This article was first published on Mad In America on August 13th 2024
In 2015, six psychiatrists from the Department of Psychiatry, University of Oxford, the UK, published the study, “Depression and Violence: A Swedish Population Study” in Lancet Psychiatry.
It was a total population study that included 47,158 people with a depression diagnosis, matched by age and sex to 898,454 general population controls.
The authors found that “After adjustment for sociodemographic confounders, the odds ratio of violent crime was 3.0 (95% CI 2.8–3.3) compared with the general population controls.”
They concluded that the risk of violent crime was increased in individuals with depression after adjustment for familial, sociodemographic and individual factors and that clinical guidelines should consider recommending violence risk assessment in certain subgroups with depression.
They also concluded that the association between a diagnosis of depression and violent crime was independent of potential confounders. This conclusion is invalid because they did not consider the most important confounder in their analyses, usage of depression drugs. It is taboo in mainstream psychiatry to even consider that psychiatric drugs may cause violence towards self and others.
When we reviewed the clinical study reports of placebo-controlled trials, we found that the risk of aggression was doubled on antidepressants (odds ratio 1.93, 95% confidence interval 1.26 to 2.95). The patient narratives listed homicidal threat, homicidal ideation, assault, sexual molestation, a threat to take a gun to school, damage to property, punching household items, aggressive assault, verbally abusive and aggressive threats, and belligerence.
Suicidal events are often omitted or miscoded in these trials. When psychiatrist David Healy and I reviewed the two trials that led to the approval of fluoxetine in children in the USA, we found that suicidal events were missing not only in the publications but also in the internal study reports submitted to the FDA. Precursors to suicidality or violence occurred more often on fluoxetine than on placebo.
My research group also did a meta-analysis of placebo-controlled trials in healthy adult volunteers using precursor events defined by the FDA. We found that SSRIs and SNRIs double the risk of harms related to suicidality and violence, and the number needed to treat to harm one healthy person was only 16 (95% confidence interval 8 to 100).
In our research, there was no issue with confounding, as we based it on randomised trials where only one group received antidepressants. It is therefore crystal clear that antidepressants increase the risk of violence, but the authors did not cite a 2010 analysis of 1,937 cases of violence submitted to the FDA, 387 of which were homicide. It showed that violence was particularly often reported for depression pills, sedatives/hypnotics, ADHD drugs, and a smoking cessation drug that also affects brain function.
So, what did the six psychiatrists say about confounding? They wrote:
“An important potential implication of our findings relates to interpretation of safety data for antidepressant medication. Anecdotally, antidepressants have been associated with self-harm and severe violence, which drew great attention in the public and media a decade ago.44 The reduction of antidepressant prescription to young people that followed failed to reduce rates of self-harm, with recent evidence suggesting that, in the USA, rates of self-harm actually increased.45 Although our study does not bear directly on the association between antidepressants and violence, it suggests that a diagnosis of depression will confound interpretation of the effects of treatment for depression on violence (and self-harm). Therefore pharmacovigilance data for antidepressants needs to be interpreted with great caution.”
The authors speak of “anecdotal evidence.” This is seriously dishonest. The FDA reported already in 2006 that depression pills double the risk of suicide, suicide attempts, or preparation for suicide in people under 25 years of age based on the placebo-controlled trials and issued a Black Box Warning.
The study the authors refer to when they claim that a drop in usage of antidepressants led to an increase in self-harm is totally unreliable. It made no sense that suicide attempts in young people increased after the FDA warned that depression drugs can increase suicidal behaviour. I noted that the authors used complicated statistics with quadratic terms to make their point, and that we should look at the graphs instead, which were revealing. Poisonings and suicides rose markedly in adolescents when usage of the pills started to increase again.
The authors wrote that psychological interventions could “potentially” be of benefit in people at high risk of suicide. This is not only a potential benefit. It is real. Randomised trials have shown that psychotherapy for patients who have attempted suicide halves the risk of another suicide attempt.
Thank you once more Professor Gotzsche. I have understood so much from your writing that I was never able to learn during a period of over 50 years of studying and practising medicine.
The word: – AKATHISIA remained a well kept secret from prescribers it would appear.
You state: –
“It is taboo in mainstream psychiatry to even consider that psychiatric drugs may cause violence towards self and others”.
We have recurrent tragedies of serious, often fatal, multiple knife attacks in England.
We hear repeatedly: – ‘The police are not looking for any other assailant”. “The police have ruled out a terrorist motive”. The one thing that seems never to be ruled out is whether the attacker was taking prescription drugs that cause AKATHISIA with disinhibition and emotional blunting; hence in effect an involuntary intoxication leading to violence rather than a criminal action?
If Inquests/coroners were required to document all prescription drugs, especially psychotropic drugs taken, dose and/or drug changes: – Especially drugs initiated or withdrawn; it might become evident as to what role akathisia does play in violent events that terminate precious lives and destroy families.
Is it an unmet opportunity to not provide this prescription drug information, and recognised violence inducing adverse drug reactions in Prevention of Future Deaths Reports?