, such as one by researchers at New York Hospital and Cornell University Medical College:
A 23-year-old man ... was intermittently delusional with auditory hallucinations ... He received two injections of 25 mg of [the antipsychotic] fluphenazine decanoate ... with noticeable improvement in his psychotic symptoms. He also developed akathisia...
A family member called to say the man had killed himself by jumping off the roof of their building. He had given no indication of being suicidal and his family believed the increased "nervousness" had driven him to this desperate measure. The patient had no previous history of suicidal behavior and did not drink alcohol or use drugs. [emphasis added]
... with baffled doctors only making things worse
Another case described in the same paper describes what can happen when doctors fail to recognize akathisia and the drugs they prescribe to treat the outward observable symptoms actually make things worse:
A 36-year-old man was seen once in our walk-in clinic because of severe restlessness and leg cramps ... When the symptoms worsened he began a series of visits to hospital emergency rooms and private psychiatrists... [one of whom] diagnosed paranoid schizophrenia and administered depot fluphenazine. Following this injection the patient developed a dystonic reaction and then began to complain continuously of leg cramps and restlessness.
In the ensuing weeks he received numerous drugs from emergency room or private physicians ... He was agitated, paced, and begged for help. He denied symptoms of depression or suicidal ideation. He claimed he was devoted to his wife and 9-year-old daughter, but he felt his unbearable symptoms would never go away...
... he killed himself without warning by jumping in front of a subway train. [emphasis added]
The authors of this research paper write:
Akathisia is an intensely unpleasant feeling characterized by muscle discomfort, inability to sit still, continuous agitation, restlessness ... Sleep may be disturbed by an inability to lie down. Some patients say they feel like jumping out of their skin. It is of interest that both patients reported here killed themselves by jumping.” [emphasis added]
They also note that “the estimated incidence of akathisia with neuroleptic use ranges from 20 to 45 percent.” This was known 40 years ago.
Kids with ADHD... or akathisia?
Zoloft is one of the most frequently prescribed antidepressants in the United States. Around 40 million prescriptions are written for this drug per year in the U.S. alone. The package insert mentions akathisia only as something that has been anecdotally observed after the drug was approved by the FDA. It is not listed among the side effects. However,the following are listed among Zoloft’s adverse events: insomnia (20% in clinical trials); agitation (8% in clinical trials); irritability; muscle spasms, tightness, or twitching; psychomotor hyperactivity.
Among children, the insert reveals that, “... in at least 2% of pediatric patients... hyperkinesia [persistent restlessness and excessive movement] ... aggression ... muscle twitching, and anxiety.”
Zoloft’s insert also includes “suicidal thoughts and behaviors” among the observed side effects, with no comment on what could be provoking them.
Murder by prescription
What drug package inserts do not mention are homicidal adverse events, even though the medical literature does document them — for instance, in this paper, published in the Journal of Pharmagenomics and Personalized Medicine in 2011.
This paper concerns 10 out of 129 subjects who had been referred ... for expert opinion or treatment ... [after being] diagnosed with akathisia/serotonin toxicity after taking psychiatric medication that had been prescribed for psychosocial distress...
Ten representative case histories involving serious violence are presented in detail.
In one case, an 18-year-old man was prescribed Prozac, took it for 14 days, and then ran out of pills.
Treated [with an antidepressant] because twin sister was comatose after a car crash. Violent akathisia for 14 days; killed father 4 days after subject ran out of pills.
This man was tried and sentenced to 60 years behind bars. In the words of the study’s author, he “recovered on withdrawal” from the drug.
Another case describes a 35-year-old man who murdered his ex-wife:
Paroxetine [Paxil] 20mg/day. Distressed by “on and off” relationship with mother of his child. Stabbed former partner 30+ times after 11 weeks of akathisia on paroxetine. No memory [of incident]. Convicted of murder. Recovered on withdrawal.
Paxil was implicated in yet another case with tragic results:
46-year-old male, Paroxetine 40mg/day for 40 weeks. Suicidal, increased to 60mg/day. Anxiety ... insomnia and weight loss. Killed son in a manic shift akathisia/delirium ... Recovered on withdrawal.
The study’s author stresses:
None of the ten subjects described had any history of mental illness; none had been violent before. All recovered from akathisia after stopping the medication without assistance or supervision and, frequently against medical advice.
Recovery from akathisia, partial or complete, IS possible. Part three of this series of articles will include stories of courageous perserverance as well as recovery, research into drugs and treatments that offer hope, as well as resources for people living with akathisia and their loved ones.
Disclaimer: The information contained in this article is for educational and information purposes only and is not intended as health, medical, financial or legal advice. Always consult a physician, lawyer, or other qualified professional regarding any questions you may have about a medical condition, health objectives, or legal or financial issues.
If you are struggling with suicidal thoughts, you can call a qualified mental health helpline or seek help from a qualified therapist.
