retractionwatch
If you read this space, you probably know the name Brad Bushman. He studies the effects of violent video games on the people who play them. He also has just retracted his third paper, and significantly corrected another.
Although Bushman remains a prominent voice in a highly contentious field — prompting numerous media to consult him after school shootings or other violent acts
— he’s retracted two papers, one following an investigation at his
institution, the Ohio State University (OSU), which prompted OSU to strip his co-author of her PhD.
(There’s a lot more to tell about that story, including the backlash
outside critics faced for taking their concerns about the paper public.
To read more, check out our in-depth piece in Motherboard.)
Bushman’s third retraction came this month; he nearly had a fourth as well, but attorneys for the publisher decided that a massive correction (to a paper which previously had been flagged with an expression of concern) would be more appropriate.
The retraction notice from Current Opinion in Psychology states the paper showed too much similarity to a 2016 paper in the same journal by Bushman and Arlin James Benjamin,
based at the University of Arkansas-Fort Smith. It notes that although
Bushman was the guest editor of the issue of the journal:
continue reading
Showing posts with label Violence. Show all posts
Showing posts with label Violence. Show all posts
Friday, August 31, 2018
Wednesday, February 28, 2018
Psychiatrist Says: More Psychiatry Means More Shootings
madinamerica
Dr Peter Breggin
Feb 26, 2018
In late September 2016, a few days after Nikolas Cruz turned 18 and became old enough to buy a gun, the Department of Children and Families sent one or more investigators to Cruz’s home. The Department had been alerted by posts on Snapchat where the young man talked crazily about cutting himself and asked for help in getting a gun.
Among the many missed opportunities widely discussed in the media, here is one on the local level where the Department of Children and Families actually went to his home to investigate. The department intended to evaluate Cruz for “possible detainment under the Baker Act, which allows authorities to hold individuals against their will for up to 72 hours.”
What did the investigator find? NBC News quotes the official report: “Mr. Cruz stated that he plans to go out and buy a gun… It is unknown what he is buying the gun for.”
Not only was Cruz planning to buy a gun while apparently refusing to say what he was planning to use it for, but his mother’s observations cast serious doubt on her son’s mental capacity to own a weapon. According to the New York Times, “She told the investigator that Mr. Cruz did not have a gun, though he did have an air gun she would take away from him when he did not follow rules about shooting only at backyard targets.”
Unbelievably, in full knowledge of Cruz’s intention to buy a gun, and his inability to take responsibility for the use of even an air gun, the department found Cruz to be a “low risk” and closed his case within two months.
Had Cruz been committed, under existing gun laws he would have become unable to legally buy a gun to carry out his murderous fantasies. Alternatively, if he had been carefully and safely removed from his psychiatric drugs while receiving good psychosocial therapy, his escalating violent impulses might have abated. Instead, he was left on his own to face the death of his mother and his expulsion from school, while his murderous impulses were fueled by drugs.
What do we know about Cruz’s psychiatric treatment?
The First Tragic Irony
According to the New York Times, the official department report that found Cruz to be “low risk” indicated that “he was regularly taking medication for A.D.H.D. It was unclear whether he was taking anything for depression, according to the report.”
In more detail, NBC News observed that Nikolas’s adoptive mother “insisted he received his necessary medication as prescribed.”
Investigators from the Department of Children and Families also contacted Cruz’s healthcare provider. NBC News quoted directly from report, “[Cruz’s] clinician from Henderson Mental Health has stated that there are no issues with [Cruz’s] medication and he has been compliant with taking his medication and keeps all his appointments.”
This is an irony of tragic proportions. Cruz was left unsupervised and free to buy a gun because he was faithfully taking psychiatric drugs that can cause or aggravate violence.
But do psychiatric drugs really cause violence?
Antidepressant-Induced Violence
In the early 1990s, a federal court appointed me to be the scientific expert for all of the combined product liability cases that were brought against Eli Lilly throughout the country concerning Prozac-induced violence, suicide and crime. Since then I have been involved in many cases in which judges and juries, and even prosecuting attorneys, have determined that psychiatric drugs have caused or substantially contributed to violence. For a lengthy list, see the Legal Section on my website.
In 2003/2004, I wrote a scientific review article about antidepressant-induced suicide, violence and mania which the FDA distributed to all its advisory committee members. This took place as the FDA Advisory Committee members prepared to review new warnings to be put in the Full Prescribing Information for all antidepressants.
In my peer-reviewed paper, I wrote:
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. (p. 2)
In words very close to and sometimes identical to mine, the FDA one year later required the manufacturers of every antidepressant to put the following observations in the Warnings section of the Full Prescribing Information:
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 for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. (Celexa 2017, p. 8, bold added)
These adverse drug effects—including agitation, irritability, hostility, aggressiveness, akathisia, and impulsivity—are an obvious prescription for violence. Akathisia, which I also described in my article, is a psychomotor agitation that is strongly associated with violence.
The FDA further confirmed that antidepressants can cause violence in the FDA-approved Medication Guide for antidepressants. By law, Medication Guides must be based on science and on the drug’s Full Prescribing Information. These several-page guides are intended to be shared and discussed by the doctor with patients and their families.
The FDA Medication Guide for antidepressants warns clinicians, patients and families to be on the alert for the following:
acting on dangerous impulses
acting aggressive or violent
feeling agitated, restless, angry or irritable
other unusual changes in behavior or mood (Celexa 2017, p. 33)
This list (above) of antidepressant adverse effects from the Medication Guide should make clear that antidepressants can cause violence.
Stimulant-Induced Violence
The FDA also acknowledges the risk of both psychosis and aggression from the stimulant drugs used to treat ADHD, but waffles somewhat in the Full Prescribing Information about aggression. These excerpts are from the Dexedrine (amphetamine) Full Prescribing Information:
Psychiatric Adverse Events
Emergence of New Psychotic or Manic Symptoms: Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses.
Aggression: Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the post-marketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of, or worsening of, aggressive behavior or hostility. (Dexedrine, 2007, p. 3)
The Medication Guide for Dexedrine warns to report to the doctor “Mental (Psychiatric) Problems” that can be caused by the stimulant. The warning for stimulants echoes some of the adverse violence-related effects caused by antidepressants:
new or worse behavior and thought problems
new or worse bipolar illness
new or worse aggressive behavior or hostility (Dexedrine, 2014, p. 9)
Study Shows Antidepressants and Stimulants Are Especially Likely to Cause Violence
One of the most convincing studies of medication-induced violence was based on reports of violence to the FDA over a several year period. When the number of prescriptions written for each drug was factored in, a small group of drugs accounted for almost all reports of violence.
In the study of violence reports to the FDA, any predisposition toward violence in the patients themselves was largely ruled out because some of the most violence-inducing drugs were not psychiatric drugs, and were being given to a more general population. Some of the violence-inducing drugs were antibiotics, including Lariam (Mefloquine), which Sgt. Robert Bales was taking when he slaughtered 16 helpless, innocent villagers in Afghanistan.
The amphetamines as a group (mostly used to treat ADHD) were third in order of frequency of violence reports per prescription. The amphetamines include drugs such as Adderall and Dexedrine (pure amphetamines) and amphetamine-like drugs based on methylphenidate, such as Ritalin, Focalin and Concerta. While amphetamines as a group were third in the list of most likely to induce violence, overall the antidepressants were the most common offenders, with Prozac, Paxil, and Effexor near the top.
Losing Track of the Threat
Cruz’s school counselor protested to the Department of Children and Families that they should re-examine their conclusion that he was a “low risk” for violence. Then in January 2017, two months after the agency had closed its investigation, the Broward County Public Schools disciplinary records indicate that the school referred Cruz to the Department of Children and Families for a “threat assessment” because of a long history of “fights with teachers” and “using profane language with school staff.” No other information was provided about the outcome of that referral.
What was going on? When public agencies have difficult children and young adults to deal with, they automatically turn to psychiatric diagnosing and drugging. Previously concerned adult authorities then withdraw their concern and attention because the child is getting “psychiatric treatment.” Caring, empathic and effective psychosocial treatments fall by the wayside.
Authorities do this without grasping that they are shoving the child under a suffocating chemical rug in the form of neurotoxins that blunt all emotions and stifle all behavior. Those dooming the children and youth to psychiatric oblivion probably do not know, as Bob Whitaker has shown in Anatomy of an Epidemic, that psychiatric drugs will diminish their competence and quality of life, while also raising the cost of their treatment and their disability payments. They do not foresee that the psychiatric strategy for treatment will sometimes lead to tragic outcomes like the school shootings. Nor do they realize that the overall evidence of harm from psychiatric drugs is infinitely greater than the evidence for good effects, as scientist Peter Gøtzsche has confirmed in Deadly Psychiatry and Organized Denial.
Another Tragic Irony
During Cruz’s build up to the mass murders, his Snapchat remarks about cutting himself and wanting to get a gun were not the only red flags that he was dangerous. Among many other warning signs, he declared on social media that he wanted to become a “professional school shooter” and he told an acquaintance that he had bought a gun and was planning to shoot up the school within weeks before it happened.
This was not mere bragging to bolster his ego. Cruz was intelligent enough to know that broadcasting his intention could lead to his being stopped. On some level of his disturbed mind, Cruz was begging to be stopped. Several people did in fact report him but to no avail.
The second great, tragic irony is that Cruz desperately signaled his dangerousness but agencies as high up as the FBI saw and never responded to his conscious or unconscious pleas to be stopped.
How Psychiatry Increases the Threat of Violence
Calling for more spending on mental health and on psychiatry will make matters worse, probably causing many more shootings than it prevents.
Not only do psychiatric drugs add to the risk of violence, but psychiatric treatment lulls the various authorities and the family into believing that the patient is now “under control” and “less of a risk.” Even the patient may think the drugs are helping, and continue to take them right up to the moment of violence.
The belief in drugs is so prevailing that the authorities, in my forensic experience, will continue the offending drugs or even increase them in jail. Sometimes the perpetrator of the violence may begin to suspect the drugs contributed to his violence, but more often he is still hoping that they help and wants his medications continued in jail.
Even when some of their patients signal with all their might that they are dangerous and need to be stopped, mental health providers are likely to give drugs, adding fuel to the heat of violent impulses, while assuming that their violence-inducing drugs will reduce the risk of serious aggression.
We have seen that Nikolas Cruz was probably being treated with violence-inducing stimulants and/or antidepressants by a psychiatrist who was nonetheless aware of his violent tendencies and serious underlying threats. We have seen how his blatant threats were disregarded, probably on the grounds that he was already in the mental health system and receiving drugs.
Psychiatry not only increases the risk of violence by giving violence-inducing drugs, but it lulls patients, families, professionals, schools and the public into an unrealistic and even disastrous sense of security. I have described dozens of such cases in my book, Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime.
James Holmes, the Aurora Theater shooter, is an extreme example of the dangers of sending a violent person for psychiatric treatment. Holmes was in graduate school when he asked for psychiatric help. He told his psychiatrist he had such violent feelings that he dared not tell her all about them for fear that she would lock him up.
What did Holmes’ psychiatrist do? On that same first visit where he warned about seriously violent feelings, she started him on the antidepressant Zoloft. Under the influence of the drug, he became grossly psychotic and began elaborating his plans and collecting weapons.
Did Holmes’ psychiatrist need more training or awareness? No, she was especially trained in the prevention of campus school shootings and immediately contacted campus security, while starting him on Zoloft. Increased training under the current mental health system will only lead to even more drugging, because that is what my colleagues in psychiatry do—they drug nearly everyone they can get their hands on.
To prevent or reduce school shootings, we need to stop relying on current mental health and psychiatric interventions to prevent mass violence. Psychiatric approaches do more harm than good.
What More Can We Do to Prevent or Reduce School Shootings?
School shootings have multiple causes. My focus in this report is on the role of psychiatric drugs because it receives so little attention, despite being one of the chief causes of mass violence. In keeping with my emphasis, for solutions I will focus again on my own area of knowledge: the provision of psychosocial and educational services to children, youth, and their caregivers or families.
One of the first required steps is to force public disclosure of any and all drugs prescribed to violent perpetrators. We still do not know exactly what was prescribed to Cruz other than that he was treated for ADHD and depression. Family members have reported that he was taking psychiatric medications for depression around the time he assaulted his school, but we lack documentation for this.
Authorities often avoid releasing information about the medications that mass murderers were taking. In 2012, twenty-year-old Adam Lanza murdered 20 children and 6 adults at Sandy Hook Elementary School. Six years later, the State of Connecticut has never released his medical records or reported the medications in his blood. Why? According to an assistant attorney general for the state, Lanza’s medications cannot be made public because the information “can cause a lot of people to stop taking their medications.”
It took a legal action to force the corner in the Las Vegas mass murder case to make public what if any medications were identified in the perpetrator’s body. When it was reported that he had Valium in his body at the time of his death, it did not even get a ho-hum response from the press.
Similarly, in 2013, when it was quickly discovered that the naval yard shooter had recently been started on the antidepressant trazodone at the VA, the news just as quickly disappeared from view. So it will not be enough to get the information we need; we will also have to work to draw attention to it.
Despite how often threat reports are ignored, they are a frontline deterrent. We need to make it easier to report threats by young people by providing well-advertised state-wide designated online and telephone reporting sites, and by preparing and empowering state and local agencies to respond to these threats. Federal agencies should play little or no role in this strategy, which requires immediate local responsiveness.
Offering Better Services
I have already emphasized the importance of no longer relying on the current mental health and psychiatric system to stop school shootings. However, even if school shootings were not such a huge problem, we still need to stop drugging our children and youth to control their feelings, thoughts and actions. Antidepressants, stimulants, benzodiazepines and all other brain-disabling, mind-altering drugs should not be used to control the minds or behaviors of young people. Children need more adult help, not more neurotoxic drugs. We must not let them to grow up with their brains and minds soaked in neurotoxins.
We need to revamp the services we deliver in our schools and families to place more emphasis on educational and psychosocial approaches to healing distressed individuals and their families. The Department of Children and Families was sent to the Cruz household to investigate and not to help. It assumed that going to a mental health clinic and taking psychiatric drugs was a good idea that reduced his dangerousness. Cruz was then left largely on his own to deal with his mother’s death and expulsion from school.
We need to focus services for young people on helping parents and children in conflict without resorting to demeaning psychiatric labels and toxic psychiatric drugs. A variety of relatively low-cost programs involving volunteers, coaches, and counselors provides the best model for help. To be most effective, we need a drug-free wraparound program with voluntary psychosocial interventions, including efforts to support and strengthen the family or care-taking unit.
Wraparound treatment would be provided not only to the identified child or youth but to the entire family. The treatment team at various times would involve teachers, school counselors, individual and/or family therapy, and direct aid to struggling families. I describe these programs in Reclaiming Our Children, a book I wrote in response to the Columbine shootings. These approaches are much less costly than providing chronic, futile psychiatric treatment, and have a better chance of stopping a catastrophic spiral into mass murder.
In the Cruz case, the school and its counselor, and many of the students, were alert to his dangerousness. Unfortunately, the dominance of drug-oriented psychiatry left no place to turn for effective help. Cruz was already being treated within a mental health clinic that provided individual treatment based on diagnoses and drugs. Instead we need psychosocial interventions, including empathic therapy, for individuals and their families.
Good psychosocial and educational help for our distressed and potentially violent children and young adults, and their families, will remain unavailable as long as psychiatry dominates theory and practice. Reforms will never occur as long as prescribers are enabled to sicken young brains and minds with neurotoxic psychiatric drugs. With biological psychiatry and the pharmaceutical industry continuing to determine the kind of mental health services that are delivered, school shootings will continue to grow in number and ferocity.
The Breggin Blog: The Conscience of Psychiatry: Dr. Breggin has been called "The Conscience of Psychiatry" for his decades of successful efforts to reform the field. He criticizes psychiatric drugs and ECT, and promotes more caring, empathic and effective therapies. His newest book is Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions.
