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Antidepressants and Mania

 

THE DISCUSSION of the role of psychotropic medications in the increased incidence of mass shootings continues. A reader cites this article by Peter R. Breggin in the International Journal of Risk and Safety in Medicine. [Note: Another reader takes strong exception to Breggin's work. See below.] Breggin wrote:

All antidepressants cause mania and mania is an acknowledged adverse effect in the FDA-approved label of all antidepressants. Preda et al. [66] carried out a retrospective study of 533 psychiatric hospital admissions over a fourteen month period and found that 43 (8.1%) could be attributed to antidepressant- induced mania and/or psychosis. The percentages for each antidepressant were as follows: the SSRIs (70%), the newer atypicals (venlafaxine, nefazodone, and buproprion) (21%), and the older tricyclic antidepressants (amitryptyline, desipramine, imipramine, nortriptyline) (21%). The total percentage ex- ceeded 100% because of overlapping medications in five cases. Twelve of the cases represented new- onset mania or psychosis. The three illustrative cases were severe, including two with marked suicidal potential. A 52-year-old married woman with a past history of bipolar disorder developed “command auditory hallucinations with suicidal content” while taking desipramine and fluvoxamine, as well as risperidone, zolpidem, and oxazepam (p. 31). A 42-year-old woman with a one-year history of depres- sion “began to experience derogatory and then command auditory hallucinations to kill herself” while on fluoxetine as well as lithium and thioridazine (p. 31). Finally, a 49-year-old woman taking venlafaxine for “low mood and anxiety” developed symptoms of paranoia, feelings of doom, and a delusion that television messages were being directed at her (p. 31). All three patients improved rapidly with treatment that included termination of the antidepressants.

Mania with psychosis is the extreme end of a stimulant continuum that often begins with lesser degrees of insomnia, nervousness, anxiety, hyperactivity and irritability and then progresses toward more severe agitation, aggression, and varying degrees of mania. [cont.]

— Comments —-

Patrick H. writes:

Zippy Catholic recommended this study by Peter Breggin, saying:

 “It has been decisively proven that these drugs actually cause violent and suicidal behavior: not just that people who are already crazy and violent take them, but that the drugs actually cause violence and suicide in a significant number of patients.”

None of that is true. Breggin’s study is misleading in its conclusions and inept or fraudulent in its methods. I am writing to try to convince you that Peter Breggin is not a friend, or even ally of convenience, for traditionalists concerned about, or seriously opposed to, the use of psycho-pharmaceuticals today. Breggin is our enemy. A simple examination of his decades-long history will demonstrate that easily enough. But I want to point out two items in support of my description of him as the enemy of tradition, common sense and human decency: one, Breggin has argued for decades against involuntary confinement of even the most severely mentally ill. Both you and Lawrence Auster have pointed to the folly of this approach, its basic inhumanity, and rightly so. And two, he has testified in court that medications were responsible for acts of violence and murder, all in the attempt to get the accused off by eliminating the defendant’s moral agency. I think you and Mr. Auster have had something to say about that, too.

I do believe that you have made an honest mistake in accepting Zippy’s recommendation and quoting from a misleading “study” by a fraud, crank and committed enemy of tradition, Christianity and of basic human decency.

The study itself is terrible, by the way, as the sentence “all antidepressants cause mania” reveals. That misleading sentence is enough all by itself to disqualify its writer from serious consideration. An examination of the rest of the study—to say nothing of Breggin’s decades-long trail of books, articles, essays, letters to the editor, radio and television talk show appearances, and highly paid testimony in lawsuits and trials—will demonstrate beyond a doubt that the sentence I quoted is part of Peter Breggin’s basic method of operating, which means it is deliberately misleading. Which means it is a lie. And which means that its writer is a liar. Peter Breggin is unworthy to be quoted by you. He is beneath you.

 Laura writes:

I appreciate the warning and the background on Breggin.

Robin writes:

I have read with interest as others have commented regarding SSRI’s and the myriad “treatments” for depression and psychosis.  There is no doubt in my mind that these dangerous medications, which are over-prescribed and un-monitored by medical professionals, are a tool of the enemy and not harmless in all but the most severe cases (which would require institutionalization anyway).

