by Julie Wood
The connection between SSRIs, violence and suicide
For many years, a few medical experts have been trying to raise awareness of the link between selective serotonin reuptake inhibitor (SSRI) antidepressants (and some other medications) and violence. The RxISK.org website Violence Zone flags the issue for people interested in researching the side effects of their medications. Still, the average person does not believe this to be true. The idea that a prescription could cause a person to do something totally out of character seems counter-intuitive. However strange the idea may seem, the evidence is clear.
This five-part series of posts draws on the lessons offered by SSRIStories’ 6,000+ news articles about the relationship between antidepressants, violence and suicide. The aim is to help people better understand how antidepressants (and some other medications) cause violence and suicide, and to expose the single biggest misunderstanding that has stopped people from spotting the connection.
The issue is explored from the perspective of experience. The posts attempt to answer some tough questions: What does it feel like to be one of those people who has a bad reaction to an antidepressant? What causes them to hurt others? Why would someone commit violence or suicide with no warning? Why would nice people with no history of violence do something completely out of character? What does the research tell us, and how should we interpret it?
How does the evidence from carefully planned studies stack up against “anecdotal” evidence, i.e. reports of individual personal experiences? Some researchers pay no attention to anecdotal evidence. There is a belief in medical science that the “gold standard” for learning about drug effects is randomized control trials (RCT). Unfortunately RCT have inherent limitations, and the data from them can be misrepresented, as Study 329 proved (see Restoring Study 329). Researchers may view individual cases as anomalies because they are single incidents, especially if they do not align with published research. Research can prove that pigs can’t fly, and this finding seems intuitively correct. However, when enough people independently report seeing pigs soaring through the air, it is time to take a second look at the research.
SSRIstories.org is a collection of thousands of “anecdotes”, reported in news articles and transcripts of legal cases, involving people who appear to have done something violent (including suicide) as the result of taking antidepressants. The collection contains many stories in which people have figured out that their medication was a factor in their misfortunes. In most of these cases, officialdom (courts, coroners, the media) overlook or deny the drug-violence connection. They favour explanations that place the blame elsewhere, usually on “mental illness”. Since people who are taking psychoactive medication have usually been diagnosed with something, this explanation seems to fit.
Many other anecdotes are reported by people who share their SSRI experiences in internet chat rooms, where they candidly discuss some horrific drug effects and learn from the experiences of others. Even though these discussions are nothing like controlled experiments, it is difficult to discount the phenomenon of so many people reporting similar experiences in great detail.
The great illusion
The general public – and, it seems, their governments – firmly believe that mentally ill people are dangerous. They cling to this belief because they think they understand.
However, the situation is more complex than has been portrayed to them. The public knows what they see, and what they see appears to confirm their belief. When the magician puts the rabbit in the hat and waves his wand, everyone sees the rabbit disappear. The magician tips his hat and the audience can see that the rabbit is gone, but things are not as they appear. The rabbit is actually safe in a concealed compartment. Like the magician’s illusion, the myth of the dangerous mentally ill depends for its perpetuation on keeping the audience (the public) from seeing what is really going on:
- The mental illness that the public is so afraid of is largely a by-product of the medication given to alleviate mental illness. The random and bizarre acts of violence that people associate with “mental illness” are actually caused by medication. Psychoactive medications are often initially prescribed for minor and usually transient emotional experiences, not illnesses at all. With medication, these minor issues can turn into severe and chronic illnesses . The medications that are hyped as a cure for chemical imbalances are actually what cause the chemical imbalances; and
- People who stop taking their medications, for whatever reason, can experience withdrawal effects which are perceived as “relapse”, and proof that the person needs the drugs and should never have stopped taking them.
The magician’s disappearing rabbit trick is harmless and enjoyable. The illusion of the dangerous mentally ill is destructive and costly. People who have taken psychoactive drugs too often get locked in a vicious circle. When they experience negative side-effects, such as agitation, insomnia or paranoia, these are interpreted as new or worsening signs of inherent mental illness, to be treated with more drugs. In other words, when people have bad reactions to these poisons, the officially sanctioned solution is more of the very poison that caused the harm. This syndrome has cost many people their health, their freedom, and sometimes their lives.
