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 1. News & Views
 2. Antidepressants and...
 3. Antidepressants increase the risk of suicide, violence and homicide at all
    ages

Rapid response to:


Feature Medicine and the Media


ANTIDEPRESSANTS AND MURDER: CASE NOT CLOSED

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3697 (Published 02 August 2017)
Cite this as: BMJ 2017;358:j3697

 * Article
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RAPID RESPONSE:


ANTIDEPRESSANTS INCREASE THE RISK OF SUICIDE, VIOLENCE AND HOMICIDE AT ALL AGES




The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the
drugs are very dangerous; otherwise daily monitoring wouldn’t be needed:
“Families and caregivers of patients should be advised to look for the emergence
of such symptoms on a day-to-day basis, since changes may be abrupt” ... “All
patients being treated with antidepressants for any indication should be
monitored appropriately and observed closely for clinical worsening,
suicidality, and unusual changes in behavior, especially during the initial few
months of a course of drug therapy, or at times of dose changes, either
increases or decreases. The following symptoms, anxiety, agitation, panic
attacks, insomnia, irritability, hostility, aggressiveness, impulsivity,
akathisia (psychomotor restlessness), hypomania, and mania, have been reported
in adult and pediatric patients being treated with antidepressants” (1).

Such daily monitoring is, however, a fake fix. People cannot be monitored every
minute and many have committed SSRI-induced suicide or homicide within a few
hours after everyone thought they were perfectly okay.

As the published trial literature related to suicidality and aggression on
antidepressants is unreliable, we looked at 64,381 pages of clinical study
reports (70 trials) we got from the European Medicines Agency. We showed for the
first time that SSRIs in comparison with placebo increase aggression in children
and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81) (2). This is an important
finding considering the many school shootings where the killers were on SSRIs.

In a systematic review of placebo-controlled trials in adult healthy volunteers,
we showed that antidepressants double the occurrence of events that the FDA has
defined as possible precursors to suicide and violence, odds ratio 1.85 (95% CI
1.11 to 3.08)(3). The number needed to treat to harm one healthy adult person
was only 16 (95% CI 8 to 100).

Based on the clinical study reports, we showed that adverse effects that
increase the risk of suicide and violence were 4-5 times more common with
duloxetine than with placebo in trials in middle-aged women with stress urinary
incontinence (4). There were also more women on duloxetine who experienced a
core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81).
The number needed to harm was only seven. It would have been quite impossible to
demonstrate how dangerous duloxetine is, if we had only had access to published
research. In accordance with our findings, the FDA has previously announced that
women who were treated with duloxetine for incontinence in the open-label
extension phase of the clinical studies had 2.6 times more suicide attempts than
other women of the same age (5).

Looking at precursor events to suicide and violence is just like looking at
prognostic factors for heart disease. We say that increased cholesterol, smoking
and inactivity increase the risk of heart attacks and heart deaths and therefore
recommend people to do something about it. Psychiatric leaders, however,
routinely try to get away with untenable arguments. Many say, for example, that
antidepressants can be given safely to children arguing that there were no more
suicides in the trials, only more suicidal events, as if there was no relation
between the two, although we all know that a suicide starts with suicidal
thoughts, followed by preparations and one or more attempts. The same can be
said about homicide. It can no longer be doubted that antidepressants are
dangerous and can cause suicide and homicide at any age (5-7). It is absurd to
use drugs for depression that increase the risk of suicide and homicide when we
know that cognitive behavioural therapy can halve the risk of suicide in
patients who have been admitted after a suicide attempt (8) and when
psychotherapy does not increase the risk of murder.

References

1. FDA. Antidepressant use in children, adolescents, and adults.
http://wayback.archive-it.org/7993/20170111122946/http://www.fda.gov/Dru...
2. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during
antidepressant treatment: systematic review and meta-analyses based on clinical
study reports. BMJ 2016;352:i65.
3. Bielefeldt AØ, Danborg PB, Gøtzsche PC. Precursors to suicidality and
violence on antidepressants: systematic review of trials in adult healthy
volunteers. J R Soc Med 2016;109:381-392.
4. Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of duloxetine
for treatment of stress urinary incontinence: a meta-analysis of clinical study
reports. CMAJ 2017;189:E194-203.
5. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s
Press; 2015.
6. Healy D. Let them eat Prozac. New York: New York University Press; 2004.
7. Breggin P. Medication madness. New York: St. Martin’s Griffin; 2008.
8. Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of
repeated suicide attempts: systematic review. J R Soc Med 2017 (in press).

Competing interests: No competing interests

03 September 2017
Peter C Gøtzsche
Professor

Nordic Cochrane Centre
Copenhagen










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