Many years ago, after leaving the home of my family of origin, I suffered from severe and debilitating depressive illness.  I literally could not get out of bed.  At all.  For days.  I was an adult, and obviously this was affecting my ability to function in the world, as I could not work and support myself.  During this depressive illness, I made the almost irreversible error of seeking help through the modern psychiatric venues.  I was seen by numerous secular psychiatrists and prescribed a litany of dangerous medications (SSRI’s as well as atypical anti-psychotics and even epilepsy meds; none of which were prescribed as per labeled FDA approved use).  These strong concoctions numbed my mind and body to the point of a catatonic state – some call this a “chemical lobotomy” because they work on the same portion of the brain, the frontal lobe, responsible for judgment in my limited understanding.

There were times that I was so ill with high blood pressure from the side-effects of these medications that I ended up in the hospital.  The last severe allergic reaction that I suffered had all appearances of a serious stroke in my brain; I remember the hospital staff calling a Code Grey, and the sheer number of medical personnel that descended upon my body in the ER was intimidating and frightening.  I was seen my neurologists, psychologists, psychiatrists, pulmonologists, cardiologists – and no one could tell me what happened to me.  The entire left side of my body had gone numb instantly; my left eye was drooping and I was drooling from the left side of my mouth.  My blood pressure was dangerously high at 150/100.  I knew God was telling me never to use these substances again.

The following morning after being released from the hospital, I flushed the medications down the toilet.  Dangerous as it was, I quit the medications cold turkey, and did suffer some frightening withdrawal symptoms.  I found a Christian psychiatrist who ordered all of my medical records from years past and declared that I was not “mentally ill” at all – I was merely sad, after having lived through a childhood of physical and emotional abuse and then an abusive marriage that ended terribly.  This precious angel of a physician that God sent me told me that I didn’t need any medication.  He told me there was nothing wrong with me.

It took a long time to believe what he said, for I had been “told” for so long that there WAS indeed, much wrong with me!  I had been told this by my mother, my father, my now ex-husband and many, many medical experts.  But through the grace of God the Father I was able to be healed in my mind and emotions (my soul) and I was able to believe through His gift of faith to me.

Why do I expose my past like this?  Why do I re-visit this?  Because during the horrible ordeal with Adam Lanza, people have spoken again and again about “why” this happened:  there has been blame placed upon violent video games, poor parenting, public education failings, fatherlessness, autism spectral diseases, social ineptitude, etc.   Yet no one has spoken of the root cause:  Godlessness.  Idolatry.  Sin.

It is Godlessness and sin that caused this.  In the lives of each person who had part in relationship with Adam Lanza, and in society at large.  We have cast God aside, we have instead worshworshipedown knowledge and our own desires, and thus engaged in sin just as in the Garden.  This is nothing new.  We ought not be surprised.

When we throw modern chemical concoctions at a spiritual problem, we ought not be surprised that it is failure, for it is Pride in thinking we can solve a problem of the soul with Pharmacopoeia;The Bible calls this witchcraft.  Manipulation.  Human control of a spiritual issue.

Not once have I heard Mr. Lanza (father) utter a word about God.  Not once.  It’s not that I think he’s uttering spiritual truths and the media isn’t reporting it, because they were sure to report Huckaby’s stance of Godlessness.  It’s that Mr. Lanza is not speaking about God, because he doesn’t see the connection.  I realize that’s a hefty judgement on my part, but it is what I see.

Until we place God as central to our family lives in our own homes, one by one, there will be no revival in society.  There will be no  God in public education again.  There will be sick and deranged and neglected children whom everyone considers either “normal” or “just a little shy.”  They cry out for help.  They surely cry out internally.

We must direct them to God through Jesus Christ.  He is the Great Physician.

Lydia Sherman writes:

I have a few jumbled thoughts about our chemical nation.

Years ago I discovered that everyone I knew was on some kind of chemical (medication).  These meds have no nutritional value, no helpful minerals. They are almost all chemical in nature. The patient never reads the label included with the med, which includes warnings that it may cause urges to become violent or commit suicide.  I have seen these same people carefully read the labels on the back of the boxes of packaged foods at the grocery store, to see that they do not get too much sodium or soy.  Yet they do not question the validity of taking these chemicals.

Almost every woman I know that is on these meds has gained a huge amount of weight around the middle of her body. I noticed in one of the photographs you featured on your site showing women leaders in a Protestant church, that they were almost all had the excess weight in places that suggested the use of anti-depressants and other chemicals like them.