Thank You Dr Breggin and MIA.
Dr Peter Breggin
Feb 26, 2018
In late September 2016, a few days after Nikolas Cruz turned 18 and became old enough to buy a gun, the Department of Children and Families sent one or more investigators to Cruz’s home. The Department had been alerted by posts on Snapchat where the young man talked crazily about cutting himself and asked for help in getting a gun.
Among the many missed opportunities widely discussed in the media, here is one on the local level where the Department of Children and Families actually went to his home to investigate. The department intended to evaluate Cruz for “possible detainment under the Baker Act, which allows authorities to hold individuals against their will for up to 72 hours.”
What did the investigator find? NBC News quotes the official report: “Mr. Cruz stated that he plans to go out and buy a gun… It is unknown what he is buying the gun for.”
Not only was Cruz planning to buy a gun while apparently refusing to say what he was planning to use it for, but his mother’s observations cast serious doubt on her son’s mental capacity to own a weapon. According to the New York Times, “She told the investigator that Mr. Cruz did not have a gun, though he did have an air gun she would take away from him when he did not follow rules about shooting only at backyard targets.”
Unbelievably, in full knowledge of Cruz’s intention to buy a gun, and his inability to take responsibility for the use of even an air gun, the department found Cruz to be a “low risk” and closed his case within two months.
Had Cruz been committed, under existing gun laws he would have become unable to legally buy a gun to carry out his murderous fantasies. Alternatively, if he had been carefully and safely removed from his psychiatric drugs while receiving good psychosocial therapy, his escalating violent impulses might have abated. Instead, he was left on his own to face the death of his mother and his expulsion from school, while his murderous impulses were fueled by drugs.
What do we know about Cruz’s psychiatric treatment?
The First Tragic Irony
According to the New York Times, the official department report that found Cruz to be “low risk” indicated that “he was regularly taking medication for A.D.H.D. It was unclear whether he was taking anything for depression, according to the report.”
In more detail, NBC News observed that Nikolas’s adoptive mother “insisted he received his necessary medication as prescribed.”
Investigators from the Department of Children and Families also contacted Cruz’s healthcare provider. NBC News quoted directly from report, “[Cruz’s] clinician from Henderson Mental Health has stated that there are no issues with [Cruz’s] medication and he has been compliant with taking his medication and keeps all his appointments.”
This is an irony of tragic proportions. Cruz was left unsupervised and free to buy a gun because he was faithfully taking psychiatric drugs that can cause or aggravate violence.
But do psychiatric drugs really cause violence?
Antidepressant-Induced Violence
In the early 1990s, a federal court appointed me to be the scientific expert for all of the combined product liability cases that were brought against Eli Lilly throughout the country concerning Prozac-induced violence, suicide and crime. Since then I have been involved in many cases in which judges and juries, and even prosecuting attorneys, have determined that psychiatric drugs have caused or substantially contributed to violence. For a lengthy list, see the Legal Section on my website.
In 2003/2004, I wrote a scientific review article about antidepressant-induced suicide, violence and mania which the FDA distributed to all its advisory committee members. This took place as the FDA Advisory Committee members prepared to review new warnings to be put in the Full Prescribing Information for all antidepressants.
In my peer-reviewed paper, I wrote:
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. (p. 2)
In words very close to and sometimes identical to mine, the FDA one year later required the manufacturers of every antidepressant to put the following observations in the Warnings section of the Full Prescribing Information:
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 for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. (Celexa 2017, p. 8, bold added)
These adverse drug effects—including agitation, irritability, hostility, aggressiveness, akathisia, and impulsivity—are an obvious prescription for violence. Akathisia, which I also described in my article, is a psychomotor agitation that is strongly associated with violence.
The FDA further confirmed that antidepressants can cause violence in the FDA-approved Medication Guide for antidepressants. By law, Medication Guides must be based on science and on the drug’s Full Prescribing Information. These several-page guides are intended to be shared and discussed by the doctor with patients and their families.
The FDA Medication Guide for antidepressants warns clinicians, patients and families to be on the alert for the following:
acting on dangerous impulses
acting aggressive or violent
feeling agitated, restless, angry or irritable
other unusual changes in behavior or mood (Celexa 2017, p. 33)
This list (above) of antidepressant adverse effects from the Medication Guide should make clear that antidepressants can cause violence.
Stimulant-Induced Violence
The FDA also acknowledges the risk of both psychosis and aggression from the stimulant drugs used to treat ADHD, but waffles somewhat in the Full Prescribing Information about aggression. These excerpts are from the Dexedrine (amphetamine) Full Prescribing Information:
Psychiatric Adverse Events
Emergence of New Psychotic or Manic Symptoms: Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses.
Aggression: Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the post-marketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of, or worsening of, aggressive behavior or hostility. (Dexedrine, 2007, p. 3)
The Medication Guide for Dexedrine warns to report to the doctor “Mental (Psychiatric) Problems” that can be caused by the stimulant. The warning for stimulants echoes some of the adverse violence-related effects caused by antidepressants:
new or worse behavior and thought problems
new or worse bipolar illness
new or worse aggressive behavior or hostility (Dexedrine, 2014, p. 9)
Study Shows Antidepressants and Stimulants Are Especially Likely to Cause Violence
One of the most convincing studies of medication-induced violence was based on reports of violence to the FDA over a several year period. When the number of prescriptions written for each drug was factored in, a small group of drugs accounted for almost all reports of violence.
In the study of violence reports to the FDA, any predisposition toward violence in the patients themselves was largely ruled out because some of the most violence-inducing drugs were not psychiatric drugs, and were being given to a more general population. Some of the violence-inducing drugs were antibiotics, including Lariam (Mefloquine), which Sgt. Robert Bales was taking when he slaughtered 16 helpless, innocent villagers in Afghanistan.
The amphetamines as a group (mostly used to treat ADHD) were third in order of frequency of violence reports per prescription. The amphetamines include drugs such as Adderall and Dexedrine (pure amphetamines) and amphetamine-like drugs based on methylphenidate, such as Ritalin, Focalin and Concerta. While amphetamines as a group were third in the list of most likely to induce violence, overall the antidepressants were the most common offenders, with Prozac, Paxil, and Effexor near the top.
Losing Track of the Threat
Cruz’s school counselor protested to the Department of Children and Families that they should re-examine their conclusion that he was a “low risk” for violence. Then in January 2017, two months after the agency had closed its investigation, the Broward County Public Schools disciplinary records indicate that the school referred Cruz to the Department of Children and Families for a “threat assessment” because of a long history of “fights with teachers” and “using profane language with school staff.” No other information was provided about the outcome of that referral.
What was going on? When public agencies have difficult children and young adults to deal with, they automatically turn to psychiatric diagnosing and drugging. Previously concerned adult authorities then withdraw their concern and attention because the child is getting “psychiatric treatment.” Caring, empathic and effective psychosocial treatments fall by the wayside.
Authorities do this without grasping that they are shoving the child under a suffocating chemical rug in the form of neurotoxins that blunt all emotions and stifle all behavior. Those dooming the children and youth to psychiatric oblivion probably do not know, as Bob Whitaker has shown in Anatomy of an Epidemic, that psychiatric drugs will diminish their competence and quality of life, while also raising the cost of their treatment and their disability payments. They do not foresee that the psychiatric strategy for treatment will sometimes lead to tragic outcomes like the school shootings. Nor do they realize that the overall evidence of harm from psychiatric drugs is infinitely greater than the evidence for good effects, as scientist Peter Gøtzsche has confirmed in Deadly Psychiatry and Organized Denial.
Another Tragic Irony
During Cruz’s build up to the mass murders, his Snapchat remarks about cutting himself and wanting to get a gun were not the only red flags that he was dangerous. Among many other warning signs, he declared on social media that he wanted to become a “professional school shooter” and he told an acquaintance that he had bought a gun and was planning to shoot up the school within weeks before it happened.
This was not mere bragging to bolster his ego. Cruz was intelligent enough to know that broadcasting his intention could lead to his being stopped. On some level of his disturbed mind, Cruz was begging to be stopped. Several people did in fact report him but to no avail.
The second great, tragic irony is that Cruz desperately signaled his dangerousness but agencies as high up as the FBI saw and never responded to his conscious or unconscious pleas to be stopped.
How Psychiatry Increases the Threat of Violence
Calling for more spending on mental health and on psychiatry will make matters worse, probably causing many more shootings than it prevents.
Not only do psychiatric drugs add to the risk of violence, but psychiatric treatment lulls the various authorities and the family into believing that the patient is now “under control” and “less of a risk.” Even the patient may think the drugs are helping, and continue to take them right up to the moment of violence.
The belief in drugs is so prevailing that the authorities, in my forensic experience, will continue the offending drugs or even increase them in jail. Sometimes the perpetrator of the violence may begin to suspect the drugs contributed to his violence, but more often he is still hoping that they help and wants his medications continued in jail.
Even when some of their patients signal with all their might that they are dangerous and need to be stopped, mental health providers are likely to give drugs, adding fuel to the heat of violent impulses, while assuming that their violence-inducing drugs will reduce the risk of serious aggression.
We have seen that Nikolas Cruz was probably being treated with violence-inducing stimulants and/or antidepressants by a psychiatrist who was nonetheless aware of his violent tendencies and serious underlying threats. We have seen how his blatant threats were disregarded, probably on the grounds that he was already in the mental health system and receiving drugs.
Psychiatry not only increases the risk of violence by giving violence-inducing drugs, but it lulls patients, families, professionals, schools and the public into an unrealistic and even disastrous sense of security. I have described dozens of such cases in my book, Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime.
James Holmes, the Aurora Theater shooter, is an extreme example of the dangers of sending a violent person for psychiatric treatment. Holmes was in graduate school when he asked for psychiatric help. He told his psychiatrist he had such violent feelings that he dared not tell her all about them for fear that she would lock him up.
What did Holmes’ psychiatrist do? On that same first visit where he warned about seriously violent feelings, she started him on the antidepressant Zoloft. Under the influence of the drug, he became grossly psychotic and began elaborating his plans and collecting weapons.
Did Holmes’ psychiatrist need more training or awareness? No, she was especially trained in the prevention of campus school shootings and immediately contacted campus security, while starting him on Zoloft. Increased training under the current mental health system will only lead to even more drugging, because that is what my colleagues in psychiatry do—they drug nearly everyone they can get their hands on.
To prevent or reduce school shootings, we need to stop relying on current mental health and psychiatric interventions to prevent mass violence. Psychiatric approaches do more harm than good.
What More Can We Do to Prevent or Reduce School Shootings?
School shootings have multiple causes. My focus in this report is on the role of psychiatric drugs because it receives so little attention, despite being one of the chief causes of mass violence. In keeping with my emphasis, for solutions I will focus again on my own area of knowledge: the provision of psychosocial and educational services to children, youth, and their caregivers or families.
One of the first required steps is to force public disclosure of any and all drugs prescribed to violent perpetrators. We still do not know exactly what was prescribed to Cruz other than that he was treated for ADHD and depression. Family members have reported that he was taking psychiatric medications for depression around the time he assaulted his school, but we lack documentation for this.
Authorities often avoid releasing information about the medications that mass murderers were taking. In 2012, twenty-year-old Adam Lanza murdered 20 children and 6 adults at Sandy Hook Elementary School. Six years later, the State of Connecticut has never released his medical records or reported the medications in his blood. Why? According to an assistant attorney general for the state, Lanza’s medications cannot be made public because the information “can cause a lot of people to stop taking their medications.”
It took a legal action to force the corner in the Las Vegas mass murder case to make public what if any medications were identified in the perpetrator’s body. When it was reported that he had Valium in his body at the time of his death, it did not even get a ho-hum response from the press.
Similarly, in 2013, when it was quickly discovered that the naval yard shooter had recently been started on the antidepressant trazodone at the VA, the news just as quickly disappeared from view. So it will not be enough to get the information we need; we will also have to work to draw attention to it.
Despite how often threat reports are ignored, they are a frontline deterrent. We need to make it easier to report threats by young people by providing well-advertised state-wide designated online and telephone reporting sites, and by preparing and empowering state and local agencies to respond to these threats. Federal agencies should play little or no role in this strategy, which requires immediate local responsiveness.
Offering Better Services
I have already emphasized the importance of no longer relying on the current mental health and psychiatric system to stop school shootings. However, even if school shootings were not such a huge problem, we still need to stop drugging our children and youth to control their feelings, thoughts and actions. Antidepressants, stimulants, benzodiazepines and all other brain-disabling, mind-altering drugs should not be used to control the minds or behaviors of young people. Children need more adult help, not more neurotoxic drugs. We must not let them to grow up with their brains and minds soaked in neurotoxins.
We need to revamp the services we deliver in our schools and families to place more emphasis on educational and psychosocial approaches to healing distressed individuals and their families. The Department of Children and Families was sent to the Cruz household to investigate and not to help. It assumed that going to a mental health clinic and taking psychiatric drugs was a good idea that reduced his dangerousness. Cruz was then left largely on his own to deal with his mother’s death and expulsion from school.
We need to focus services for young people on helping parents and children in conflict without resorting to demeaning psychiatric labels and toxic psychiatric drugs. A variety of relatively low-cost programs involving volunteers, coaches, and counselors provides the best model for help. To be most effective, we need a drug-free wraparound program with voluntary psychosocial interventions, including efforts to support and strengthen the family or care-taking unit.
Wraparound treatment would be provided not only to the identified child or youth but to the entire family. The treatment team at various times would involve teachers, school counselors, individual and/or family therapy, and direct aid to struggling families. I describe these programs in Reclaiming Our Children, a book I wrote in response to the Columbine shootings. These approaches are much less costly than providing chronic, futile psychiatric treatment, and have a better chance of stopping a catastrophic spiral into mass murder.
In the Cruz case, the school and its counselor, and many of the students, were alert to his dangerousness. Unfortunately, the dominance of drug-oriented psychiatry left no place to turn for effective help. Cruz was already being treated within a mental health clinic that provided individual treatment based on diagnoses and drugs. Instead we need psychosocial interventions, including empathic therapy, for individuals and their families.
Good psychosocial and educational help for our distressed and potentially violent children and young adults, and their families, will remain unavailable as long as psychiatry dominates theory and practice. Reforms will never occur as long as prescribers are enabled to sicken young brains and minds with neurotoxic psychiatric drugs. With biological psychiatry and the pharmaceutical industry continuing to determine the kind of mental health services that are delivered, school shootings will continue to grow in number and ferocity.
The Breggin Blog: The Conscience of Psychiatry: Dr. Breggin has been called "The Conscience of Psychiatry" for his decades of successful efforts to reform the field. He criticizes psychiatric drugs and ECT, and promotes more caring, empathic and effective therapies. His newest book is Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions.
Thank You Dr Breggin and MIA.
Wednesday, November 16, 2016
Antidepressants Increase Suicide and Violence Risk In All Ages
madinamerica
By Peter Gøtzsche, MD November 16, 2016
Drug agencies warn against using antidepressants in children and adolescents because they increase the risk of suicide. It is more difficult to know what the risk is in adults, as there has been massive underreporting and even fraud in the reporting of suicides, suicide attempts and suicidal thoughts in the placebo-controlled trials(1,2). The US Food and Drug Administration (FDA) has contributed to the obscurity by downplaying the problems, by choosing to trust the drug companies, by suppressing important information, and by other means(2).
In a meta-analysis of the placebo-controlled trials from 2006, the FDA reported only five suicides in 52,960 patients on SSRIs (one per 10,000 patients)(3), but there were many more suicides in these trials(2). Five years earlier, in 2001, Thomas Laughren, who was responsible for the FDA’s meta-analysis, published a paper using FDA data where he reported 22 suicides in 22,062 patients randomised to antidepressants(4), which is 10 per 10,000, or 10 times as many as he reported in 2006. In Laughren’s 2001 paper, there were four times as many suicides on antidepressants as on placebo, which was statistically significant (P = 0.03, my calculation). However, Laughren did not tell his readers about this but wrote: “There is obviously no suggestion of an excess suicide risk in placebo-treated patients.” No, but there surely was in the drug-treated patients!
