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Re: Drug-related Violence and Suicide (and more)

Posted by SLS on May 29, 2000, at 11:31:40

In reply to Re: Drug-related Violence , posted by Cam W. on May 29, 2000, at 6:55:11

> The Church of Scientology released press reports that were alarmist and unscientific (made to look scientific).

They have made a science of this.

> The reason for these suicides while taking Prozac was that the Prozac was relieving the depressive symptoms in these people who committed suicide. These people already had suicidal ideation and the Prozac had given them more energy to act upon their impulses.

This is, of course, true in many cases. I guess this applies with any antidepressant. A good psychiatrist understands that there is an increased risk of suicide within the first three or four weeks of treatment (assuming they begin to respond after two weeks), exactly for the reasons you describe. This makes a good argument for close doctor supervision using weekly visits.

> So, yes, I guess you could say that it was the Prozac that caused their death by relieving their depression. I guess if these people were never treated, and were depressed for the rest of their lives, they wouldn't have committed suicide.

A definite possibility.

> Any disease requires disease-management. There are no cures in pharmacy. All of the medication are only bandages.

Gosh, the term "bandage" really rubs me the wrong way. Sorry, Cam. I do know what your point is, though. A bandage sounds like a temporary superficial patch to be used until the REAL problem is solved. Yes, a bandage stops the bleeding, but it does nothing to prevent the wielded knife from opening up the wound again, or cutting open new ones. I would rather think of an antidepressant as being more of a corrective agent, changing the operation of the brain to bring about a restoration and normalization of function. That this correction must be maintained by the drug that produces it indefinitely indicates that the illness has not been cured. But it is in remission. It has gone away.

> Psychotherapy is necessary (be it talking to a therapist, your pastor, a family member, or a friend) to recover from depression.

No. (Sorry again)

> It has been well established that drugs alone will not "cure" a depression.

See above.

I find this to be a misleading application of semantics. It is well established that insulin injections alone will not "cure" diabetes. Neither will psychotherapy, although it might help preserve glucose dynamics by reducing stress. (wild guess)

> It is people with mental illness, who have violent or suicidal thoughts, that neede to be followed closely during treatment. Other people who know a potentially violent or suicidal person (and especially the doctor) can notice signs of changes in the ill person (usually before that person does) and can head off any potentially violent of suicidal tendencies as someone recovers from depression. Recovery does not occur in a vaccuum.

Getting back to antidepressant-induced suicide and violence...

That this occurs is so manifestly true.

I don't think it makes sense to begin a discourse as to the phenomenology of the psychobiological substrate for spontaneous suicidal states (as opposed to a cerebral decision making process) and for that of violence. There is a plethora of personal descriptions on this board to demonstrate conclusively that this is indeed the case.

Check out the posts that are on the board right now!

Serzone-induced anger. What's this all about? Prozac-induced agitation. Wellbutrin-induced rage. How might the evolution of these mental states affect the behavior of a disgruntled postal worker with a gun? Browse the board, you'll find plenty more.

* I apologize for the postal worker thing. It just made for an easily described scenario based upon its popularity. I make no judgments as to its validity.

I experienced reboxetine-induced suicidality. Unfortunately, this was not a manifestation of an improvement of depression. It is significant that my suicidal state was dose-dependant. At 4mg., I experienced anxiety, dysphoria, and some catastrophic thinking. At 8mg., these things became quite severe, and suicidal ideation became prominent. I called my parents and told them that I wanted to begin getting my affairs in order. I wanted to hide my savings so that I could bequeath it to family and friends, leaving the state to pay for my burial. Suicidality vanished within 36 hours of my last dose of reboxetine.

What about violent rage produced by benzodiazepine-induced disinhibition? Alcohol?

Of course, psychotropics are not the only drugs capable of exerting a psychotropic effect resulting in depression, aggression, or psychosis. Prednisone, Dianabol, testosterone, Inderal, reserpine, digoxin, l-dopa - Cam, help me out here.

These are just things that can happen when only *one* drug is used. What about combinations of drugs?

Suicidal or violent psychological profile + drug-induced biological perturbation = Suicide and Murder.

This stuff is so obvious, regardless of the statistical rate of occurrence.