The people I know who are on meds also tend to group together with those of like-medications, to discuss their meds.  Medication has become a culture and thanks to the pharmaceutical companies, we are a chemical nation. Though they are not violent, people on these medications exhibit irrationality and strange, impulsive behavior.

I am not a prophet but when there has been such violence, I usually say the person was on a pharmacuetical, even before the press admits it.

Not everyone is violent on these drugs, and I am thinking in particular of the artist, Thomas Kinkade. A few months before his death, a photograph appeared in the paper after an arrest for drunk driving.  His eyes showed the signs of chemicals and his body was bloated and fat, when in photos of previous years he appeared to be thin.  I said, “Some doctor has prescribed anti-depressants for him.” Several months later, he suddenly died at the age of 52.

It was later reported that Kinkade died of an accumulation of antidepressants and alcohol. On an old message board called “Prozac Nightmare,” I read the testimonies of mates of people on these drugs, and they all said that these meds caused a craving for alchohol.

 LLH writes:

Full disclosure: I take a variety of anti-depressants, and find that they’ve brought great improvements to my life since I first discovered the right one, or ones. So I could be considered biased.

That said, I would recommend taking a hard look at the critics of anti-depressants – I mean the ones with journalistic and/or academic credentials in the field, and consider whether they too might have an agenda. Sometimes, believe it or not, that agenda might be promoting another drug or type of drug; sometimes it might be promoting “talk therapy” as opposed to drug therapy. Occasionally, it might even be a wish to promote institutionalization, or better care at the local level. All of these goals are or could be worthy ones, and all might in certain situations be more appropriate than medication. But to dismiss medication so readily, when in many cases it is the one thing that may be keeping a schizophrenic patient from complete collapse into paranoid fantasy, is very strange.

Another point: I don’t know whether this is true in the U.S., but in Canada doctors have been quite reluctant to use SSRIs to treat psychotics – i.e. the mentally ill who are sick enough to be actually delusional, whether schizophrenics or bipolars – in the belief that they do, in fact, aggravate the symptoms of such illnesses. Instead, they use very different medications, like Thorazine, Risperdal, clozapine, and newer anti-psychotics like Invega and Abilify. Because most of these are more or less stupefying, and can cause tremendous weight-gain, they may be a tragic compromise from the point of view of patient care for the psychotic, but they are not very likely to cause angry and/or violent outbreaks. I’m not sure about Invega or Abilify: they are relatively new addition to the cocktail of medicines prescribed for schizophrenics, mostly as alternatives to Risperdal or clozapine because of the weight gain and stupefaction they cause.

Anti-depressants are far more likely to be used by ordinary, non-delusional, non-psychotic people like me, and I would be very sorry to have them taken away. If they are being prescribed to psychotic patients or those with serious “anger” issues, that is perhaps the problem here, and not anti-depressants themselves.

Here’s a link to a blogger “The Last Psychiatrist,” with an interesting perspective on the reaction against anti-depressants, written back in 2011 when another “study” of their supposed uselessness came out.

Zippy Catholic writes:

I don’t know what Peter Breggin’s credentials as an enemy of traditionalism have to do with the fact that SSRIs have been proven to cause violence and suicide in some patients. Heck, all you need to do is read the black box warnings, which the drug companies have been forced to put on there because the link has been proven.

Also, the fact that they cause violence and suicide in some patients doesn’t mean that they don’t help other patients. That is one reason why I recommend that people who are taking drugs for any chronic condition read David Healy’s book.

Paul writes:

Antidepressants, generally, are not preventatives of the psychotic behavior of the type seen in Newtown. Moreover, the idea that antidepressants were a causative factor will no doubt be refuted. Darn near every psychiatric and other internal medicine drug can cause bizarre behavior in some people. Antidepressants are used for psychotic people mainly to relieve their non-psychotic symptoms. This young man was not taking his antipsychotics, which I hope he was prescribed. He was not taking them either because of malpractice or because they made him feel bad. Antipsychotics often make the patient feel bad. Drugs are not a cure all for psychiatric illness.

Also, antidepressants have absolutely no beneficial effect on 40 percent of the population. Assuming he was prescribed antidepressants, his mother probably stopped filling his prescriptions because he threw them away; so there is no relevance to the early evidence that there were no antidepressants found in the home. Although I have handled many commitments, I am not a psychiatrist, the experts and the only people (besides Jesus) who have any chance of helping these ill people. Perhaps one can expand on, refute, or modify my propositions.