In its meta-analysis, the FDA found that paroxetine increased suicide attempts significantly in adults with psychiatric disorders, odds ratio 2.76 (95% confidence interval 1.16 to 6.60)(3). GlaxoSmithKline also found an increase in suicide attempts in adults and in 2006, GSK USA sent a “Dear Doctor” letter that pointed out that the risk of suicidal behaviour was increased also above age 24(2).
The FDA was inconsistent. The agency claimed in 2009 that it is only in those below 24 years of age that these drugs are risky(5). But in 2007, the agency admitted, at least indirectly, that SSRIs can cause suicide at all ages(6): “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.” The FDA also noted that, “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.” It seems that the FDA finally admitted that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed. Such daily monitoring is, however, a fake fix. People cannot be monitored every minute and many have committed SSRI-induced suicide within a few hours after everyone thought they were perfectly okay.
Since there is pervasive scientific misconduct in the published trial literature related to suicidality and aggression on antidepressants, we decided to look elsewhere. We obtained 64,381 pages of clinical study reports from the European Medicines Agency, which proved to be very revealing(7). In January 2016 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). This is an important finding considering the many school shootings where the killers were on SSRIs.
In October, we showed in a systematic review of placebo-controlled trials in adult healthy volunteers that antidepressants double the occurrence of events that can lead to suicide and violence, odds ratio 1.85 (95% CI 1.11 to 3.08)(8). The number needed to treat to harm one healthy adult person was only 16 (95% CI 8 to 100).
On November 14th, 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 women with stress urinary incontinence(9). The results were similar for FDA-defined activation events, and there were also more women on duloxetine that experienced a core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81). Many women were hit by the harms of duloxetine. There were 187 who had at least one core or potential activation event on duloxetine out of 958, whereas only 42 of 955 women on placebo experienced such events, i.e. 15% more women were harmed when on active drug than on placebo, or one out of every seven treated.
Duloxetine was never approved for use in stress incontinence in the US or in Canada whereas it is approved in Europe. We performed a meta-analysis of 4 randomised placebo-controlled trials of duloxetine (involving a total of 1913 patients) submitted to the European Medicines Agency for marketing approval. We used data from the clinical study reports (totalling 6870 pages and including individual patient data). It would have been quite impossible to demonstrate how dangerous duloxetine is, if we had only had access to published research.
Our systematic review underlines that antidepressants not only increase the risk of suicide and violence in children and adolescents, but also in much older people: The women in the trials had a mean age of 52 years. In accordance with this, 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(2).
I have no doubt that the manufacturers of antidepressants and their paid allies among the psychiatrists will argue that there is nothing to worry about because we did not find an increase in suicides or suicide attempts in adult healthy volunteers or in women with urinary incontinence, only an increase in precursors to such events. But this argumentation is faulty. Looking at precursor events to suicide 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.
Conclusions
Although the drug industry, our drug regulators and leading psychiatrists have done what they could to obscure these facts(2), it can no longer be doubted that antidepressants are dangerous and can cause suicide and homicide at any age(2,10,11). Antidepressants have many other important harms and their clinical benefit is doubtful(2). Therefore, my conclusion is that they shouldn’t be used at all. It is particularly absurd to use drugs for depression that increase the risk of suicide when we know that psychotherapy decreases the risk of suicide(12). The psychotherapy trials have been criticised for lack of blinding(12) but it is difficult to blind such trials. Furthermore, suicidality is a pretty hard outcome.
We should do our utmost to avoid putting people on antidepressant drugs and to help those who are already on them to stop by slowly tapering them off under close supervision. People with depression should get psychotherapy and psychosocial support, not drugs.
* * * * *
References:
1. Healy D. Did regulators fail over selective serotonin reuptake inhibitors? BMJ 2006;333:92–5.
2. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.
3. Laughren TP. Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). 2006 Nov 16. www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf.
4. Laughren TP. The scientific and ethical basis for placebo-controlled trials in de¬pression and schizophrenia: an FDA perspective. Eur Psychiatry 2001;16:418-23.
5. Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009;339:b2880.
6. FDA. Antidepressant use in children, adolescents, and adults. http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm096273.htm.
7. 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.
8. 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.
9. Maund E, Guski LS, Freund N, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ 2016;14 November. http://www.cmaj.ca/lookup/doi/10.1503/cmaj.151104.
10. Healy D. Let them eat Prozac. New York: New York University Press; 2004.
11. Breggin P. Medication madness. New York: St. Martin’s Griffin; 2008.
12. Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2016; 5: CD012189.
Thank You Dr Gotzsche and MIA.
Tuesday, November 15, 2016
H4640: Congressman Jolly's Bill: Veteran Suicide Prevention Act
Introduced earlier this year by Congressman David Jolly
Are you electing advocates of buying More of the suicide and violence causing agent (mental health drugs and psychiatric/psychological bullshit)?
Get Vets hooked up with other Vets who've been there, done that. The track record of Mental Health Professionals is beneath contempt.
We strongly recommend you contact your US Representatives asking them to support Congressman Jolly's Bill and your US Senators to support Senator McCain's Bill in this matter.
govtrack
The text of the bill below is as of Feb 26, 2016 (Introduced).
Source: GPO
114th CONGRESS
2d Session
H. R. 4640
IN THE HOUSE OF REPRESENTATIVES
February 26, 2016
Mr. Jolly (for himself, Ms. Titus, Mr. Abraham, and Ms. Gabbard) introduced the following bill; which was referred to the Committee on Veterans’ Affairs
A BILL
To direct the Secretary of Veterans Affairs to conduct a review of the deaths of certain veterans who died by suicide, and for other purposes. 1.
Short title
This Act may be cited as the Veteran Suicide Prevention Act. 2.
Department of Veterans Affairs review of certain veterans’ deaths by suicide (a)
Review required
Not later than 18 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a review of the deaths of all covered veterans who died by suicide during the five-year period preceding the date of the enactment of this Act. Such review shall include— (1)
the total number of veterans who died by suicide during the five-year period preceding the date of the enactment of this Act; (2)
a summary of such veterans that includes the age, gender, and race of such veterans; (3)
a comprehensive list of the medications prescribed to, and found in the systems of, such veterans at the time of their deaths, specifically listing any medications that carried a black box warning, were off-label, psychotropic, or carried warnings that included suicidal ideation; (4)
a summary of medical diagnoses by Department of Veterans Affairs physicians which led to the prescribing of the medications referred to in paragraph (3); (5)
the number of instances in which the veteran who died by suicide was concurrently on multiple medications prescribed by Department of Veterans Affairs physicians; (6)
the percentage of veterans who died by suicide who were not taking any medication prescribed by a Department of Veterans Affairs physician; (7)
the percentage of veterans referred to in paragraph (1) with combat experience or trauma (including, but not limited to military sexual trauma, traumatic brain injury, and post-traumatic stress); (8)
Veteran Health Administration facilities with markedly high prescription and suicide rates of patients being treated at those facilities; (9)
a description of Department of Veterans Affairs policies governing the prescribing of medications referred to in paragraph (3); (10)
any patterns apparent to the Secretary based on the review; and (11)
recommendations for further action that would improve the safety and well-being of veterans. (b)
Public availability
Not later than 30 days after the completion of the review required under subsection (a), the Secretary shall— (1)
submit to Congress a report on the results of the review; and (2)
make such report publicly available. (c)
Covered veteran
In this section: (1)
The term covered veteran means any veteran who received hospital care or medical services furnished by the Department of Veterans Affairs during the five-year period preceding the death of the veteran. (2)
The term black box warning means a warning displayed within a box in the prescribing information for drugs that have special problems, particularly ones that may lead to death or serious injury.
Thank you Congressman Jolly, govtrack, and Dr Hickey.
Are you electing advocates of buying More of the suicide and violence causing agent (mental health drugs and psychiatric/psychological bullshit)?
Get Vets hooked up with other Vets who've been there, done that. The track record of Mental Health Professionals is beneath contempt.
We strongly recommend you contact your US Representatives asking them to support Congressman Jolly's Bill and your US Senators to support Senator McCain's Bill in this matter.
govtrack
The text of the bill below is as of Feb 26, 2016 (Introduced).
Source: GPO
114th CONGRESS
2d Session
H. R. 4640
IN THE HOUSE OF REPRESENTATIVES
February 26, 2016
Mr. Jolly (for himself, Ms. Titus, Mr. Abraham, and Ms. Gabbard) introduced the following bill; which was referred to the Committee on Veterans’ Affairs
A BILL
To direct the Secretary of Veterans Affairs to conduct a review of the deaths of certain veterans who died by suicide, and for other purposes. 1.
Short title
This Act may be cited as the Veteran Suicide Prevention Act. 2.
Department of Veterans Affairs review of certain veterans’ deaths by suicide (a)
Review required
Not later than 18 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a review of the deaths of all covered veterans who died by suicide during the five-year period preceding the date of the enactment of this Act. Such review shall include— (1)
the total number of veterans who died by suicide during the five-year period preceding the date of the enactment of this Act; (2)
a summary of such veterans that includes the age, gender, and race of such veterans; (3)
a comprehensive list of the medications prescribed to, and found in the systems of, such veterans at the time of their deaths, specifically listing any medications that carried a black box warning, were off-label, psychotropic, or carried warnings that included suicidal ideation; (4)
a summary of medical diagnoses by Department of Veterans Affairs physicians which led to the prescribing of the medications referred to in paragraph (3); (5)
the number of instances in which the veteran who died by suicide was concurrently on multiple medications prescribed by Department of Veterans Affairs physicians; (6)
the percentage of veterans who died by suicide who were not taking any medication prescribed by a Department of Veterans Affairs physician; (7)
the percentage of veterans referred to in paragraph (1) with combat experience or trauma (including, but not limited to military sexual trauma, traumatic brain injury, and post-traumatic stress); (8)
Veteran Health Administration facilities with markedly high prescription and suicide rates of patients being treated at those facilities; (9)
a description of Department of Veterans Affairs policies governing the prescribing of medications referred to in paragraph (3); (10)
any patterns apparent to the Secretary based on the review; and (11)
recommendations for further action that would improve the safety and well-being of veterans. (b)
Public availability
Not later than 30 days after the completion of the review required under subsection (a), the Secretary shall— (1)
submit to Congress a report on the results of the review; and (2)
make such report publicly available. (c)
Covered veteran
In this section: (1)
The term covered veteran means any veteran who received hospital care or medical services furnished by the Department of Veterans Affairs during the five-year period preceding the death of the veteran. (2)
The term black box warning means a warning displayed within a box in the prescribing information for drugs that have special problems, particularly ones that may lead to death or serious injury.
Thank you Congressman Jolly, govtrack, and Dr Hickey.
S 3410: Veteran Overmedication Prevention Act of 2016
Here's the text of Senator McCain's Bill,
to force the Veteran's Administration to study and publish the problems pointed out by Dr Hickey in his article at madinamerica: Psychiatric Drugs Causing Violence and Suicide among Veterans.
govtrack
The text of the bill below is as of Sep 28, 2016 (Introduced).
Source: GPO
II
114th CONGRESS
2d Session
S. 3410
IN THE SENATE OF THE UNITED STATES
September 28, 2016
Mr. McCain introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs
A BILL
To direct the Secretary of Veterans Affairs to conduct an independent review of the deaths of certain veterans by suicide, and for other purposes. 1.
Short title
This Act may be cited as the Veteran Overmedication Prevention Act of 2016.
Sec 2. Department of Veterans Affairs independent review of certain deaths of veterans by suicide (a)
Review required
(1) In general
Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine under which the National Academies shall conduct a review of the deaths of all covered veterans who died by suicide during the five-year period ending on the date of the enactment of this Act. (2)
Alternate organization (A)
In general
If the Secretary is unable to enter into an agreement described in paragraph (1) with the National Academies of Sciences, Engineering, and Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that— (i)
is not part of the Federal Government; (ii)
operates as a not-for-profit entity; and (iii)
has expertise and objectivity comparable to that of the National Academies of Sciences, Engineering, and Medicine. (B)
Treatment
If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this section to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization. (3)
Elements
The review required by paragraph (1) shall include the following: (A)
The total number of covered veterans who died by suicide during the five-year period ending on the date of the enactment of this Act. (B)
The total number of covered veterans who died by a violent death during such five-year period. (C)
The total number of covered veterans who died by an accidental death during such five-year period. (D)
A description of each covered veteran described in subparagraphs (A) through (C), including age, gender, race, and ethnicity. (E)
A comprehensive list of prescribed medications and legal or illegal substances as annotated on toxicology reports of covered veterans described in subparagraphs (A) through (C), specifically listing any medications that carried a black box warning, were prescribed for off-label use, were psychotropic, or carried warnings that included suicidal ideation. (F)
A summary of medical diagnoses by physicians of the Department of Veterans Affairs or physicians providing services to covered veterans through programs of the Department that led to the prescribing of medications referred to in subparagraph (E) in cases of post-traumatic stress disorder, traumatic brain injury, military sexual trauma, and other anxiety and depressive disorders. (G)
The number of instances in which a covered veteran described in subparagraph (A), (B), or (C) was concurrently on multiple medications prescribed by physicians of the Department or physicians providing services to veterans through programs of the Department to treat post-traumatic stress disorder, traumatic brain injury, military sexual trauma, other anxiety and depressive disorders, or instances of comorbidity. (H)
The number of covered veterans described in subparagraphs (A) through (C) who were not taking any medication prescribed by a physician of the Department or a physician providing services to veterans through a program of the Department. (I)
With respect to the treatment of post-traumatic stress disorder, traumatic brain injury, military sexual trauma, or other anxiety and depressive disorders, the percentage of covered veterans described in subparagraphs (A) through (C) who received a non-medication first-line treatment compared to the percentage of such veterans who received medication only. (J)
With respect to the treatment of covered veterans described in subparagraphs (A) through (C) for post-traumatic stress disorder, traumatic brain injury, military sexual trauma, or other anxiety and depressive disorders, the number of instances in which a non-medication first-line treatment (such as cognitive behavioral therapy) was attempted and determined to be ineffective for such a veteran, which subsequently led to the prescribing of a medication referred to in subparagraph (E). (K)
A description and example of how the Department determines and continually updates the clinical practice guidelines governing the prescribing of medications. (L)
A description of the efforts of the Department to maintain appropriate staffing levels for mental health professionals, such as mental health counselors, marriage and family therapists, and other appropriate counselors, including— (i)
a description of any impediments to carry out the education, training, and hiring of mental health counselors and marriage and family therapists under section 7302(a) of title 38, United States Code; (ii)
with respect to mental health counselors, marriage and family therapists, and other appropriate counselors, an identification of resolutions for— (I)
any standardized credentialing discrepancies; and (II)
any impediments to the development of an internship training program; (iii)
an assessment of the development by the Department of hiring guidelines for mental health counselors, marriage and family therapists, and other appropriate counselors; and (iv)
a description of how the Department— (I)
identifies gaps in the supply of mental health professionals; and (II)
determines successful staffing ratios for mental health professionals of the Department. (M)
The percentage of covered veterans described in subparagraphs (A) through (C) with combat experience or trauma related to combat experience (including military sexual trauma, traumatic brain injury, and post-traumatic stress). (N)
An identification of the medical facilities of the Department with markedly high prescription rates and suicide rates for veterans receiving treatment at those facilities. (O)
An analysis, by State, of programs of the Department that collaborate with State Medicaid agencies and the Centers for Medicare and Medicaid Services, including the following: (i)
An analysis of the sharing of prescription and behavioral health data for veterans. (ii)
An analysis of whether Department staff check with State prescription drug monitoring programs before prescribing medications to veterans. (iii)
A description of the procedures of the Department for coordinating with prescribers outside of the Department to ensure that veterans are not overprescribed. (iv)
A description of actions that the Department takes when a veteran is determined to be overprescribed. (P)
An analysis of the collaboration of medical centers of the Department with medical examiners’ offices or local jurisdictions to determine veteran mortality and cause of death. (Q)
An identification and determination of a best practice model to collect and share veteran death certificate data between the Department of Veterans Affairs, the Department of Defense, States, and tribal entities. (R)
An assessment of any patterns apparent to the National Academies of Sciences, Engineering, and Medicine based on the review conducted under paragraph (1). (S)
Such recommendations for further action that would improve the safety and well-being of veterans as the National Academies of Sciences, Engineering, and Medicine determine appropriate. (4)
Compilation of data (A)
Form of compilation
The Secretary of Veterans Affairs shall ensure that data compiled under paragraph (3) is compiled in a manner that allows it to be analyzed across all data fields for purposes of informing and updating clinical practice guidelines of the Department of Veterans Affairs. (B)
Compilation of data regarding covered veterans
In compiling data under paragraph (3) regarding covered veterans described in subparagraphs (A) through (C) of such paragraph, data regarding veterans described in each such subparagraph shall be compiled separately. (5)
Completion of review and report
The agreement entered into under paragraph (1) shall require that the National Academies of Sciences, Engineering, and Medicine complete the review under such paragraph and submit to the Secretary of Veterans Affairs a report containing the results of the review not later than 180 days after entering into the agreement. (b)
Report
Not later than 30 days after the completion by the National Academies of Sciences, Engineering, and Medicine of the review required under subsection (a), the Secretary of Veterans Affairs shall— (1)
submit to Congress a report on the results of the review; and (2)
make such report publicly available. (c)
Definitions
In this section: (1)
The term black box warning means a warning displayed on the label of a prescription drug that is designed to call attention to the serious or life-threatening risk of the prescription drug. (2)
The term covered veteran means a veteran who received hospital care or medical services furnished by the Department of Veterans Affairs during the five-year period preceding the death of the veteran. (3)
The term first-line treatment means a potential intervention that has been evaluated and assigned a high score within clinical practice guidelines. (4)
The term State means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Thank You Senator McCain, govtrack, and Dr. Hickey for the heads up.
to force the Veteran's Administration to study and publish the problems pointed out by Dr Hickey in his article at madinamerica: Psychiatric Drugs Causing Violence and Suicide among Veterans.
govtrack
The text of the bill below is as of Sep 28, 2016 (Introduced).