If we don't take our heads out of the sand with this one, more people will get hurt.

Drug-induced depression, aggression, rage, psychosis, and suicidality should all be regarded simply as being the adverse side effects and reactions that they are. Just like any other set of drug side effects, they must be screened for through appropriate monitoring. Patients should be educated to the potential of these reactions and be encouraged to report them.

As far as psychological versus biological causes and remedies for depression are concerned, I think it is best conceptualized as a spectrum of contribution and interaction. I may be bipolar, but I hope my posts don't give the impression that I am bound by polar thinking.

I wrote a little piece back aways that I think makes a good framework for this conceptualization (it may suck, but I like it just the same). "Biology or Psychology?" It's pretty short.

* Does Prozac cause suicide? Yes.


- Scott


: Biol Psychiatry 2000 May 1;47(9):804-12 Related Articles, Books

Lactate-induced rage and panic in a select group of subjects who perpetrate acts of domestic violence.

George DT, Hibbeln JR, Ragan PW, Umhau JC, Phillips MJ, Doty L, Hommer D, Rawlings RR

Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-1610, USA.

[Medline record in process]

BACKGROUND: Perpetrators of domestic violence frequently report symptoms of autonomic arousal and a sense of fear and/or loss of control at the time of the violence. Since many of these symptoms are also associated with panic attacks, we hypothesized that perpetrators of domestic violence and patients with panic attacks may share similar exaggerated fear-related behaviors. To test this hypothesis, we employed the panicogenic agent sodium lactate to examine the response of perpetrators to anxiety fear induced by a chemical agent. METHODS: Using a double-blind, placebo-controlled design, we infused 0.5 mol/L sodium lactate or placebo over 20 min on separate days to a select group of subjects who perpetrate acts of domestic violence and two nonviolent comparison groups. We compared their behavioral, neuroendocrine, and physiologic responses. RESULTS: Lactate administration elicited intense emotional responses in the perpetrators of domestic violence. Perpetrators evidenced more lactate-induced rage and panic and showed greater changes in speech, breathing, and motor activity than did nonviolent control subjects. There were no significant differences between the groups for any neuroendocrine or physiologic measure. CONCLUSIONS: These results are consistent with our hypothesis that some perpetrators of domestic violence have exaggerated fear-related behavioral responses.

PMID: 10812039, UI: 20277614


1 : Harv Rev Psychiatry 1998 Jan-Feb;5(5):239-46 Related Articles, Books, LinkOut

Mood symptoms during corticosteroid therapy: a review.

Brown ES, Suppes T

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-9070, USA.

Corticosteroids such as prednisone are commonly prescribed for a variety of illnesses mediated by the immune system. This paper reviews the available literature on mood symptoms during corticosteroid treatment. Few studies have used well-recognized measures of symptoms or clearly defined diagnostic criteria to characterize such mood changes. The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy. Symptoms appear to be dose dependent and generally begin during the first few weeks of treatment. Risk factors for the development of mood instability or psychosis are not known. The similarities of the psychiatric symptoms resulting from corticosteroid treatment to the symptoms of bipolar disorder are discussed.

Publication Types:
Review, tutorial

PMID: 9493946, UI: 98152965


: J Med Assoc Thai 1998 Jul;81(7):551-4 Related Articles, Books, LinkOut

Drug-induced akathisia and suicidal tendencies in psychotic patients.

Kasantikul D

Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Five patients, while being treated with high potency antipsychotic drugs developed akathisia and tended towards committing suicide as a consequence of the inner agitation and restlessness they were suffering. Upon discontinuation of the respective medication or switching to low potency drugs, as well as addition of anti-parkinson drugs or benzodiazepines, the akathisia and suicidal tendencies abated. Clinicians ought to be aware of suicidal impulses emerging in patients suffering from akathisia. By prompt recognition and treatment of akathisia such suicidal tendencies and attempts can be prevented.

PMID: 9676095, UI: 98340746


17 : Int J Clin Pract 1997 Jul-Aug;51(5):330-1 Related Articles, Books, LinkOut

Suicide attempt due to metoclopramide-induced akathisia.

Chow LY, Chung D, Leung V, Leung TF, Leung CM

Department of Psychiatry, Chinese University of Hong Kong.

Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.

PMID: 9489098, UI: 98150356


Drugs Aging 1997 May;10(5):367-83 Related Articles, Books

Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment.

Young BK, Camicioli R, Ganzini L

Mental Health Division, Portland Veterans Affairs Medical Center, Oregon, USA.

Parkinson's disease (PD) is a progressive neurological condition that causes considerable disability in the elderly. Drugs used to treat PD, such as levodopa, offer symptomatic relief but often have neuropsychiatric adverse effects, most prominently psychosis and delirium. Aged patients and those with dementia are particularly vulnerable to these adverse effects. Evaluating PD patients with drug-induced neuropsychiatric adverse effects is made difficult by their complex clinical presentations. The treatment of drug-induced psychosis and delirium begins with manipulating the antiparkinsonian drug regimen, but this frequently worsens motor function. Atypical antipsychotics such as clozapine have been successfully employed to treat the psychosis without worsening the motor disability. Patient intolerance of clozapine therapy has prompted open-label studies with newer agents such as risperidone, remoxipride, zotepine, mianserin and ondansetron.

Publication Types:
Review, tutorial

PMID: 9143857, UI: 97288925


29 : J Emerg Med 1994 Sep-Oct;12(5):685-7 Related Articles, Books, LinkOut

Revisiting fluoxetine (Proxac) and suicidal preoccupations.

Tueth MJ

Department of Psychiatry, University of Florida, Gainesville 32608.

Several reports were published in the psychiatric literature in 1990 and 1991 documenting fluoxetine (Prozac) causing patients to consider or attempt suicide. During the following 2 years, retrospective studies appeared in the medical literature that seemed to indicate that suicidal preoccupation was not related to the antidepressant fluoxetine (Prozac) but was probably a symptom of the depressive illness. Recent studies have suggested, however, that fluoxetine (Prozac) may in fact lead to suicidal behavior because the drug appears to adversely affect serotonergic neuronal discharge and induce an akathisia-like extrapyramidal reaction. While fluoxetine (Prozac) has a very favorable side effect profile compared to the tricyclic antidepressants, it may cause akathisia and induce a small subset of patients to consider or attempt suicide.

PMID: 7989697, UI: 95081530


50 : J Clin Psychiatry 1991 Dec;52(12):491-3 Related Articles, Books, LinkOut

Reexposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia.

Rothschild AJ, Locke CA

McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA 02178.

Considerable controversy exists regarding the relationship between fluoxetine and the emergence of suicidal ideation. Three cases are presented of patients who were reexposed to fluoxetine after having previously made a serious suicide attempt during fluoxetine treatment. All three patients developed severe akathisia during retreatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts. The akathisia and suicidal thinking abated upon the discontinuation of the fluoxetine or the addition of propranolol. The emergence of suicidal ideation during treatment with fluoxetine may be secondary to the development of akathisia. Gradual increments of fluoxetine dose and the prompt recognition and treatment of akathisia may reduce further the rare occurrence of suicidal ideation during fluoxetine treatment.

Comment in: J Clin Psychiatry 1992 Jul;53(7):256-7
Comment in: J Clin Psychiatry 1993 Nov;54(11):439

PMID: 1752848, UI: 92091324


J Clin Psychopharmacol 1993 Aug;13(4):235-42 Related Articles, Books

Postmarketing surveillance by patient self-monitoring: trazodone versus fluoxetine.

Fisher S, Bryant SG, Kent TA

Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston 77555.

This article presents incidence estimates and relative risks for a number of adverse clinical events reported by outpatients being treated with either trazodone or fluoxetine. Data were collected via an innovative method of patient self-monitoring. Many of the suggested differences between the two drugs are quite consistent with expected adverse drug reactions documented in both the package insert data for outpatients and with reports in the literature. Findings not so readily anticipated for trazodone, however, include higher relative frequencies for muscle weakness or soreness, skin swelling, and urinary complaints compared with fluoxetine; for fluoxetine, data are presented indicating a higher incidence of various psychologic/psychiatric adverse clinical events, including delusions and hallucinations, aggression, and suicidal ideation. Other possible interpretations of the results are discussed.

PMID: 8376610, UI: 93388901





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