Because these incidents are occurring more than ever before, there must be a cultural connection. The causative factors need to be considered.

Laura writes:

I don’t think it is yet known what, if any, drugs Adam Lanza was taking.

LLH writes:

Zippy, it’s not Peter Breggin’s credentials as an enemy of traditionalism that are at issue here. It’s the fact that he has an “agenda” of his own, and that he goes to great lengths to defend it and to attack those who disagree with it. Did you look carefully at the statistics you quote? Out of 533 hospital admissions in a 14-month period (not a very large meta-sample to draw such sweeping conclusions from, by the way), 8.1 percent “could be attributed to antidepressant-induced mania and/or psychosis.” Note that “could be.” Note, too, that that’s 8.1 percent. Out of 533. In 14 months.

On the other hand, doing a brief google sweep yesterday, I came across a suggestion that one in ten Americans is now taking antidepressants. What’s that – about thirty-three million? That may be cause for concern in itself. Why is everyone so depressed? What is America (or the Western world) doing wrong? It certainly suggests that the commentator who says we need God in our lives is correct. But it does not mean that anyone should casually attribute incidents like Newtown (or Columbine) to antidepressants, especially since no one knows yet whether Adam Lanza took any antidepressant at all.

Breggin is also misleading in another way. The suggestion that all anti-depressants cause or can cause mania is not only false, it’s wrong-headed in that the term “antidepressant” in fact includes a varied group of drugs with nothing in common except that they are used to treat depression. The chemical structure of Wellbutrin is entirely different from that of Prozac, for example, as The Last Psychiatrist’s blog points out. Do read that post; I think you’d find it eye-opening. Don’t assume, though, that the writer is a great defender of psychiatry or psychiatric medication. He isn’t. He merely points out the varied kinds of vested interests at work in this “debate.”

As for the “black box warnings” on antidepressant medication, those are there as a result of the litigious nature of American medical culture, and not because there is a definitive link between SSRIs and violence and/or suicide in some patients. If the link were that clear, the drugs would have been taken off the market altogether. Look at what happened to the popular diet drugs fen-phen: about a third of the people (that’s a good deal more than 8.1 percent, no?) in a Mayo clinic study of the drug combination in 1997 showed some kind of heart-valve damage. I very much doubt that there’s anything more than a slight connection, statistically, between antidepressants and violence or suicide, or they would have been taken off the market.

Laura writes:

Just to clarify, this discussion of psychotropic drugs began in response to an article that pointed out that a significant number of other mass murderers have been on the drugs. So whether Lanza was taking drugs or not, the issue was still relevant.

Zippy Catholic writes:

LLH writes:

Zippy, it’s not Peter Breggin’s credentials as an enemy of traditionalism that are at issue here.

I was responding to Patrick H.’s comment, which is basically an ad hominem about how Breggin must be wrong because he is an enemy of traditionalism.

Did you look carefully at the statistics you quote?

Have you ever looked at clinical trial data in general, and how statistical significance is used to beg the question of effectiveness and safety for drugs in general?  If you are really interested in the subject you should, as I’ve suggested several times now, read Phamageddon.  I agree with looking at the agendas of various parties, and that includes the drug companies, prescribers, and patients looking for validation of the little world they live in.  It includes you and me, as far as that goes.

Furthermore, nobody has suggested that a large percentage of SSRI users are likely to go on shooting sprees.  For that matter very few heroine users become violent and suicidal, especially when you control for issues surrounding their legality.  Opioids have a legitimate place in medicine too.  The problem isn’t SSRIs per se, it is that they are treated as if they are never the problem when often enough they are the problem.  Contrast this to, say, alcohol.  Nobody would think twice about drugs being a causal factor if we were talking about phencyclidine.

Also, I suggest taking care not to jump to the conclusion that the black box warnings are all the lawyers’ fault.  Folks ought to at least read the trial transcripts before ascribing them to litigious gold-digging.

As for myself, although I’ve never been on psychotropic drugs, I’ve personally seen people who were not violent or suicidal become violent and suicidal on SSRI’s, and then lose those characteristics when carefully weaned off of them.  Furthermore, I’ve seen cases of ‘tolerance withdrawal’ from prescribed psychotropic drugs up close and personal.  So I know as a matter of absolute fact that there exist people who believe that their lives have been improved by the drugs but in fact are walking time bombs.  And that just scratches the surface of my own involuntary knowledge of the subject. It is the last thing I am interested in by my own nature, but it only took one fatality to get me involved as a matter of personal responsibilities.