Source: GPO
II
114th CONGRESS
2d Session
S. 3410
IN THE SENATE OF THE UNITED STATES
September 28, 2016
Mr. McCain introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs
A BILL
To direct the Secretary of Veterans Affairs to conduct an independent review of the deaths of certain veterans by suicide, and for other purposes. 1.
Short title
This Act may be cited as the Veteran Overmedication Prevention Act of 2016.
Sec 2. Department of Veterans Affairs independent review of certain deaths of veterans by suicide (a)
Review required
(1) In general
Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine under which the National Academies shall conduct a review of the deaths of all covered veterans who died by suicide during the five-year period ending on the date of the enactment of this Act. (2)
Alternate organization (A)
In general
If the Secretary is unable to enter into an agreement described in paragraph (1) with the National Academies of Sciences, Engineering, and Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that— (i)
is not part of the Federal Government; (ii)
operates as a not-for-profit entity; and (iii)
has expertise and objectivity comparable to that of the National Academies of Sciences, Engineering, and Medicine. (B)
Treatment
If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this section to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization. (3)
Elements
The review required by paragraph (1) shall include the following: (A)
The total number of covered veterans who died by suicide during the five-year period ending on the date of the enactment of this Act. (B)
The total number of covered veterans who died by a violent death during such five-year period. (C)
The total number of covered veterans who died by an accidental death during such five-year period. (D)
A description of each covered veteran described in subparagraphs (A) through (C), including age, gender, race, and ethnicity. (E)
A comprehensive list of prescribed medications and legal or illegal substances as annotated on toxicology reports of covered veterans described in subparagraphs (A) through (C), specifically listing any medications that carried a black box warning, were prescribed for off-label use, were psychotropic, or carried warnings that included suicidal ideation. (F)
A summary of medical diagnoses by physicians of the Department of Veterans Affairs or physicians providing services to covered veterans through programs of the Department that led to the prescribing of medications referred to in subparagraph (E) in cases of post-traumatic stress disorder, traumatic brain injury, military sexual trauma, and other anxiety and depressive disorders. (G)
The number of instances in which a covered veteran described in subparagraph (A), (B), or (C) was concurrently on multiple medications prescribed by physicians of the Department or physicians providing services to veterans through programs of the Department to treat post-traumatic stress disorder, traumatic brain injury, military sexual trauma, other anxiety and depressive disorders, or instances of comorbidity. (H)
The number of covered veterans described in subparagraphs (A) through (C) who were not taking any medication prescribed by a physician of the Department or a physician providing services to veterans through a program of the Department. (I)
With respect to the treatment of post-traumatic stress disorder, traumatic brain injury, military sexual trauma, or other anxiety and depressive disorders, the percentage of covered veterans described in subparagraphs (A) through (C) who received a non-medication first-line treatment compared to the percentage of such veterans who received medication only. (J)
With respect to the treatment of covered veterans described in subparagraphs (A) through (C) for post-traumatic stress disorder, traumatic brain injury, military sexual trauma, or other anxiety and depressive disorders, the number of instances in which a non-medication first-line treatment (such as cognitive behavioral therapy) was attempted and determined to be ineffective for such a veteran, which subsequently led to the prescribing of a medication referred to in subparagraph (E). (K)
A description and example of how the Department determines and continually updates the clinical practice guidelines governing the prescribing of medications. (L)
A description of the efforts of the Department to maintain appropriate staffing levels for mental health professionals, such as mental health counselors, marriage and family therapists, and other appropriate counselors, including— (i)
a description of any impediments to carry out the education, training, and hiring of mental health counselors and marriage and family therapists under section 7302(a) of title 38, United States Code; (ii)
with respect to mental health counselors, marriage and family therapists, and other appropriate counselors, an identification of resolutions for— (I)
any standardized credentialing discrepancies; and (II)
any impediments to the development of an internship training program; (iii)
an assessment of the development by the Department of hiring guidelines for mental health counselors, marriage and family therapists, and other appropriate counselors; and (iv)
a description of how the Department— (I)
identifies gaps in the supply of mental health professionals; and (II)
determines successful staffing ratios for mental health professionals of the Department. (M)
The percentage of covered veterans described in subparagraphs (A) through (C) with combat experience or trauma related to combat experience (including military sexual trauma, traumatic brain injury, and post-traumatic stress). (N)
An identification of the medical facilities of the Department with markedly high prescription rates and suicide rates for veterans receiving treatment at those facilities. (O)
An analysis, by State, of programs of the Department that collaborate with State Medicaid agencies and the Centers for Medicare and Medicaid Services, including the following: (i)
An analysis of the sharing of prescription and behavioral health data for veterans. (ii)
An analysis of whether Department staff check with State prescription drug monitoring programs before prescribing medications to veterans. (iii)
A description of the procedures of the Department for coordinating with prescribers outside of the Department to ensure that veterans are not overprescribed. (iv)
A description of actions that the Department takes when a veteran is determined to be overprescribed. (P)
An analysis of the collaboration of medical centers of the Department with medical examiners’ offices or local jurisdictions to determine veteran mortality and cause of death. (Q)
An identification and determination of a best practice model to collect and share veteran death certificate data between the Department of Veterans Affairs, the Department of Defense, States, and tribal entities. (R)
An assessment of any patterns apparent to the National Academies of Sciences, Engineering, and Medicine based on the review conducted under paragraph (1). (S)
Such recommendations for further action that would improve the safety and well-being of veterans as the National Academies of Sciences, Engineering, and Medicine determine appropriate. (4)
Compilation of data (A)
Form of compilation
The Secretary of Veterans Affairs shall ensure that data compiled under paragraph (3) is compiled in a manner that allows it to be analyzed across all data fields for purposes of informing and updating clinical practice guidelines of the Department of Veterans Affairs. (B)
Compilation of data regarding covered veterans
In compiling data under paragraph (3) regarding covered veterans described in subparagraphs (A) through (C) of such paragraph, data regarding veterans described in each such subparagraph shall be compiled separately. (5)
Completion of review and report
The agreement entered into under paragraph (1) shall require that the National Academies of Sciences, Engineering, and Medicine complete the review under such paragraph and submit to the Secretary of Veterans Affairs a report containing the results of the review not later than 180 days after entering into the agreement. (b)
Report
Not later than 30 days after the completion by the National Academies of Sciences, Engineering, and Medicine of the review required under subsection (a), the Secretary of Veterans Affairs shall— (1)
submit to Congress a report on the results of the review; and (2)
make such report publicly available. (c)
Definitions
In this section: (1)
The term black box warning means a warning displayed on the label of a prescription drug that is designed to call attention to the serious or life-threatening risk of the prescription drug. (2)
The term covered veteran means a veteran who received hospital care or medical services furnished by the Department of Veterans Affairs during the five-year period preceding the death of the veteran. (3)
The term first-line treatment means a potential intervention that has been evaluated and assigned a high score within clinical practice guidelines. (4)
The term State means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Thank You Senator McCain, govtrack, and Dr. Hickey for the heads up.
Monday, November 14, 2016
Senator McCain Introduces Bill Calling For VA Study RE: Psychiatric Drugs Causing Suicides
madinamerica
Neuroleptic Drugs, Akathisia, and Suicide and Violence
Thirty-three years ago, in August 1983, an article titled Suicide Associated with Akathisia and Depot Fluphenazine Treatment appeared in the Journal of Clinical Psychopharmacology. The authors were Katherine Shear, MD, Allen Frances, MD, and Peter Weiden, MD.
Here are some quotes, interspersed with my comments/observations:
"Akathisia is a common and distressing side effect of neuroleptic medication that can be difficult to recognize and treat. Several previous reports mention maladaptive behavioral consequences, such as poor compliance with prescribed medication and aggressive or self-destructive outbursts. We are reporting suicides in two young Hispanic men who had developed severe akathisia after treatment with depot fluphenazine. Depression with suicidal behavior has been observed following fluphenazine injection, but suicide associated with akathisia has not been previously noted."
Fluphenazine is a neuroleptic drug of the phenothiazine class that was introduced in 1959. It is marketed as Prolixin and other brand names, and according to Wikipedia, is on the WHO's "List of Essential Medicines, most important medications needed in a basic health system."
The "treatment" used in each case was a depot injection of fluphenazine. This is a long-lasting injection, typically 30 days, in which the drug is lodged in a dermal or muscular mass from which it is slowly drawn into the blood stream. (Hence depot: a place where goods are stored for later distribution.)
Depot injections have some obvious convenience value, but in psychiatry are usually used to ensure compliance. Their major downside is that if the person has an adverse reaction to the drug, there's no way to remove the stored chemicals from his body.
The authors may be correct in stating that this is the first published report of suicide associated with akathisia, but it is not the first report of suicide associated with fluphenazine. Seventeen years earlier, Dorothy West, MD, had published the following letter in the British Journal of Psychiatry, 117 (1970), 718-9:
Dangers of Fluphenazine
Dear Sir,
A new drug is being widely used in the treatment of mental illness. It is long-acting and used by injection – its name is fluphenazine (Moditen). Is this the thalidomide of the 70's? I would like to have the opinion of other doctors. Whilst it is still new maybe we are lulled into a false sense of security, but are we justified in using a drug, which may take up to six weeks to eradicate from the tissues, without being sure of its safety? Its side effects alone are legion. A study of 13 papers gives the following:
Common side-effects reported are – lethargy, drowsiness, dizziness, muscular inco-ordination, paraesthesia, hypotension, blurring of vision, dryness of mouth, malaise, feelings of tension, confusion, nausea, vomiting, and aches and pains.
Parkinsonism is extremely common. Incidence in reports varies from 100 per cent to 24 per cent with many reports around 50 per cent. Depression is quite common and tends to be severe – 5 suicides reported and two suicide attempts. Other reported side-effects include psychotic relapse and glaucoma.
Dorothy West
. . . . .
Back to the Shear, Frances, and Weiden paper:
CASE NO. 1
"A 23-year-old single unemployed Hispanic man had been socially withdrawn, blunted in affect, and thought disordered since his early teenage years. He was intermittently delusional with auditory hallucinations which responded to phenothiazines. He was treated in a day hospital after one of multiple hospitalizations; depot fluphenazine was used because of medication noncompliance. He received two injections of 25 mg of fluphenazine decanoate separated by 1 week, with noticeable improvement in his psychotic symptoms. He also developed akathisia and was prescribed trihexyphenadyl, 2 mg twice a day, which he probably did not take. There was no improvement in his akathisia and no anticholinergic side effects. He soon stopped attending the day hospital and a family member called a week later to say that 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."
So, we have a young man who has been socially withdrawn and joyless since his early teens. Not surprisingly his perceptions and thinking patterns deviated from the conventional. For reasons unknown he came within the orbit of psychiatry, and had had extensive contact with the psychiatric system. He was given two depot injections of fluphenazine one week apart. His "psychotic symptoms" improved, but he developed akathisia. He was prescribed an anticholinergic agent to combat the akathisia, but apparently this was ineffective, or as the authors suggest, he didn't take it. In any event, a week later he killed himself by jumping from the roof of a building.
We don't know if the fluphenazine was administered involuntarily, but we do know that he had taken phenothiazine in the past and had been noncompliant. So it is reasonable to assume that there was some adverse effect. Did the day hospital psychiatrists explore the reason for this "noncompliance"? In any event, given the outcome, the phrase "depot fluphenazine was used because of medication noncompliance" is a haunting and compelling testament to psychiatric arrogance. This anonymous young man was clearly prone to acute akathisia, and his "noncompliance" was a sensible and correct response to the neuro-poisoning he was receiving from psychiatrists. He stopped attending the day hospital (again, understandably),but he had no way to get the drug out of his body. The trihexyphenidyl is an anticholinergic agent and might have mitigated the akathisia. Or perhaps he took it and it was not effective, as is frequently the case.
CASE NO. 2
"A 36-year-old non-English speaking Hispanic man was seen once in our walk-in clinic because of severe restlessness and leg cramps. Intermittent somatic symptoms and nervousness began shortly after he arrived in the United States 8 months earlier. When the symptoms worsened, he began a series of visits to hospital emergency rooms and private psychiatrists. Three weeks before the walk-in visit a Spanish-speaking psychiatrist 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, some given by injection and some by prescription. He brought bottles of thiothixene, chlorazepate, amitriptyline, meprobamate, and lorazepam to the clinic. 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 made good contact in a translated interview and showed no thought disorder, hallucinations, or delusions. Thorough medical examination was negative except for the parkinsonian symptoms. He had no prior history of psychiatric treatment and the family history was negative for depression, nervousness, and significant psychiatric or medical illness. Since the diagnosis was uncertain, plans were made to discontinue all medication and a follow-up appointment was scheduled. The next day he killed himself without warning by jumping in front of a subway train."
The 36-year-old man had come to the US eight months earlier, and had begun to experience "somatic symptoms and nervousness". This seems hardly surprising in someone who is having to adapt to a new environment, but we are provided no details with regards to his psychosocial context, other than the fact that he had a wife and 9-year-old daughter, and that he didn't speak English. What we do know is that he visited "emergency rooms and private psychiatrists" to help with "somatic symptoms and nervousness". One of the psychiatrists "diagnosed paranoid schizophrenia", and gave him a depot injection of fluphenazine. He developed severe akathisia, and continued to visit emergency rooms and private psychiatrists in an attempt to gain some relief. During this period he received "numerous drugs" from these sources, some by injection, some by prescription. At this point he came to the authors' walk-in clinic.
"He was agitated, paced, and begged for help."
and
"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."
Plans were made to discontinue all the drugs, which the authors euphemistically refer to as medications, but it was too little, too late. He jumped to his death in front of a train the next day.
