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Shedding Light in the Darkness

Rx For Violence? Aggression & Antidepressants

anti-depressants

In an article headlined “Rx for violence? Crime risk rises for young people on antidepressants,” the Los Angeles Times reported on a new study out of Sweden linking antidepressants and violence.

Data from Sweden shows that young adults between the ages of 15 and 24 who had filled prescriptions for the drugs were more likely to be convicted of a homicide, assault, robbery, arson, kidnapping, sexual offense or other violent crime when they were taking the medications than when they weren’t. The researchers found no link between antidepressant use and criminal activity for older patients.

The findings, published in the journal PLOS Medicine, build on other evidence that the antidepressants – known as selective serotonin reuptake inhibitors, or SSRIs – work differently in the brains of adolescents and adults. Several studies have shown that the drugs actually boost the risk of suicidal thoughts in children, teens and young adults, but not in older adults.

After adjustment for age, the association between SSRIs and convictions for violent crimes remained significant for individuals (males and females combined or males and females considered separately) aged 15 to 24 years but became non-significant among older individuals.

However the findings don’t prove that taking SSRIs actually causes an increase in violent crime among young people because the analytical approach used does not fully account for time-varying risk factors such as symptom severity or alcohol misuse that might affect an individual’s risk of committing a violent crime (residual confounding).

The warning about an association between prescription drugs and troubling behavior has a long history.

In 2004, the Australian Therapeutic Goods Administration published an Adverse Drug Reactions Bulletin recommending that any use of SSRI antidepressants in children and adolescents should be carefully monitored for the emergence of suicidal ideation.  In a recent study involving Prozac, it said, there was an increase in adverse psychiatric events of suicide, self-harm, aggression and violence.

In 2005, the FDA announced its intention to make labeling changes for Concerta and other methylphenidate (Ritalin) products (stimulants) to include, “psychiatric events such as visual hallucinations, suicidal ideation, psychotic behavior, as well as aggression or violent behavior.”

Also in 2005 – The Commission of the European Communities, representing 25 European countries, endorsed and issued the strongest warning against child antidepressant use as recommended by Europe’s Committee for Medicinal Products for Human Use (CHMP). Clinical trials had shown that the drugs caused suicidal behavior including suicide attempts and suicidal ideation, aggression, hostility (predominantly aggression, oppositional behavior and anger) and/or related behavior.

In 2006, Health Canada approved a new warning label for Paxil that read, in part: “A small number of patients taking drugs of this type may feel worse instead of better. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts, such as thoughts of self-harm or harm to others.”  Health Canada required Paxil’s product information to detail a list of “rare” side effects, affecting fewer than one in 1,000 patients. These include delusions, hostility, psychosis, and psychotic depression.

In 2008, Eli Lilly in Europe included warnings that Strattera causes “hallucinations, delusional thinking, mania or agitation in children and adolescents without a prior history of psychotic illness or mania…” Strattera is an antidepressant prescribed as a “non stimulant” drug to treat ADHD.

And the FDA required a boxed warning – Co-morbidities occurring with ADHD may be associated with an increase in the risk of suicidal ideation and/or behavior…

In 2009, the Japanese Ministry of Health, Labor and Welfare investigated news reports of antidepressant users “who developed increased feelings of hostility or anxiety, and have even committed sudden acts of violence against others.” After its investigation, the Ministry decided to revise the label warnings on newer antidepressants stating, “There are cases where we cannot rule out a causal relationship [of hostility, anxiety, and sudden acts of violence] with the medication.”

Also in 2009, the FDA required the manufacturers of the smoking cessation aids varenicline (Chantix) and bupropion (Zyban, aka the antidepressant Wellbutrin) to add new Boxed Warnings and develop patient Medication Guides highlighting the risk of serious neuropsychiatric symptoms in patients using these products. These symptoms include changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide.

This year The British Medical Journal published a reanalysis of an antidepressant trial concluding the popular drug Paroxetine was ineffective and unsafe for adolescents. The new results contradict the original research findings that portrayed paroxetine as an effective and safe treatment for children and adolescents with major depression.

The original study funded in 2001 by GlaxoSmithKline and published in the Journal of the American Academy of Child and Adolescent Psychiatry, was criticized by the Food and Drug Administration (FDA) in 2002. Yet, that year, over two million prescriptions were written for children and adolescents in the United States. In 2012 GSK was fined a record $3 billion in part for fraudulently promoting paroxetine.

Using previously confidential trial documents, the researchers re-analysed the original data and found that neither paroxetine nor high dose imipramine was more effective than placebo in the treatment of major depression in adolescents. The authors considered the increase in harms with both drugs to be clinically significant.

In 2011 Time magazine published information from a study by the Institute for Safe Medication Practices listing the top 10 drugs associated with violence.

10) Desvenlafaxine (Pristiq) An antidepressant which affects both serotonin and noradrenaline, this drug is 7.9 times more likely to be associated with violence than other drugs.

9)  Venlafaxine (Effexor) A drug related to Pristiq in the same class of antidepressants, both are also used to treat anxiety disorders. Effexor is 8.3 times more likely than other drugs to be related to violent behavior.

8) Fluvoxamine (Luvox) An antidepressant that affects serotonin (SSRI), Luvox is 8.4 times more likely than other medications to be linked with violence

7) Triazolam (Halcion) A benzodiazepine which can be addictive, used to treat insomnia. Halcion is 8.7 times more likely to be linked with violence than other drugs, according to the study.

6) Atomoxetine (Strattera) Used to treat attention-deficit hyperactivity disorder (ADHD), Strattera affects the neurotransmitter noradrenaline and is 9 times more likely to be linked with violence compared to the average medication.

5) Mefoquine (Lariam) A treatment for malaria, Lariam has long been linked with reports of bizarre behavior. It is 9.5 times more likely to be linked with violence than other drugs.

4) Amphetamines: (Various) Amphetamines are used to treat ADHD and affect the brain’s dopamine and noradrenaline systems. They are 9.6 times more likely to be linked to violence, compared to other drugs.

3) Paroxetine (Paxil) An SSRI antidepressant, Paxil is also linked with more severe withdrawal symptoms and a greater risk of birth defects compared to other medications in that class. It is 10.3 times more likely to be linked with violence compared to other drugs.

2) Fluoxetine (Prozac) The first well-known SSRI antidepressant, Prozac is 10.9 times more likely to be linked with violence in comparison with other medications.

1) Varenicline (Chantix) The anti-smoking medication Chantix affects the nicotinic acetylcholine receptor, which helps reduce craving for smoking. Unfortunately, it’s 18 times more likely to be linked with violence compared to other drugs — by comparison, that number for Xyban is 3.9 and just 1.9 for nicotine replacement.

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