So I don’t need Breggin or Healy or anyone else to tell me that it happens.  They just helped explain what I saw with my own lying eyes.

James P. writes:

Paul writes:

“Moreover, the idea that antidepressants were a causative factor will no doubt be refuted. Darn near every psychiatric and other internal medicine drug can cause bizarre behavior in some people.”

Since the claim is not that these drugs turn everyone who takes them nto a homicidal maniac, but only some people, I am not sure where the refutation would come from in the Lanza case if he was on them. The drugs cause bizarre behavior in some people, inlcuding (apparently) a long list of spree killers.

If these drugs turn some people into homicidal maniacs, the question becomes how many drug-inspired killing sprees are we prepared to accept in order to treat whatever conditions these drugs are supposed to treat?

Samson writes:

As someone who actually prescribes antidepressant medication fairly regularly, I don’t find the discussion particularly interesting, and it’s certainly news to me that the serotonin theory of depression has been “discredited”. Likewise, I have never heard of SSRI antidepressants causing patients to become violent in the manner suggested at your site. Some readers may choose to take that as evidence of Big Pharma’s victory over the medical profession.

I was really only moved to respond after reading comments like the recent one from James P.:

If these drugs turn some people into homicidal maniacs, the question becomes how many drug-inspired killing sprees are we prepared to accept in order to treat whatever conditions these drugs are supposed to treat?

I can’t help but note the parallel to the question so prominent in the news recently: how many killing sprees are we prepared to tolerate in order to allow citizens the right to bear arms? Perhaps James’ comment was intended as parody of this (typically liberal) cry. In any event, I would argue that in both cases – antidepressants and firearms – the extreme minority of tragic incidents is far outweighed by the good that these things do.

Lydia Sherman writes:

Some of your readers may be interested in this video about antidepressants and violence.

Terry Morris writes:

Most of the information I have on this subject is anecdotal. But like Zippy Catholic, I need no more convincing that these drugs are harmful, and that they can, and often do, lead to acts of violence. If a school teacher or “counselor” ever suggested to me that, in her opinion, one of my children might need psychotropic drugs in order to help him focus, she would receive for her trouble the worst tongue-lashing she could ever imagine. The joke around my house, and within my circle, is that every one of my children began to show signs of ADHD very early on in their lives … until (and here is the punchline) I beat it out of them. But it is only a half-joke, because the front half is true, whereas the back half is an exaggeration for effect. So maybe it is only a quarter-joke. Ha, ha.

Zippy Catholic writes:

Samson wrote:

As someone who actually prescribes antidepressant medication fairly regularly, I don’t find the discussion particularly interesting, 

I find that sadly unsurprising.  In my experience the medical profession is very, very bad at listening to patients when patients suggest that the medication might be the problem; and even when it is acknowledged that the medication is the problem, that information never makes it back into “the system.” Carefully orchestrated ghost written papers and clinical trials with question-begging claims of statistical significance form the basis for what doctors think about medications, while actual experience with the products by millions of actual patients is discounted as mere anecdote and shunted to ground.  This is what is meant by “evidence-based medicine,” an Orwellian term if every there was one.  David Healy suggests that this is perpetuated in part because in the prescription drug regime the person who makes the purchase decision (the doctor) is not the person who has to live with the consequences (the patient).

…and it’s certainly news to me that the serotonin theory of depression has been “discredited”.

The article I linked to in that fringe conspiracy-theory publication Psychology Today points out basically that in medical academia the competition is not over whether or not the serotonin “chemical imbalance” theory is wrong.  The competition is over who knew that it was wrong first, and who is making the unfair argument that the opposition must still believe in such a thoroughly discredited theory.

Dec. 23rd

Lawrence Auster writes:

I take issue with Laura’s uncritically approving response to Patrick H.’s comment about Peter Breggin, and I agree with Zippy Catholic that Patrick H. was making an ad hominem argument. The fact that Breggin is anti-traditionalist is, obviously, entirely irrelevant to the validity of his data on the effect of anti-depressant drugs.

Mr. Auster adds:

Of course, as those “in the know” know, my disagreement with Laura on this point is a mere feint to help conceal the fact that I am Laura.

 

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