So, we have a healthy young man, devoted to his wife and daughter, who seeks medical help for what were probably stress-related "somatic complaints and nervousness". Psychiatrists throw a bewildering array of drugs at him, including a depot injection of fluphenazine, which results in his death. And the only reason we know about this forgotten victim of psychiatry is because the authors wrote up and published the case. How many other thousands have died from the same kind of irresponsible drug-pushing; from the same arrogant conviction that for every human problem, psychiatry has a "safe and effective" pill?
. . . . .
Here are some more quotes from the Shear et al article:
"Akathisia is an intensely unpleasant feeling characterized by muscle discomfort, inability to sit still, continuous agitation, restlessness, and fidgety feelings. Sleep may be disturbed by an inability to lie down. Some patients say they feel like jumping out of their skin"
"The estimated incidence of akathisia with neuroleptic use ranges from 20 to 45%. Several studies using depot fluphenazine report an incidence around 35%."
"Akathisia is a distressing symptom which may be difficult to diagnose and treat. Restlessness may be mistaken for anxiety and clinicians may err by raising neuroleptic dosage."
"Sometimes the only effective treatment is withdrawal of the neuroleptic. Although we cannot be sure that akathisia caused the deaths of our patients, akathitic symptoms seemed to be immediate precipitants of suicidal behavior. We urge clinicians to be alert to the discomfort of akathisia and to treat it aggressively. If treatment with anticholinergics or γ-aminobutyric acid agonists fails or symptoms are especially severe, hospitalization may be indicated."
It is clear that the authors are leaning heavily towards the conclusion that neuroleptic-induced akathisia was the immediate precipitant of both suicides.
OTHER SIMILAR REPORTS
Several similar reports have appeared in the literature for decades. Here are some examples, with relevant quotes:
Van Putten, T., MD, The Many Faces of Akathisia, Comprehensive Psychiatry, 1975, 16(1):
"AKATHISIA, a common side effect of neuroleptic therapy, is an emotional state and 'refers not to any type or pattern of movement, but rather to a subjective need or desire to move.'"
"A 44-year-old woman with hebephrenic schizophrenia started to bang her head against the wall three days after an injection of 25 mg of fluphenazine enanthate. Her only utterance was: 'I just want to get rid of this whole body.'"
"Akathisia is often associated with strong affects of fright, terror, anger or rage, anxiety, and vague somatic complaints."
"On this regime, she usually developed an episode of akathisia during the week following her injection. She described several such episodes as follows: 'I just get these attacks of tension. I don't feel right. My stomach feels strange. It's like I'm churning inside. I feel hostile and I hate (with intense affect) everybody."
"Patients have described the inner restlessness and agitation of akathisia in many other ways, such as: 'My nerves are just jumping' I feel like I'm wired to the ceiling; I just feel impatient and nasty. I can't concentrate; it's like I got ants in my pants; my nerves are raw; I just feel on edge; I feel just nasty; I feel like jumping out of my skin; if this feeling continues, I would rather be dead. I can't describe the feelings; I'm quivery from the waist up; I want to climb the walls; I feel all revved up; it's like I got diaper rash inside.'"
"Patients with severe akathisia, however, cannot sit quietly for more than a few seconds at a time, and at times the 'impatience musculaire' can result in running, agitated dancing, or rocking."
"Akathisia is tolerated very poorly by hostile paranoid patients in that they tend to misinterpret the inner agitation of akathisia as further proof that they are being poisoned or controlled by outside malevolent forces."
Note the presumably unintended irony in the word misinterpret. In reality, they are being poisoned and controlled by outside forces!
. . . . .
Keckich, W., MD: Neuroleptics: Violence as a Manifestation of Akathisia, JAMA, 1978, Nov 10 (240) 20, 2185:
"NEUROLEPTIC medications (eg, phenothiazines, butyrophenones) are used in medicine to control psychotic symptoms and concomitant agitated and violent behavior. They also are used to control anxiety and agitation whenever minor tranquilizers (eg, benzodiazepines) would be inappropriate. Development of akathisia as a parkinsonian side effect is confirmed in the use of these drugs. Akathisia is a condition that gives rise to the subjective desire to be in constant motion, with a feeling of inner agitation and muscle tension. The patient cannot sit still and paces constantly"
"One week later the patient reported that he was more agitated at night. Since it was not known at the time that akathisia was beginning, haloperidol treatment was increased to 4 mg at bedtime to decrease the agitation. Four days later, after his evening dose of 4 mg of haloperidol, he became uncontrollably agitated, could not sit still, and paced for several hours. He complained of 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. He was given 50 mg of thioridazine hydrochloride, which brought the hostility under control but did not remove it.
He subsequently discontinued the treatment with imipramine and haloperidol. The following morning he reported that the muscle tightness, jumpy feelings, and hostility were decreased but still present. Three days after drug treatment was discontinued all of the symptoms had ceased, and he was at his baseline of difficulty once again. The half-life of haloperidol is approximately 24 hours, and this symptom relief coincided with expected excretion of the drug.
In retrospect it was apparent that he had experienced increasing akathitic side effects from the haloperidol medication, which accounted for his increasing night-time agitation and culminated in a stimulation of violent and aggressive activity."
. . . . .
Schulte, JL, MD, Homicide and Suicide Associated with Akathisia and Haloperidol, American Journal of Forensic Psychiatry, Jan 1985, 6(2):
"The following five cases are reported to bring attention to the potential for severe violence, as a result of akathisia, following such administration of a neuroleptic for acute psychiatric symptoms. Particular emphasis is directed to an experience of sensory dissociation associated with the uncomfortable physical reactions, resulting in extreme acts of physical violence."
CASE NO. 1
"A 23-year-old married, Salvadorian-born male, with a four-day history of progressive paranoia and disorganized behavior, had been taken by the police department to a hospital at the request of his parents. The physician insisted he receive an injection of haloperidol in the emergency room while awaiting admission to the psychiatric unit where he had previously been a patient on a number of occasions.
He tried to resist but felt he had no option with the staff and police surrounding him. He felt he was being unnecessarily delayed in being admitted to the inpatient unit. In addition, he felt he had been lied to, in that apparently he had been told he was going to see his wife who had deserted him approximately 48 hours earlier. He then escaped from the emergency room and the authorities, ran several miles to a park, tried to get a policeman to help him, escaped again and totally disrobed. Within the next 45-minute period of time, he assaulted one woman who was walking her dog and attempted to rape her. When pulled off by the husband, he proceeded down the street, broke down the front door of a house where an 81-year-old lady was sleeping. He severely beat her with his fists, 'to a pulp', by his own description. Following which he found knives and stabbed her repeatedly, resulting in her death. Then, after being confronted in the street by a policeman who sprayed him with Mace, he returned through the house, exiting the back door where he ran into another woman with her child. He repeatedly stabbed the woman in front of the child, whereupon he moved on to the next person he encountered, a woman whom he severely assaulted and stabbed to the extent that an eye was lost and an opening into the anus was created resulting in major surgery and serious residual problems, including a colostomy. He was then finally captured and subdued by eight policemen and hospitalized.
He had ten previous psychiatric hospitalizations between 1975 and the present. All of these hospitalizations have been only a matter of hours to several days. He would always be placed on medication and released, following which he would stop taking the medication and go along until another upheaval would occur.
He had a history of problems with anger and acute paranoid beliefs leading to hyperactive behavior and one incident in which it was reported he tried to choke one of his brothers.
His description of his mental status at the time of his offense is quite striking. He describes himself as feeling almost like a spectator in a movie. He makes a point of describing how he had lost all sense of caring about anything or anyone in life. Additionally, he describes a feeling of loss of physical sensation, including feeling nothing when maced by the police. He felt enormous energy with a feeling of needing to rid himself of it.
He gives the history of having been picked up by the police on a traffic violation in 1979 and placed in jail for the first time in his life. He became angry and was given a series of haloperidol injections, becoming progressively more agitated and unmanageable to the point he was rolled up in a mattress and handcuffed in order to be transported to a psychiatric inpatient unit. In 1980, during another hospitalization, he was, despite his protests, changed from chlorpromazine to haloperidol and within hours became totally unmanageable, requiring six individuals to subdue him and place him in seclusion and restraint." [Emphasis added]
It is noteworthy that this individual asked not to be changed from chlorpromazine to haloperidol, but his request was ignored.
Eight years later, Herrera et al confirmed in a controlled study that an increase in violent behavior was more likely with haloperidol than with chlorpromazine. Apparently, the individual had some intuitive awareness of this from previous experience, but as is often the case, the psychiatrists discounted his protests and gave him the haloperidol anyway.
Here are two quotes from the Herrera et al study:
"We found in a controlled study that some patients have a marked increase in violence when treated with moderately high-dose haloperidol."
"…these patients did not show an increase in violence during a placebo period, nor did they have a history of violent behavior."
Back to the Schulte JL article:
CASE NO. 2
"A 30-year-old man with a history of mental illness dating back seven years, with hospitalizations in three other states, was admitted to the hospital on six counts of burglary. His diagnosis was paranoid schizophrenia, and he had been found not guilty by reason of insanity by the courts. The admission note by the psychiatrist stated, 'He is somewhat paranoid, but says he has side effects from most tranquilizers.' On the third day of hospitalization, he was referred to the psychiatrist by nurses because of difficulty getting to sleep. No evidence of aggressiveness or self-injurious behavior was charted that day in the nurses' notes. The psychiatrist prescribed haloperidol, 5mg. three times a day, which was begun the next day, with three doses administered with Cogentin, 2mg twice a day. Nurses' notes that day stated, 'He was very anxious about being in the hospital and threatened to kill himself if he gets up the nerve.' At 10:45 p.m., notes stated, 'He has regressed during this shift in all assessment areas. His hygiene is poor, and he is irresponsible, e.g., lying on the floor without shoes or socks.' He refused medication initially at 5 p. m., and stated that phenothiazines, 'fuck me up.' He finally took the medication but then stated angrily, 'Now I'll really get crazy.' He ranted loudly and profanely for 30 minutes. He took his 9 p.m. medication and started his haranguing again, only louder and more threatening. 'l'll kill all of you mother-fuckers before I leave here,' He was found in his room at 6:50 a.m., having hung himself with a bed sheet. A letter from his attorney to the hospital had stated that 'medications caused him problems (l should perhaps state that by medications I mean psychotropic drugs).'" [Emphasis added]
CASE NO. 3
"A 52-year-old male first came to psychiatric attention eleven years earlier following an assault on his wife. He had delusions of cancer, a belief he would die and felt sexually inadequate.
He had been unsuccessfully treated with Lithium and antidepressants, as well as various tranquilizers. He had continually been an inpatient or in board and care facilities, and three and one-half months earlier, he had his medications changed to 10mg. of Haloperidol in the a.m. and 40mg. of Haloperidol at hour of sleep, with 2mg.of Artane twice daily. Each month he stated he complained to his psychiatrist of severe restlessness. He stated he had to roll over and over in bed at night and usually would be unable to get to sleep until 3 or 4 a.m. During the day, he would try to lie down but couldn't because of his severe uncomfortableness. He described after being turned down again by the psychiatrist, he became despondent and angry, lost hope and decided if he could not ever even sleep like the rest of his boarding home mates that life wasn't worthwhile. He secured a knife and repeatedly stabbed himself in the abdomen, was rushed to the hospital and barely survived. He remarked he could never even feel the knife when stabbing himself." [Emphasis added]
. . . . .
Van Putten, T. MD and Marder, SR, MD, Behavioral Toxicity of Antipsychotic Drugs, J Clin Psychiatry, September 1987, 48: 9 (Suppl):
"The subjective restlessness of akathisia is usually accompanied by telltale foot movements: rocking from foot to foot while standing or walking on the spot. Akathisia is strongly associated with depression and dysphoric responses to neuroleptics and has even been linked to suicidal and homicidal behavior in extreme cases."
"The aforementioned case literature reads convincingly: it is reasonable to conclude that akathisia, in the extreme case, can drive people to suicide or homicide."
. . . . .
Crowner, ML, Douyon, R, et al, Akathisia and violence Psychopharmacology Bulletin, 1990: 26(1): 115-7:
"Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed."
The extraordinary irony here is that the individuals in this study "were from a special unit for violent patients," but in fact the drug used to control this behavior was actually precipitating more violence!
. . . . .
Galynker, I, MD, PhD and Nazarian, D, MD, letter to the editor, Journal of Clinical Psychiatry, 1997, 58: 31-32:
"Case Report. Mr. A, a 47-year-old white man with a diagnosis of bipolar mood disorder, was brought to the emergency room because he was screaming in the streets. Mr. A had over 30 past psychiatric admissions associated with agitation and violence and was often discharged against medical advice. He was nearly always noncompliant with his antipsychotic medications, claiming that they made him 'jump and lose my temper.' Prior to the present admission, Mr. A's daily medications included haloperidol 20 mg, lithium carbonate 1500 mg, divalproex sodium 500 mg, and benztropine 1 mg. At admission, the patient was grandiose, had loud and pressured speech, and admitted he was not taking haloperidol. He was given haloperidol 15 mg q.h.s. and benztropine 1 mg q.a.m. Within 24 hours he started pacing; became restless, agitated, and violent; complained of feeling 'jumpy'; and attacked a staff member. On Day 5 of his hospitalization, haloperidol and benztropine were discontinued; chlorpromazine was started, and the dose was increased to 950 mg/day. Mr. A, although sedated, remained threatening and violent. On Day 13, chlorpromazine was discontinued, and haloperidol was restarted at a higher dose of 15 mg p.o. b.i.d. Mr. A again complained of 'jumpiness' and punched a television cabinet, causing a self-inflicted fracture. On hospital Day 17, owing to an error, haloperidol was discontinued. The patient became calmer, less irritable, displayed no angry outbursts, and required no further room restrictions. After 5 days, when the error was discovered, haloperidol was restarted at a lower daily dose of 10 mg. Within 3 days, the patient became violent and required room restriction. Haloperidol was then discontinued, the patient's agitation and violence resolved, and a week later he was discharged. His daily medications were lithium carbonate 1500 mg (serum level = 0.9mEq/L; this dose had not been changed during his hospitalization), lorazepam 1 mg, and divalproex sodium 500 mg. On these mediations, he remained well 6 months postdischarge, his longest period as an outpatient."
In their commentary, the authors point out:
"The fact that the jumpiness occurred with haloperidol and not with chlorpromazine is another factor indicative that Mr. A has exhibited akathisia rather than nonspecific activation of mania; this is because akathisia is more common with higher potency as compared with low-potency neuroleptics."
and, with more candor than one customarily finds in psychiatry:
"One can also speculate that Mr. A's rocky clinical history was related to aggressive behavior perpetuated by antipsychotic administration."
And it is worth remembering that Mr. A's "rocky clinical history" entailed "over 30 past psychiatric admissions associated with agitation and violence".
. . . . .
So, since at least the early 80's, individual psychiatrists have been drawing attention to the fact that neuroleptic drugs induce akathisia in many cases, and that in some cases this can precipitate suicide and/or homicide.
Akathisia & Antidepressants
Although it is well known that neuroleptic drugs cause akathisia, the link between antidepressants and this condition is less widely appreciated. The Wikipedia article on akathisia contains this:
"Antidepressants can also induce the appearance of akathisia, due to increased serotonin signalling within the CNS."
. . . . .
Hamilton, MS, MD, Obler, LA, Akathisia, suicidality, and fluoxetine, J Clin Psychiatry, 1992, Nov 53(11), 401-406, write:
"The propose[d] link between fluoxetine and suicidal ideation is explained by fluoxetine-induced akathisia and other dysphoric extrapyramidal reactions."
and
"The literature suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of de novo suicidal ideation."
Fluoxetine is an SSRI, marketed as Prozac, Sarafem, and other names.
. . . . .
