Crooks on drugs -- assassination by prescription?
Listen to Prozac — what is it saying?
It’s almost superfluous to ask whether Thomas Matthew Crooks, the alleged Trump assassin, was taking psychotropic medication. Around 15 percent of American adolescents are taking some kind of psychiatric drug. Someone like Crooks, described by former classmates and college acquaintances as a “loner,” an “outcast,” and a kid who was “bullied so much ... it’s honestly kind of sad,” would almost certainly have been on some kind of medication to help him “deal with” issues. According to some reports, his father is a behavioral counselor, which would also increase the odds that his issues would have been addressed medically.
What kind of drug can help a loner to emerge from his solitude and engage in a positive way with his peers? The answer depends on who’s giving it. Those who believe in psychiatry’s power to change personalities (in the tradition of Peter Kramer’s Listening to Prozac) will be able to provide a list of drugs that can allegedly cure social anxiety and give a person a new lease on life. Those who are all too aware of the dark side of such drugs (in the tradition of Talking Back to Prozac, by Peter Breggin) will protest that personalities don’t change, regardless of medication, and that the underlying problems need to be addressed rather than stifled — or warped.
Babies on drugs
Prescribing antidepressants for young children is well established in the psychiatric community, so much so that even as far back as thirty years ago, around three in every thousand American preschoolers were taking an antidepressant drug. Many are given SSRIs (the most commonly prescribed type of antidepressant) for social anxiety including what is often described as “selective mutism.”
Some parents wax enthusiastic at the changes they see in their young children once drugged, such as Chapline, a Texas schoolteacher.
On her first day of kindergarten, teacher called me midway through first day, asking what she could do. Emily was literally frozen. She couldn't do anything. We made the decision right there that we had to try the medication to give her the chance to function in school.
Two years later, her daughter Emily was still on Prozac and Chapline described her daughter as “a happy kid, bright, who loves school.”
She has somewhat different relationships with her classmates because she doesn’t speak with most of them. But she's making progress and on her way to becoming a normal girl.
Twelve-year-old murderers
Prozac, like all other SSRI drugs, comes with a boxed warning that it can cause suicidal impulses. The patient insert doesn’t mention anything about homicide but the list of adverse effects that have been reported in people using the drug (both adults and children) includes “agitation ... irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania.”
At age four, six, eight, and perhaps ten, even the most aggressive child is unlikely to do serious harm. But Christopher Pittman (who now calls himself Kristen) was just 12 when he shot and killed his grandparents (with whom he had lived for years) before setting fire to their home and fleeing, with an implausible cover story that did nothing to help him evade a 30-year prison sentence for murder.
Pittman was on Zoloft, a common SSRI drug, at the time of the killings, having been abruptly switched from Paxil not long before. His father later recalled that after his dose was doubled by a local doctor, Christopher looked like he was in “an adrenaline rush. He was shaking his hands and feet like he was nervous.”
Drug-induced terror
What Pittman’s father was describing was probably akathisia, and the explanation “psychomotor restlessness” doesn’t do justice to the sensations people experience while in its grip. Dr. Joseph Glenmullen likens it to “torture” and stresses that there are two aspects to akathisia: the “outer restlessness that you can observe,” and the other “much more important one, an extraordinary state of terror inside a person.”
While suicidal impulses are a more common response to akathisia than homicidal ones, both have been linked to this drug-induced state. SSRIs are not the only drugs implicated — akathisia can also result from taking benzodiazepines and from drug withdrawal, especially if abrupt.
I had severe akathisia after my doctor forced me off of benzos he had prescribed me for over a year and a half. Paranoid delusions, severe panic attacks, tremors, loss of sleep for over a week, auditory and visual hallucinations, burning skin etc. If my will had not been strong enough, I would have killed myself and/or someone else.
When the voices take over
On the day he killed his grandparents, who “meant the world to him,” Christopher’s father later testified, the 12-year-old got into a fight and hurt a younger boy and his grandfather allegedly “paddled” him. That night, he took his grandfather’s shotgun and shot both grandparents as they slept.
In a letter the boy wrote afterward, he described the events:
When I was lying in my bed that night, I couldn’t sleep because my voice in my head kept echoing through my mind telling me to kill them. I got up, got the gun, and I went upstairs and I pulled the trigger. Through the whole thing, it was like watching your favorite TV show. You know what is going to happen, but you can’t do anything to stop it.
Drugs whose mechanism is a mystery
According to Prof. David Healy, around one in every 200 people using antidepressant drugs will experience psychosis — entering an altered state of consciousness. Over a thousand reports are received each year by the FDA related to violent acts linked to use of psychiatric drugs; between 2004 and 2011, 300 psychiatric drug-related homicides were reported. Every single one of the SSRI drugs has been implicated.
And yet, millions of other people use such drugs without becoming violent. Where are the studies examining the risk factors? Do they exist?
The problem is that no one knows how SSRIs work. Some doctors still defend the now-disproven serotonin theory of depression, but even that wouldn’t explain why everyone reacts differently to these drugs.
But there are clues. Antidepressants are used not only for depression, but also to treat social anxiety, selective mutism, and anorexia nervosa. What all these have in common is a certain kind of inhibition — fear of the effects of eating, fear of the reactions of strangers, fear of dealing with the emotions that social pressures can involve. SSRI drugs remove inhibitions, though it’s not exactly clear how.
