Pysch drug link to violent episodes analysed

Forensic testing of blood can now determine if anti- depressants were the cause of violent behaviour, including murder or suicide, new research has found.

Genetic variations in metabolism affect how different people react to anti-depressants, and now medical examiners say they can identify those variations, and use the evidence to “potentially absolve people charged with homicide”, and explain why they acted like they did.

The research, published recently in the Journal of Forensic and Legal Medicine, was carried out by a medical specialist, a forensic psychiatrist and a pharmacogeneticist. It looks specifically at three cases where people with no previous diagnosis, who were prescribed antidepressants for stress-related issues, ended up killing others, with two attempting suicide.

“An out-of-character unmotivated homicide or suicide by a person taking medication might be chemically induced and involuntary. The capacity to use frontal lobe functions and control behaviour can be impaired by brain toxicity,” the paper states.

“None improved on medication, and no prescriber recognised complaints as adverse drug reactions or was aware of impending danger.”

The researchers took accounts of restlessness, akathisia (a state of severe restlessness associated with thoughts of death and violence), 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 recognised their actions to be out of character, and their beliefs and behaviours horrified them,” the paper notes.

The research concludes that the “medicalisation of common human distress” has resulted in a very large number of people getting medication that may do more harm than good by causing “suicides and homicides and the mental states that lead up to them”.

Irish mental health campaigner Leonie Fennell, whose son Shane was prescribed anti-depressants and soon afterwards killed himself and another person, said she has been aware of this evolving science for some years, and has had Shane’s blood tested in Australia.

The researcher who tested Shane’s blood, Dr Yolande Lucire, is one of the papers’ authors. She cited his case in another research project she carried out in 2011. Dr Lucire noted Shane was initially prescribed a double dose of the common SSRI anti-depressant, citalopram.

Five days later he overdosed on the tablets, and two days later he told his doctor, who then restarted him on a lower dose of the anti-depressant.

“He immediately became violently akathisic, unable to stay in one place, moving constantly between the houses of friends, unable to sit and have a conversation. According to his mother, communicating with him was like ‘talking to a brick wall’. His friends reported that, immediately after taking citalopram, he became agitated, emotional, irrational, and aggressive. His brother saw him throw a mobile phone, destroying it, with trivial, if any provocation,” Lucire writes.

Post-mortem toxicology of blood revealed levels of citalopram of about 30 times the therapeutic level.

Dr Lucire, a forensic psychiatrist who specialises in adverse drug reactions to psychiatric drugs, said in her experience patients do not need the drugs they are being prescribed.