Wirshing, WC, MD, Van Putten, T, MD, Rosenberg, J, MD, et al, Fluoxetine, Akathisia, and Suicidality: Is There a Causal Connection?, Arch Gen Psychiatry, 1992, 49(7), 580-581, write:
"We have now had experience with five such patients. All were women. None had a history of significant suicidal behavior; all described their distress as an intense and novel somatic-emotional state; all reported an urge to pace that paralleled the intensity of the distress; all experienced suicidal thoughts at the peak of their restless agitation; and all experienced a remission of their agitation, restlessness, pacing urge, and suicidality after the fluoxetine was discontinued. We describe herein five cases of what we think might be fluoxetine-induced akathisia accounting for suicidal ideation."
Eikelenboom-Schieveld, SJM, Lucire, Y, MD, Fogleman, J, PhD, The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide, Journal of Forensic and legal Medicine, 2016, 41. 65-71, wrote:
"Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence."
and
"In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events"
and
"Three persons committed homicide, two of which intended to commit suicide. None had been aggressive or mentally ill before getting medication. None had known that they needed to take medication regularly or how to stop taking it safely. None improved on medication, and no prescriber recognized their complaints as adverse drug reactions or was aware of impending danger. Interviews elicited accounts of restlessness, akathisia, confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and incomplete recall of events. Weird impulses to kill were acted on without warning. On recovery, all recognized their actions to be out of character, and their beliefs and behaviours horrified them."
. . . . .
Whitehead, PD, Causality and Collateral Estoppel: Process and Content of Recent SSRI Litigation, 2003, J Am Acad Psychiatry Law 31:377–82, wrote:
"In Tobin v. SmithKline Beecham Pharmaceuticals a jury in the U.S. District Court for the District of Wyoming found that the medication Paxil 'can cause some individuals to commit homicide and/or suicide,' and that it was a legal cause of the deaths in this case."
. . . . .
Breggin, PR, MD, Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis. International Journal of Risk & Safety in Medicine, 2004, 16, 31-49, wrote:
"Evidence from many sources confirms that selective serotonin reuptake inhibitors (SSRIs) commonly cause or exacerbate a wide range of abnormal mental and behavioral conditions. These adverse drug reactions include the following overlapping clinical phenomena: a stimulant profile that ranges from mild agitation to manic psychoses, agitated depression, obsessive preoccupations that are alien or uncharacteristic of the individual, and akathisia. Each of these reactions can worsen the individual’s mental condition and can result in suicidality, violence, and other forms of extreme abnormal behavior. Evidence for these reactions is found in clinical reports, controlled clinical trials, and epidemiological studies in children and adults. Recognition of these adverse drug reactions and withdrawal from the offending drugs can prevent misdiagnosis and the worsening of potentially severe iatrogenic disorders. These findings also have forensic application in criminal, malpractice, and product liability cases."
and
"There are many reports and studies confirming that SSRI antidepressants can cause violence, suicide, mania and other forms of psychotic and bizarre behavior."
. . . . .
Although there is a great deal of prima facie evidence and many case reports detailing the neuroleptic/antidepressant link to suicide and violence, there has not to my knowledge been a definitive large-scale study by American psychiatry of the link between psychiatric drugs and the murder/suicides that are occurring with increased frequency.
And the great question is: why not? Why is this urgent, life-threatening issue not afforded the highest priority by the APA, NIMH, and university psychiatry departments? Is their self-serving need to protect psychiatry from the consequences of its errors eclipsing their ethical integrity and their sense of responsibility?
DSM & Akathisia
In this regard, it's interesting to see how psychiatric drug-induced akathisia has been handled in the various editions of DSM.
DSM-III-R (1987) makes no specific reference to neuroleptic or antidepressant-induced akathisia. There are, however, a number of statements in the chapter on "schizophrenia" which clearly (and deceptively) ascribe symptoms of akathisia and tardive dyskinesia to "schizophrenia" itself. For instance:
"In addition, odd mannerisms, grimacing, or waxy flexibility may be present [in schizophrenia]. (p 190)
"Almost any symptom can occur as an associated feature [of schizophrenia]. The person may appear perplexed, disheveled, or eccentrically groomed or dressed. Abnormalities of psychomotor activity—e.g., pacing, rocking, or apathetic immobility—are common." (p 190) [Emphasis added]
In reality, most of the pacing, grimacing, and rocking exhibited by people labeled schizophrenic is a direct result of neuroleptic drug poisoning, and not an associated feature of the so-called illness itself.
"Dysphoric mood is common [with schizophrenia], and may take the form of depression, anxiety, anger, or a mixture of these." (p 190)
Anxiety and anger are also direct effects of neuroleptic poisoning for many people.
"Although violent acts performed by people with this disorder often attract public attention, whether their frequency is actually greater than in the general population is not known. What is known is that the life expectancy of people with Schizophrenia is shorter than that of the general population because of an increased suicide rate and death from a variety of other causes." (p 191)
As is clear from the material quoted earlier, suicide is frequently a result of akathisia. The phrase "death from a variety of other causes" is unclear.
. . . . .
DSM-IV (1994) was markedly more honest in acknowledging the existence of neuroleptic-induced akathisia. In fact, this was included as an actual diagnosis in the fourth edition. It was coded as 333.99, and 2½ pages (744-746) were devoted to its description. Here are some quotes:
"In its most severe form, the individual may be unable to maintain any position for more than a few seconds." (p 744)
"The subjective distress resulting from akathisia is significant and can lead to noncompliance with neuroleptic treatment. Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts. Worsening of psychotic symptoms or behavioral dyscontrol may lead to an increase in neuroleptic medication dose, which may exacerbate the problem. Akathisia can develop very rapidly after initiating or increasing neuroleptic medication. The development of akathisia appears to be dose dependent and to be more frequently associated with particular neuroleptic medications. Acute akathisia tends to persist for as long as neuroleptic medications are continued, although the intensity may fluctuate over time. The reported prevalence of akathisia among individuals receiving neuroleptic medication has varied widely (20%-75%)." (p 745) [Emphasis added]
Note the reference in the third line above to "irritability, aggression, or suicide attempts". In fact, as the material quoted earlier makes clear, neuroleptic-induced akathisia has been causally-linked to actual homicides and suicides. This understatement was clearly deliberate, as Allen Frances, MD, architect of DSM-IV, was also one of the authors of the Shear et al paper quoted earlier, which linked neuroleptic-induced akathisia to actual completed suicides.
"Neuroleptic-Induced Acute Akathisia may be clinically indistinguishable from syndromes of restlessness due to certain neurological or other general medical conditions, to nonneuroleptic substances, and to agitation presenting as part of a mental disorder (e.g., a Manic Episode)." (p 745)
In other words, people who are experiencing neuroleptic-induced acute akathisia are at risk of being assigned a "diagnosis" of "bipolar disorder"!
"Serotonin-specific reuptake inhibitor antidepressant medications may produce akathisia that appears to be identical in phenomenology and treatment response to Neuroleptic-Induced Acute Akathisia. Akathisia due to nonneuroleptic medication can be diagnosed as Medication-Induced Movement Disorder Not Otherwise Specified." (p 745) [Bold face in original]
and
"Individuals with Depressive Episodes, Manic Episodes, Generalized Anxiety Disorder, Schizophrenia and other Psychotic Disorders, Attention-Deficit/Hyperactivity Disorder, dementia, delirium, Substance Intoxication, (e.g., with cocaine), or Substance Withdrawal (.e.g., from an opioid) may also display agitation that is difficult to distinguish from akathisia." (p 745-746) [Bold face in original]
Which prompts one to wonder how many people who have been assigned these so-called diagnoses were actually suffering from one of the toxic effects of neuroleptic drugs or SSRI's. It is also entirely plausible, as DSM-IV suggests, that many of these individuals would have been "treated" with even higher doses of neuroleptics!
. . . . .
The entry in DSM-IV-TR (2000) is identical to that in DSM-IV except for the following addition:
"Although the atypical [newer] neuroleptic medications are less likely to cause akathisia than the typical [older] neuroleptics, nonetheless, these medications do cause akathisia in some individuals." (p 801)
. . . . .
DSM-5 is remarkably less frank concerning psychiatric drug-induced akathisia than was DSM-IV. The name Neuroleptic-Induced Acute Akathisia was changed to Medication-Induced Acute Akathisia and the entry is given a total of four-and-a-half lines of text:
"333.99 (G25.71) Medication-Induced Acute Akathisia
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms." (p 711) [Bold face in original]
There is no reference to the fact that, as earlier psychiatric authors had stated, the condition can be so unbearable as to drive people to suicide and even homicide.
There is, however, an interesting admission in a separate, also brief, entry:
"333.72 (G24.09) Tardive Dystonia
333.99 (G25.71) Tardive Akathisia
Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction." (p 712) [Bold face in original]
In other words, neuroleptic-induced akathisia can persist for years, even if the person stops taking the drugs! But even granting this admission, it is clear that DSM-5 is markedly down-playing the significance and seriousness of neuroleptic-induced akathisia. And it is also clear from elsewhere in the text that the agenda here is to protect the reputation of the neuroleptic drugs:
"The term neuroleptic is becoming outdated because it highlights the propensity of antipsychotic medications to cause abnormal movements, and it is being replaced with the term antipsychotic in many contexts." (p 709)
Note the deceptive use of the passive voice ("is becoming outdated"). In reality, psychiatrists are consciously and deliberately phasing out the term "neuroleptic" in an attempt to conceal, or at least not draw attention to, the severe and potentially life-threatening neurotoxic effects of these drugs.
But the more important question is why has the APA eliminated the DSM-IV category "neuroleptic-induced akathisia" that ran to 2 ½ pages, and replaced it with the more general "medication-induced acute akathisia", which runs to 4 ½ lines? Why has this dangerous and relatively widespread adverse effect been so downplayed? On page 809 of the DSM-5 text there is a section called Highlights of Changes from DSM-IV to DSM-5, but there is no explanation for the change there. There is a note in this section referring the reader to "An expanded description of nearly all changes…" on the APA website. The link leads to an article titled "Highlights of Changes from DSM-IV-TR to DSM-5". But the article contains no reference to the change in question.
So we don't know the APA's justification for suppressing information about this potentially devastating adverse effect. But we do know that neuroleptic drugs are being prescribed for an increasing range of problems, and are even being prescribed to toddlers for temper tantrums and to nursing home residents for "management problems". Some have even acquired "block-buster" sales status. It is clearly in pharma's interests to suppress this information and it is consistent with psychiatry's hand-in-glove relationship with pharma that they should oblige their generous benefactors in this way. Remember, 69% of the DSM-5 workforce were in the pay of pharma while working on the revision.
Despite the early, and very clear, statements from individual psychiatrists linking psychiatric drugs to murder/suicides, the psychiatric leadership has consistently failed to address this link. Instead, they deceptively attribute these incidents to a lack of psychiatric "treatment", and they call for legal enforcement of even more drugging.
Finally
On June 9, 2016, Maria Oquendo, MD, President of the APA, wrote a post in support of the Senate's so-called Mental Health Reform Bill. The post was standard psychiatric propaganda, including the inane 21% annual and 50% lifetime prevalence of "mental illness". The reality is that if one can invent illnesses at will and arbitrarily reduce the "diagnostic" thresholds of these "illnesses", one can produce any prevalence numbers one chooses.
The post also drew attention to the fact that there were 41,000 suicides in the US in 2013, and asserted that "…we continue to fail people with mental illness every day."
In other words, more psychiatric treatment would reduce the suicide rate. But meanwhile, we have no data on how many of these individuals were in the throes of neuroleptic or antidepressant-induced akathisia. And as long as psychiatry and pharma are controlling the research agenda, such information will be systematically repressed.
As I've stated many times, psychiatry is intellectually and morally bankrupt. They are adamantly resistant to anything resembling critical self-appraisal, and there are no depths of deception and spin to which they will not go, to suppress the reality and the consequences of their drug-pushing depredations. Neuroleptic and antidepressant drugs induce some individuals to take their own lives and/or the lives of others. Neuroleptic and antidepressant drugs are almost certainly the proximate causes of many of the mass shootings that have plagued our country for almost twenty years. How much longer can psychiatry sustain this dreadful, self-serving deception?
And, Incidentally
Senator John McCain and Congressman David Jolly have introduced bills in their respective chambers that if enacted will require the Veterans Administration to conduct a comprehensive study of the link between psychiatric drugs and veterans' suicides. It will be an enormous step forward if these bills become law. It is also an interesting reflection that these bills were initiated by politicians, and not by psychiatrists, who present themselves as caring professionals acting in the best interests of their so-called patients.
If you live in the US, please encourage your representatives to support the McCain and Jolly bills (S 3410 and H 4640).
Thank You Dr Hickey, MIA and Sen McCain.
Neuroleptic Drugs, Akathisia, and Suicide and Violence
Thirty-three years ago, in August 1983, an article titled Suicide Associated with Akathisia and Depot Fluphenazine Treatment appeared in the Journal of Clinical Psychopharmacology. The authors were Katherine Shear, MD, Allen Frances, MD, and Peter Weiden, MD.
Here are some quotes, interspersed with my comments/observations:
"Akathisia is a common and distressing side effect of neuroleptic medication that can be difficult to recognize and treat. Several previous reports mention maladaptive behavioral consequences, such as poor compliance with prescribed medication and aggressive or self-destructive outbursts. We are reporting suicides in two young Hispanic men who had developed severe akathisia after treatment with depot fluphenazine. Depression with suicidal behavior has been observed following fluphenazine injection, but suicide associated with akathisia has not been previously noted."
Fluphenazine is a neuroleptic drug of the phenothiazine class that was introduced in 1959. It is marketed as Prolixin and other brand names, and according to Wikipedia, is on the WHO's "List of Essential Medicines, most important medications needed in a basic health system."
The "treatment" used in each case was a depot injection of fluphenazine. This is a long-lasting injection, typically 30 days, in which the drug is lodged in a dermal or muscular mass from which it is slowly drawn into the blood stream. (Hence depot: a place where goods are stored for later distribution.)
Depot injections have some obvious convenience value, but in psychiatry are usually used to ensure compliance. Their major downside is that if the person has an adverse reaction to the drug, there's no way to remove the stored chemicals from his body.
The authors may be correct in stating that this is the first published report of suicide associated with akathisia, but it is not the first report of suicide associated with fluphenazine. Seventeen years earlier, Dorothy West, MD, had published the following letter in the British Journal of Psychiatry, 117 (1970), 718-9:
Dangers of Fluphenazine
Dear Sir,
A new drug is being widely used in the treatment of mental illness. It is long-acting and used by injection – its name is fluphenazine (Moditen). Is this the thalidomide of the 70's? I would like to have the opinion of other doctors. Whilst it is still new maybe we are lulled into a false sense of security, but are we justified in using a drug, which may take up to six weeks to eradicate from the tissues, without being sure of its safety? Its side effects alone are legion. A study of 13 papers gives the following:
Common side-effects reported are – lethargy, drowsiness, dizziness, muscular inco-ordination, paraesthesia, hypotension, blurring of vision, dryness of mouth, malaise, feelings of tension, confusion, nausea, vomiting, and aches and pains.
Parkinsonism is extremely common. Incidence in reports varies from 100 per cent to 24 per cent with many reports around 50 per cent. Depression is quite common and tends to be severe – 5 suicides reported and two suicide attempts. Other reported side-effects include psychotic relapse and glaucoma.
Dorothy West
. . . . .
Back to the Shear, Frances, and Weiden paper:
CASE NO. 1
"A 23-year-old single unemployed Hispanic man had been socially withdrawn, blunted in affect, and thought disordered since his early teenage years. He was intermittently delusional with auditory hallucinations which responded to phenothiazines. He was treated in a day hospital after one of multiple hospitalizations; depot fluphenazine was used because of medication noncompliance. He received two injections of 25 mg of fluphenazine decanoate separated by 1 week, with noticeable improvement in his psychotic symptoms. He also developed akathisia and was prescribed trihexyphenadyl, 2 mg twice a day, which he probably did not take. There was no improvement in his akathisia and no anticholinergic side effects. He soon stopped attending the day hospital and a family member called a week later to say that 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."