Much more than ‘hyper’
This effect has been demonstrated in several studies, including one where “behavioral disinhibition” was distinguished from actual mania (which can also result from antidepressant use).
Behavioral disinhibition is more commonly seen than (hypo)manic reaction during treatment with Selective Serotonin Reuptake Inhibitors (SSRIs). It is differentiated from (hypo)manic reaction by the absence of more specific manic symptoms such as elevated mood and grandiosity.
Symptoms reported to be associated with drug induced behavioral disinhibition (DIBD) include increased oppositional behaviors, hyperactivity, excessive talking, irritability, socially inappropriate behavior(swearing, and obscene gesture), verbal and/or physical aggression, increased euphoria, akathisia or agitation, and self injurious behavior.
Enrolled in this study were 10 children between the ages of 6 and 11, who were being treated for OCD (obsessive-compulsive disorder), depression, selective mutism, separation anxiety disorder, or generalized anxiety disorder. Contrary to what many believe — that adverse events will develop almost immediately upon drug commencement — the children’s problematic behaviors started anywhere between 1 and 12 weeks after beginning treatment.
The researchers concluded that antidepressants,
... especially when used in the treatment of anxiety disorders and OCD, appeared to increase the risk of DIBD [drug induced behavior disinhibition]. As a result, clinicians are advised to be more cautious when using SSRIs in children for the treatment of anxiety disorders.
Intact brain + detached emotions = ?
A second study, conducted at the University of Copenhagen, enrolled 66 volunteers in a double-blind placebo-controlled experiment on the effects of escitalopram (more commonly known as Lexapro). After several weeks, the trial subjects were assessed to see how they responded to various cognitive tests.
When it came to performing tasks that involved using memory, attention, and reasoning, as well as decision-making, moral judgment, and emotion recognition, those on Lexapro performed just as well as those on placebo.
However, when assessing what is called reinforcement sensitivity — learning based on reward or punishment — volunteers taking Lexapro were less sensitive in their responses to reward and punishment in the here and now.
The researchers concluded that Lexapro dials down a person’s response to the positive and negative consequences of their actions, without affecting their reasoning power.
Importantly, our results are of considerable relevance when considering the patients’ experience of taking SSRIs chronically. Patients often report experiencing a “blunting” effect. This blunting effect has also been demonstrated for rewarding and punishing stimuli. Specifically, participants receiving 7 days of SSRI had lower neural processing of both rewarding and aversive stimuli. In light of our own results, it is possible that the clinical effectiveness of SSRIs for MDD [major depressive disorder] is due to this reduced negative affect. However, if indeed a positive affect is also reduced, then this would lead to a more general blunting effect, as often reported by patients taking SSRIs long term. This is supported by this study, in which lower reinforcement sensitivity would suggest decreased control over behavior by both rewarding and punishing stimuli.
It would seem reasonable to conclude that a drug that blunts a person’s emotions while leaving their general cognitive functions intact may lead a person to do things he would otherwise not dream of doing. These results relate to people who did not become psychotic, 199 out of 200 who use antidepressants. But 1 out of 200 also developed psychosis, and that rate multiplied by the millions who use these drugs is a lot of people.
Who lives with the consequences?
Little Emily is, according to her mother, thriving on Prozac and learning to be “normal.” Thomas Matthew Crooks is dead. The “meltdown” he allegedly had not long ago on a college campus would seem to fit in with the behavioral disinhibition described above.
Crooks will never stand trial, but Pittman did, and was found guilty of murder. In 2001, after Donald Schell killed his wife, his daughter, his granddaughter, and then himself, GlaxoSmithKline, the maker of the Paxil he was taking, was ordered to pay $8 million to his surviving family members. In Canada in 2011, a 16-year-old boy with no history of violence who stabbed a friend to death was found not guilty after the judge accepted the evidence of Dr. Peter Breggin that the defendant’s symptoms were consistent with Prozac-induced mood disorder with manic features.
In his summing-up, the judge stated that,
... his basic normalcy now further confirms he no longer poses a risk of violence to anyone and that his mental deterioration and resulting violence would not have taken place without exposure to Prozac.
Normal, that is, other than having to forever live with the knowledge of having killed a person while in an involuntary drug-induced stupor.
Psychiatry’s response? It was all ‘by chance’
If the medical profession as a whole would come to the same conclusion, perhaps then, people like Crooks, Pittman, and hundreds if not thousands of others would be living normal lives, undrugged, in control of their emotions, even seeking genuine treatment for their undoubted issues.
The response of many in the medical profession, though, is typified in this comment from Prof. Carmine Pariante, a professor of biological psychiatry at King’s College, London:
There is no good evidence that antidepressants increase the risk of violent behavior, and the extremely rare (and tragic) cases that are cited in support of this theory could be explained by chance: antidepressants are prescribed relatively widely, and so by chance someone on antidepressants will commit a violent act. Moreover, people on antidepressants may be suffering from some forms of mental disorder or distress that may, albeit very occasionally, increase the risk of reacting impulsively or violently.
She continues,
With 7 percent of the UK population and 11 population of the US population currently taking an antidepressant, we would have clearly seen an increased risk of violence if there was one.
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 free mental health helpline or seek help from a qualified therapist.