So, we have a young man who has been socially withdrawn and joyless since his early teens. Not surprisingly his perceptions and thinking patterns deviated from the conventional. For reasons unknown he came within the orbit of psychiatry, and had had extensive contact with the psychiatric system. He was given two depot injections of fluphenazine one week apart. His "psychotic symptoms" improved, but he developed akathisia. He was prescribed an anticholinergic agent to combat the akathisia, but apparently this was ineffective, or as the authors suggest, he didn't take it. In any event, a week later he killed himself by jumping from the roof of a building.
We don't know if the fluphenazine was administered involuntarily, but we do know that he had taken phenothiazine in the past and had been noncompliant. So it is reasonable to assume that there was some adverse effect. Did the day hospital psychiatrists explore the reason for this "noncompliance"? In any event, given the outcome, the phrase "depot fluphenazine was used because of medication noncompliance" is a haunting and compelling testament to psychiatric arrogance. This anonymous young man was clearly prone to acute akathisia, and his "noncompliance" was a sensible and correct response to the neuro-poisoning he was receiving from psychiatrists. He stopped attending the day hospital (again, understandably),but he had no way to get the drug out of his body. The trihexyphenidyl is an anticholinergic agent and might have mitigated the akathisia. Or perhaps he took it and it was not effective, as is frequently the case.
CASE NO. 2
"A 36-year-old non-English speaking Hispanic man was seen once in our walk-in clinic because of severe restlessness and leg cramps. Intermittent somatic symptoms and nervousness began shortly after he arrived in the United States 8 months earlier. When the symptoms worsened, he began a series of visits to hospital emergency rooms and private psychiatrists. Three weeks before the walk-in visit a Spanish-speaking psychiatrist 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, some given by injection and some by prescription. He brought bottles of thiothixene, chlorazepate, amitriptyline, meprobamate, and lorazepam to the clinic. 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 made good contact in a translated interview and showed no thought disorder, hallucinations, or delusions. Thorough medical examination was negative except for the parkinsonian symptoms. He had no prior history of psychiatric treatment and the family history was negative for depression, nervousness, and significant psychiatric or medical illness. Since the diagnosis was uncertain, plans were made to discontinue all medication and a follow-up appointment was scheduled. The next day he killed himself without warning by jumping in front of a subway train."
The 36-year-old man had come to the US eight months earlier, and had begun to experience "somatic symptoms and nervousness". This seems hardly surprising in someone who is having to adapt to a new environment, but we are provided no details with regards to his psychosocial context, other than the fact that he had a wife and 9-year-old daughter, and that he didn't speak English. What we do know is that he visited "emergency rooms and private psychiatrists" to help with "somatic symptoms and nervousness". One of the psychiatrists "diagnosed paranoid schizophrenia", and gave him a depot injection of fluphenazine. He developed severe akathisia, and continued to visit emergency rooms and private psychiatrists in an attempt to gain some relief. During this period he received "numerous drugs" from these sources, some by injection, some by prescription. At this point he came to the authors' walk-in clinic.
"He was agitated, paced, and begged for help."
and
"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."
Plans were made to discontinue all the drugs, which the authors euphemistically refer to as medications, but it was too little, too late. He jumped to his death in front of a train the next day.
So, we have a healthy young man, devoted to his wife and daughter, who seeks medical help for what were probably stress-related "somatic complaints and nervousness". Psychiatrists throw a bewildering array of drugs at him, including a depot injection of fluphenazine, which results in his death. And the only reason we know about this forgotten victim of psychiatry is because the authors wrote up and published the case. How many other thousands have died from the same kind of irresponsible drug-pushing; from the same arrogant conviction that for every human problem, psychiatry has a "safe and effective" pill?
. . . . .
Here are some more quotes from the Shear et al article:
"Akathisia is an intensely unpleasant feeling characterized by muscle discomfort, inability to sit still, continuous agitation, restlessness, and fidgety feelings. Sleep may be disturbed by an inability to lie down. Some patients say they feel like jumping out of their skin"
"The estimated incidence of akathisia with neuroleptic use ranges from 20 to 45%. Several studies using depot fluphenazine report an incidence around 35%."
"Akathisia is a distressing symptom which may be difficult to diagnose and treat. Restlessness may be mistaken for anxiety and clinicians may err by raising neuroleptic dosage."
"Sometimes the only effective treatment is withdrawal of the neuroleptic. Although we cannot be sure that akathisia caused the deaths of our patients, akathitic symptoms seemed to be immediate precipitants of suicidal behavior. We urge clinicians to be alert to the discomfort of akathisia and to treat it aggressively. If treatment with anticholinergics or γ-aminobutyric acid agonists fails or symptoms are especially severe, hospitalization may be indicated."
It is clear that the authors are leaning heavily towards the conclusion that neuroleptic-induced akathisia was the immediate precipitant of both suicides.
OTHER SIMILAR REPORTS
Several similar reports have appeared in the literature for decades. Here are some examples, with relevant quotes:
Van Putten, T., MD, The Many Faces of Akathisia, Comprehensive Psychiatry, 1975, 16(1):
"AKATHISIA, a common side effect of neuroleptic therapy, is an emotional state and 'refers not to any type or pattern of movement, but rather to a subjective need or desire to move.'"
"A 44-year-old woman with hebephrenic schizophrenia started to bang her head against the wall three days after an injection of 25 mg of fluphenazine enanthate. Her only utterance was: 'I just want to get rid of this whole body.'"
"Akathisia is often associated with strong affects of fright, terror, anger or rage, anxiety, and vague somatic complaints."
"On this regime, she usually developed an episode of akathisia during the week following her injection. She described several such episodes as follows: 'I just get these attacks of tension. I don't feel right. My stomach feels strange. It's like I'm churning inside. I feel hostile and I hate (with intense affect) everybody."
"Patients have described the inner restlessness and agitation of akathisia in many other ways, such as: 'My nerves are just jumping' I feel like I'm wired to the ceiling; I just feel impatient and nasty. I can't concentrate; it's like I got ants in my pants; my nerves are raw; I just feel on edge; I feel just nasty; I feel like jumping out of my skin; if this feeling continues, I would rather be dead. I can't describe the feelings; I'm quivery from the waist up; I want to climb the walls; I feel all revved up; it's like I got diaper rash inside.'"
"Patients with severe akathisia, however, cannot sit quietly for more than a few seconds at a time, and at times the 'impatience musculaire' can result in running, agitated dancing, or rocking."
"Akathisia is tolerated very poorly by hostile paranoid patients in that they tend to misinterpret the inner agitation of akathisia as further proof that they are being poisoned or controlled by outside malevolent forces."
Note the presumably unintended irony in the word misinterpret. In reality, they are being poisoned and controlled by outside forces!
. . . . .
Keckich, W., MD: Neuroleptics: Violence as a Manifestation of Akathisia, JAMA, 1978, Nov 10 (240) 20, 2185:
"NEUROLEPTIC medications (eg, phenothiazines, butyrophenones) are used in medicine to control psychotic symptoms and concomitant agitated and violent behavior. They also are used to control anxiety and agitation whenever minor tranquilizers (eg, benzodiazepines) would be inappropriate. Development of akathisia as a parkinsonian side effect is confirmed in the use of these drugs. Akathisia is a condition that gives rise to the subjective desire to be in constant motion, with a feeling of inner agitation and muscle tension. The patient cannot sit still and paces constantly"
"One week later the patient reported that he was more agitated at night. Since it was not known at the time that akathisia was beginning, haloperidol treatment was increased to 4 mg at bedtime to decrease the agitation. Four days later, after his evening dose of 4 mg of haloperidol, he became uncontrollably agitated, could not sit still, and paced for several hours. He complained of 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. He was given 50 mg of thioridazine hydrochloride, which brought the hostility under control but did not remove it.
He subsequently discontinued the treatment with imipramine and haloperidol. The following morning he reported that the muscle tightness, jumpy feelings, and hostility were decreased but still present. Three days after drug treatment was discontinued all of the symptoms had ceased, and he was at his baseline of difficulty once again. The half-life of haloperidol is approximately 24 hours, and this symptom relief coincided with expected excretion of the drug.
In retrospect it was apparent that he had experienced increasing akathitic side effects from the haloperidol medication, which accounted for his increasing night-time agitation and culminated in a stimulation of violent and aggressive activity."
. . . . .
Schulte, JL, MD, Homicide and Suicide Associated with Akathisia and Haloperidol, American Journal of Forensic Psychiatry, Jan 1985, 6(2):
"The following five cases are reported to bring attention to the potential for severe violence, as a result of akathisia, following such administration of a neuroleptic for acute psychiatric symptoms. Particular emphasis is directed to an experience of sensory dissociation associated with the uncomfortable physical reactions, resulting in extreme acts of physical violence."
CASE NO. 1
"A 23-year-old married, Salvadorian-born male, with a four-day history of progressive paranoia and disorganized behavior, had been taken by the police department to a hospital at the request of his parents. The physician insisted he receive an injection of haloperidol in the emergency room while awaiting admission to the psychiatric unit where he had previously been a patient on a number of occasions.
He tried to resist but felt he had no option with the staff and police surrounding him. He felt he was being unnecessarily delayed in being admitted to the inpatient unit. In addition, he felt he had been lied to, in that apparently he had been told he was going to see his wife who had deserted him approximately 48 hours earlier. He then escaped from the emergency room and the authorities, ran several miles to a park, tried to get a policeman to help him, escaped again and totally disrobed. Within the next 45-minute period of time, he assaulted one woman who was walking her dog and attempted to rape her. When pulled off by the husband, he proceeded down the street, broke down the front door of a house where an 81-year-old lady was sleeping. He severely beat her with his fists, 'to a pulp', by his own description. Following which he found knives and stabbed her repeatedly, resulting in her death. Then, after being confronted in the street by a policeman who sprayed him with Mace, he returned through the house, exiting the back door where he ran into another woman with her child. He repeatedly stabbed the woman in front of the child, whereupon he moved on to the next person he encountered, a woman whom he severely assaulted and stabbed to the extent that an eye was lost and an opening into the anus was created resulting in major surgery and serious residual problems, including a colostomy. He was then finally captured and subdued by eight policemen and hospitalized.
He had ten previous psychiatric hospitalizations between 1975 and the present. All of these hospitalizations have been only a matter of hours to several days. He would always be placed on medication and released, following which he would stop taking the medication and go along until another upheaval would occur.
He had a history of problems with anger and acute paranoid beliefs leading to hyperactive behavior and one incident in which it was reported he tried to choke one of his brothers.
His description of his mental status at the time of his offense is quite striking. He describes himself as feeling almost like a spectator in a movie. He makes a point of describing how he had lost all sense of caring about anything or anyone in life. Additionally, he describes a feeling of loss of physical sensation, including feeling nothing when maced by the police. He felt enormous energy with a feeling of needing to rid himself of it.
He gives the history of having been picked up by the police on a traffic violation in 1979 and placed in jail for the first time in his life. He became angry and was given a series of haloperidol injections, becoming progressively more agitated and unmanageable to the point he was rolled up in a mattress and handcuffed in order to be transported to a psychiatric inpatient unit. In 1980, during another hospitalization, he was, despite his protests, changed from chlorpromazine to haloperidol and within hours became totally unmanageable, requiring six individuals to subdue him and place him in seclusion and restraint." [Emphasis added]
It is noteworthy that this individual asked not to be changed from chlorpromazine to haloperidol, but his request was ignored.
Eight years later, Herrera et al confirmed in a controlled study that an increase in violent behavior was more likely with haloperidol than with chlorpromazine. Apparently, the individual had some intuitive awareness of this from previous experience, but as is often the case, the psychiatrists discounted his protests and gave him the haloperidol anyway.
Here are two quotes from the Herrera et al study:
"We found in a controlled study that some patients have a marked increase in violence when treated with moderately high-dose haloperidol."
"…these patients did not show an increase in violence during a placebo period, nor did they have a history of violent behavior."
Back to the Schulte JL article:
CASE NO. 2
"A 30-year-old man with a history of mental illness dating back seven years, with hospitalizations in three other states, was admitted to the hospital on six counts of burglary. His diagnosis was paranoid schizophrenia, and he had been found not guilty by reason of insanity by the courts. The admission note by the psychiatrist stated, 'He is somewhat paranoid, but says he has side effects from most tranquilizers.' On the third day of hospitalization, he was referred to the psychiatrist by nurses because of difficulty getting to sleep. No evidence of aggressiveness or self-injurious behavior was charted that day in the nurses' notes. The psychiatrist prescribed haloperidol, 5mg. three times a day, which was begun the next day, with three doses administered with Cogentin, 2mg twice a day. Nurses' notes that day stated, 'He was very anxious about being in the hospital and threatened to kill himself if he gets up the nerve.' At 10:45 p.m., notes stated, 'He has regressed during this shift in all assessment areas. His hygiene is poor, and he is irresponsible, e.g., lying on the floor without shoes or socks.' He refused medication initially at 5 p. m., and stated that phenothiazines, 'fuck me up.' He finally took the medication but then stated angrily, 'Now I'll really get crazy.' He ranted loudly and profanely for 30 minutes. He took his 9 p.m. medication and started his haranguing again, only louder and more threatening. 'l'll kill all of you mother-fuckers before I leave here,' He was found in his room at 6:50 a.m., having hung himself with a bed sheet. A letter from his attorney to the hospital had stated that 'medications caused him problems (l should perhaps state that by medications I mean psychotropic drugs).'" [Emphasis added]
CASE NO. 3
"A 52-year-old male first came to psychiatric attention eleven years earlier following an assault on his wife. He had delusions of cancer, a belief he would die and felt sexually inadequate.
He had been unsuccessfully treated with Lithium and antidepressants, as well as various tranquilizers. He had continually been an inpatient or in board and care facilities, and three and one-half months earlier, he had his medications changed to 10mg. of Haloperidol in the a.m. and 40mg. of Haloperidol at hour of sleep, with 2mg.of Artane twice daily. Each month he stated he complained to his psychiatrist of severe restlessness. He stated he had to roll over and over in bed at night and usually would be unable to get to sleep until 3 or 4 a.m. During the day, he would try to lie down but couldn't because of his severe uncomfortableness. He described after being turned down again by the psychiatrist, he became despondent and angry, lost hope and decided if he could not ever even sleep like the rest of his boarding home mates that life wasn't worthwhile. He secured a knife and repeatedly stabbed himself in the abdomen, was rushed to the hospital and barely survived. He remarked he could never even feel the knife when stabbing himself." [Emphasis added]
. . . . .
Van Putten, T. MD and Marder, SR, MD, Behavioral Toxicity of Antipsychotic Drugs, J Clin Psychiatry, September 1987, 48: 9 (Suppl):
"The subjective restlessness of akathisia is usually accompanied by telltale foot movements: rocking from foot to foot while standing or walking on the spot. Akathisia is strongly associated with depression and dysphoric responses to neuroleptics and has even been linked to suicidal and homicidal behavior in extreme cases."
"The aforementioned case literature reads convincingly: it is reasonable to conclude that akathisia, in the extreme case, can drive people to suicide or homicide."
. . . . .
Crowner, ML, Douyon, R, et al, Akathisia and violence Psychopharmacology Bulletin, 1990: 26(1): 115-7:
"Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed."
The extraordinary irony here is that the individuals in this study "were from a special unit for violent patients," but in fact the drug used to control this behavior was actually precipitating more violence!
. . . . .
Galynker, I, MD, PhD and Nazarian, D, MD, letter to the editor, Journal of Clinical Psychiatry, 1997, 58: 31-32:
"Case Report. Mr. A, a 47-year-old white man with a diagnosis of bipolar mood disorder, was brought to the emergency room because he was screaming in the streets. Mr. A had over 30 past psychiatric admissions associated with agitation and violence and was often discharged against medical advice. He was nearly always noncompliant with his antipsychotic medications, claiming that they made him 'jump and lose my temper.' Prior to the present admission, Mr. A's daily medications included haloperidol 20 mg, lithium carbonate 1500 mg, divalproex sodium 500 mg, and benztropine 1 mg. At admission, the patient was grandiose, had loud and pressured speech, and admitted he was not taking haloperidol. He was given haloperidol 15 mg q.h.s. and benztropine 1 mg q.a.m. Within 24 hours he started pacing; became restless, agitated, and violent; complained of feeling 'jumpy'; and attacked a staff member. On Day 5 of his hospitalization, haloperidol and benztropine were discontinued; chlorpromazine was started, and the dose was increased to 950 mg/day. Mr. A, although sedated, remained threatening and violent. On Day 13, chlorpromazine was discontinued, and haloperidol was restarted at a higher dose of 15 mg p.o. b.i.d. Mr. A again complained of 'jumpiness' and punched a television cabinet, causing a self-inflicted fracture. On hospital Day 17, owing to an error, haloperidol was discontinued. The patient became calmer, less irritable, displayed no angry outbursts, and required no further room restrictions. After 5 days, when the error was discovered, haloperidol was restarted at a lower daily dose of 10 mg. Within 3 days, the patient became violent and required room restriction. Haloperidol was then discontinued, the patient's agitation and violence resolved, and a week later he was discharged. His daily medications were lithium carbonate 1500 mg (serum level = 0.9mEq/L; this dose had not been changed during his hospitalization), lorazepam 1 mg, and divalproex sodium 500 mg. On these mediations, he remained well 6 months postdischarge, his longest period as an outpatient."
In their commentary, the authors point out:
"The fact that the jumpiness occurred with haloperidol and not with chlorpromazine is another factor indicative that Mr. A has exhibited akathisia rather than nonspecific activation of mania; this is because akathisia is more common with higher potency as compared with low-potency neuroleptics."
and, with more candor than one customarily finds in psychiatry:
"One can also speculate that Mr. A's rocky clinical history was related to aggressive behavior perpetuated by antipsychotic administration."
And it is worth remembering that Mr. A's "rocky clinical history" entailed "over 30 past psychiatric admissions associated with agitation and violence".
. . . . .
So, since at least the early 80's, individual psychiatrists have been drawing attention to the fact that neuroleptic drugs induce akathisia in many cases, and that in some cases this can precipitate suicide and/or homicide.
Akathisia & Antidepressants
Although it is well known that neuroleptic drugs cause akathisia, the link between antidepressants and this condition is less widely appreciated. The Wikipedia article on akathisia contains this:
"Antidepressants can also induce the appearance of akathisia, due to increased serotonin signalling within the CNS."
. . . . .
Hamilton, MS, MD, Obler, LA, Akathisia, suicidality, and fluoxetine, J Clin Psychiatry, 1992, Nov 53(11), 401-406, write:
"The propose[d] link between fluoxetine and suicidal ideation is explained by fluoxetine-induced akathisia and other dysphoric extrapyramidal reactions."
and
"The literature suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of de novo suicidal ideation."
Fluoxetine is an SSRI, marketed as Prozac, Sarafem, and other names.
. . . . .
Wirshing, WC, MD, Van Putten, T, MD, Rosenberg, J, MD, et al, Fluoxetine, Akathisia, and Suicidality: Is There a Causal Connection?, Arch Gen Psychiatry, 1992, 49(7), 580-581, write:
"We have now had experience with five such patients. All were women. None had a history of significant suicidal behavior; all described their distress as an intense and novel somatic-emotional state; all reported an urge to pace that paralleled the intensity of the distress; all experienced suicidal thoughts at the peak of their restless agitation; and all experienced a remission of their agitation, restlessness, pacing urge, and suicidality after the fluoxetine was discontinued. We describe herein five cases of what we think might be fluoxetine-induced akathisia accounting for suicidal ideation."
Eikelenboom-Schieveld, SJM, Lucire, Y, MD, Fogleman, J, PhD, The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide, Journal of Forensic and legal Medicine, 2016, 41. 65-71, wrote:
"Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence."
and
"In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events"
and
"Three persons committed homicide, two of which intended to commit suicide. None had been aggressive or mentally ill before getting medication. None had known that they needed to take medication regularly or how to stop taking it safely. None improved on medication, and no prescriber recognized their complaints as adverse drug reactions or was aware of impending danger. Interviews elicited accounts of restlessness, akathisia, confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and incomplete recall of events. Weird impulses to kill were acted on without warning. On recovery, all recognized their actions to be out of character, and their beliefs and behaviours horrified them."
. . . . .
Whitehead, PD, Causality and Collateral Estoppel: Process and Content of Recent SSRI Litigation, 2003, J Am Acad Psychiatry Law 31:377–82, wrote:
"In Tobin v. SmithKline Beecham Pharmaceuticals a jury in the U.S. District Court for the District of Wyoming found that the medication Paxil 'can cause some individuals to commit homicide and/or suicide,' and that it was a legal cause of the deaths in this case."
. . . . .
Breggin, PR, MD, Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis. International Journal of Risk & Safety in Medicine, 2004, 16, 31-49, wrote:
"Evidence from many sources confirms that selective serotonin reuptake inhibitors (SSRIs) commonly cause or exacerbate a wide range of abnormal mental and behavioral conditions. These adverse drug reactions include the following overlapping clinical phenomena: a stimulant profile that ranges from mild agitation to manic psychoses, agitated depression, obsessive preoccupations that are alien or uncharacteristic of the individual, and akathisia. Each of these reactions can worsen the individual’s mental condition and can result in suicidality, violence, and other forms of extreme abnormal behavior. Evidence for these reactions is found in clinical reports, controlled clinical trials, and epidemiological studies in children and adults. Recognition of these adverse drug reactions and withdrawal from the offending drugs can prevent misdiagnosis and the worsening of potentially severe iatrogenic disorders. These findings also have forensic application in criminal, malpractice, and product liability cases."
and
"There are many reports and studies confirming that SSRI antidepressants can cause violence, suicide, mania and other forms of psychotic and bizarre behavior."
. . . . .
Although there is a great deal of prima facie evidence and many case reports detailing the neuroleptic/antidepressant link to suicide and violence, there has not to my knowledge been a definitive large-scale study by American psychiatry of the link between psychiatric drugs and the murder/suicides that are occurring with increased frequency.
And the great question is: why not? Why is this urgent, life-threatening issue not afforded the highest priority by the APA, NIMH, and university psychiatry departments? Is their self-serving need to protect psychiatry from the consequences of its errors eclipsing their ethical integrity and their sense of responsibility?
DSM & Akathisia
In this regard, it's interesting to see how psychiatric drug-induced akathisia has been handled in the various editions of DSM.
DSM-III-R (1987) makes no specific reference to neuroleptic or antidepressant-induced akathisia. There are, however, a number of statements in the chapter on "schizophrenia" which clearly (and deceptively) ascribe symptoms of akathisia and tardive dyskinesia to "schizophrenia" itself. For instance:
"In addition, odd mannerisms, grimacing, or waxy flexibility may be present [in schizophrenia]. (p 190)
"Almost any symptom can occur as an associated feature [of schizophrenia]. The person may appear perplexed, disheveled, or eccentrically groomed or dressed. Abnormalities of psychomotor activity—e.g., pacing, rocking, or apathetic immobility—are common." (p 190) [Emphasis added]
In reality, most of the pacing, grimacing, and rocking exhibited by people labeled schizophrenic is a direct result of neuroleptic drug poisoning, and not an associated feature of the so-called illness itself.
"Dysphoric mood is common [with schizophrenia], and may take the form of depression, anxiety, anger, or a mixture of these." (p 190)
Anxiety and anger are also direct effects of neuroleptic poisoning for many people.
"Although violent acts performed by people with this disorder often attract public attention, whether their frequency is actually greater than in the general population is not known. What is known is that the life expectancy of people with Schizophrenia is shorter than that of the general population because of an increased suicide rate and death from a variety of other causes." (p 191)
As is clear from the material quoted earlier, suicide is frequently a result of akathisia. The phrase "death from a variety of other causes" is unclear.
. . . . .
DSM-IV (1994) was markedly more honest in acknowledging the existence of neuroleptic-induced akathisia. In fact, this was included as an actual diagnosis in the fourth edition. It was coded as 333.99, and 2½ pages (744-746) were devoted to its description. Here are some quotes:
"In its most severe form, the individual may be unable to maintain any position for more than a few seconds." (p 744)
"The subjective distress resulting from akathisia is significant and can lead to noncompliance with neuroleptic treatment. Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts. Worsening of psychotic symptoms or behavioral dyscontrol may lead to an increase in neuroleptic medication dose, which may exacerbate the problem. Akathisia can develop very rapidly after initiating or increasing neuroleptic medication. The development of akathisia appears to be dose dependent and to be more frequently associated with particular neuroleptic medications. Acute akathisia tends to persist for as long as neuroleptic medications are continued, although the intensity may fluctuate over time. The reported prevalence of akathisia among individuals receiving neuroleptic medication has varied widely (20%-75%)." (p 745) [Emphasis added]
Note the reference in the third line above to "irritability, aggression, or suicide attempts". In fact, as the material quoted earlier makes clear, neuroleptic-induced akathisia has been causally-linked to actual homicides and suicides. This understatement was clearly deliberate, as Allen Frances, MD, architect of DSM-IV, was also one of the authors of the Shear et al paper quoted earlier, which linked neuroleptic-induced akathisia to actual completed suicides.
"Neuroleptic-Induced Acute Akathisia may be clinically indistinguishable from syndromes of restlessness due to certain neurological or other general medical conditions, to nonneuroleptic substances, and to agitation presenting as part of a mental disorder (e.g., a Manic Episode)." (p 745)
In other words, people who are experiencing neuroleptic-induced acute akathisia are at risk of being assigned a "diagnosis" of "bipolar disorder"!
"Serotonin-specific reuptake inhibitor antidepressant medications may produce akathisia that appears to be identical in phenomenology and treatment response to Neuroleptic-Induced Acute Akathisia. Akathisia due to nonneuroleptic medication can be diagnosed as Medication-Induced Movement Disorder Not Otherwise Specified." (p 745) [Bold face in original]
and
"Individuals with Depressive Episodes, Manic Episodes, Generalized Anxiety Disorder, Schizophrenia and other Psychotic Disorders, Attention-Deficit/Hyperactivity Disorder, dementia, delirium, Substance Intoxication, (e.g., with cocaine), or Substance Withdrawal (.e.g., from an opioid) may also display agitation that is difficult to distinguish from akathisia." (p 745-746) [Bold face in original]
Which prompts one to wonder how many people who have been assigned these so-called diagnoses were actually suffering from one of the toxic effects of neuroleptic drugs or SSRI's. It is also entirely plausible, as DSM-IV suggests, that many of these individuals would have been "treated" with even higher doses of neuroleptics!
. . . . .
The entry in DSM-IV-TR (2000) is identical to that in DSM-IV except for the following addition:
"Although the atypical [newer] neuroleptic medications are less likely to cause akathisia than the typical [older] neuroleptics, nonetheless, these medications do cause akathisia in some individuals." (p 801)
. . . . .
DSM-5 is remarkably less frank concerning psychiatric drug-induced akathisia than was DSM-IV. The name Neuroleptic-Induced Acute Akathisia was changed to Medication-Induced Acute Akathisia and the entry is given a total of four-and-a-half lines of text:
"333.99 (G25.71) Medication-Induced Acute Akathisia
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms." (p 711) [Bold face in original]
There is no reference to the fact that, as earlier psychiatric authors had stated, the condition can be so unbearable as to drive people to suicide and even homicide.
There is, however, an interesting admission in a separate, also brief, entry:
"333.72 (G24.09) Tardive Dystonia
333.99 (G25.71) Tardive Akathisia
Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction." (p 712) [Bold face in original]
In other words, neuroleptic-induced akathisia can persist for years, even if the person stops taking the drugs! But even granting this admission, it is clear that DSM-5 is markedly down-playing the significance and seriousness of neuroleptic-induced akathisia. And it is also clear from elsewhere in the text that the agenda here is to protect the reputation of the neuroleptic drugs:
"The term neuroleptic is becoming outdated because it highlights the propensity of antipsychotic medications to cause abnormal movements, and it is being replaced with the term antipsychotic in many contexts." (p 709)
Note the deceptive use of the passive voice ("is becoming outdated"). In reality, psychiatrists are consciously and deliberately phasing out the term "neuroleptic" in an attempt to conceal, or at least not draw attention to, the severe and potentially life-threatening neurotoxic effects of these drugs.
But the more important question is why has the APA eliminated the DSM-IV category "neuroleptic-induced akathisia" that ran to 2 ½ pages, and replaced it with the more general "medication-induced acute akathisia", which runs to 4 ½ lines? Why has this dangerous and relatively widespread adverse effect been so downplayed? On page 809 of the DSM-5 text there is a section called Highlights of Changes from DSM-IV to DSM-5, but there is no explanation for the change there. There is a note in this section referring the reader to "An expanded description of nearly all changes…" on the APA website. The link leads to an article titled "Highlights of Changes from DSM-IV-TR to DSM-5". But the article contains no reference to the change in question.
So we don't know the APA's justification for suppressing information about this potentially devastating adverse effect. But we do know that neuroleptic drugs are being prescribed for an increasing range of problems, and are even being prescribed to toddlers for temper tantrums and to nursing home residents for "management problems". Some have even acquired "block-buster" sales status. It is clearly in pharma's interests to suppress this information and it is consistent with psychiatry's hand-in-glove relationship with pharma that they should oblige their generous benefactors in this way. Remember, 69% of the DSM-5 workforce were in the pay of pharma while working on the revision.
Despite the early, and very clear, statements from individual psychiatrists linking psychiatric drugs to murder/suicides, the psychiatric leadership has consistently failed to address this link. Instead, they deceptively attribute these incidents to a lack of psychiatric "treatment", and they call for legal enforcement of even more drugging.
Finally
On June 9, 2016, Maria Oquendo, MD, President of the APA, wrote a post in support of the Senate's so-called Mental Health Reform Bill. The post was standard psychiatric propaganda, including the inane 21% annual and 50% lifetime prevalence of "mental illness". The reality is that if one can invent illnesses at will and arbitrarily reduce the "diagnostic" thresholds of these "illnesses", one can produce any prevalence numbers one chooses.
The post also drew attention to the fact that there were 41,000 suicides in the US in 2013, and asserted that "…we continue to fail people with mental illness every day."
In other words, more psychiatric treatment would reduce the suicide rate. But meanwhile, we have no data on how many of these individuals were in the throes of neuroleptic or antidepressant-induced akathisia. And as long as psychiatry and pharma are controlling the research agenda, such information will be systematically repressed.
As I've stated many times, psychiatry is intellectually and morally bankrupt. They are adamantly resistant to anything resembling critical self-appraisal, and there are no depths of deception and spin to which they will not go, to suppress the reality and the consequences of their drug-pushing depredations. Neuroleptic and antidepressant drugs induce some individuals to take their own lives and/or the lives of others. Neuroleptic and antidepressant drugs are almost certainly the proximate causes of many of the mass shootings that have plagued our country for almost twenty years. How much longer can psychiatry sustain this dreadful, self-serving deception?
And, Incidentally
Senator John McCain and Congressman David Jolly have introduced bills in their respective chambers that if enacted will require the Veterans Administration to conduct a comprehensive study of the link between psychiatric drugs and veterans' suicides. It will be an enormous step forward if these bills become law. It is also an interesting reflection that these bills were initiated by politicians, and not by psychiatrists, who present themselves as caring professionals acting in the best interests of their so-called patients.
If you live in the US, please encourage your representatives to support the McCain and Jolly bills (S 3410 and H 4640).
Thank You Dr Hickey, MIA and Sen McCain.
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