Why don’t most people spot the connection between SSRIs and violence?
People believe that mentally ill people are the ones who become violent because of the Great Illusion. The idea that somehow mental illness leads to violence fits with the facts as presented to them. Journalists, like everyone else, have been fooled, and for them the illusion would only be reinforced by verifying their interpretation with experts such as psychiatrists, or in relying on the interpretations of those experts. Consequently, the public sees and hears news involving violence that “proves” to them that mentally ill people are dangerous, and must be isolated and controlled. News coverage conveys to them that:
- mentally ill people threaten public safety. Every year, a number are shot by police in public while causing disturbances. Often the victims are behaving in unusual ways, but are not a threat to anyone. Whenever such an incident occurs, it is widely reported. The role of drugs is only discussed if the drugs are illegal, and only then are they described as a contributing cause. Each time, a few citizens express concern (but not outrage), no charges are laid, an inquest acknowledges the importance of public safety and calls for better police training, and the incident is closed;
- when senseless violent crimes are committed it is because of inherent mental illness. Psychoactive drugs are sometimes mentioned, but not as a cause of the incident. They are mentioned only as proof that the perpetrator was mentally ill; and
- mentally ill people cannot be counted on to take their meds, because they simply do not have the judgement and the capacity to know what is good for them, and thus intervention is necessary to force such people to take their prescribed medication, for public protection. Legislation that sanctions forced drugging sends a message to citizens that the drugs are beneficial and once medicated, these people will no longer be a threat.
The foundation for this misguided conventional wisdom appears solid because reported facts appear to fit the reported stories. However, just as the magician seems to make the rabbit vanish, when the rabbit is really just not visible, things are not as they appear. People who have been diagnosed may be disproportionately responsible for public disturbances and senseless acts of violence, but what the public is actually witnessing is not the phenomenon they have been led to believe it is.
SSRIstories.org has thousands of reports of people whose serious problems began when they were given medication. The problems for which they were prescribed meds like SSRIs are trivial compared to the disasters that ultimately get them into the news. The official interpretation in these cases is that the people who did these bad things were mentally ill, and despite treatment they became worse and committed the violent act. Nobody wonders if the extreme worsening was because of the treatment.
Key to maintaining this destructive illusion is the public’s lack of understanding of the difference between “ordinary” madness, and drug-induced delirium-psychosis. Madness that evolves without medication is very different from the state that can result from taking, or stopping, legal or illegal drugs. It is the drug-induced delirium-psychosis that causes violence, and that is behind the most terrible violent incidents in the news.
SSRIs and alcohol
Conventional wisdom has it that mentally ill people drink to “self-medicate”, and there is no doubt that troubled people have drowned their sorrows as long as
alcoholic drinks have existed. However, the illusion is at work here, too.
Addiction and crime are associated, and addiction and mental health issues are associated. The general assumption is that mental illness leads to substance use (to alleviate symptoms, or “self-medicating”) which becomes addiction and leads to crime. But what if prescription medications lead to mental illness and addictions, which in turn lead to the commission of crimes?
Medical literature is full of proof that mental illness and substance abuse are linked, the assumption being that mental illness leads to addiction. In Anatomy of an Epidemic, author Robert Whitaker observes:
“Fifty years ago, physicians virtually never saw manic-depressive illness in preteens, and they rarely diagnosed it in adolescents. Then pediatricians and psychiatrists began prescribing Ritalin…and suddenly the medical journals began running case reports of manic children. This problem grew as the prescribing or Ritalin increased, and then it exploded with the introduction of the SSRIs.” 
Whitaker then cites research showing that “the long-term prognosis for these children is grim… pre-adult onset is associated with greater rates of comorbid anxiety disorders and substance abuse.”  This clearly suggests than in the cause-and-effect puzzle of mental illness, medication and addiction, it was medication that came first.
Research intended to show one thing can occasionally reveal things it does not intend. For example, one study, the aim of which was to identify optimal treatment strategies for people with bipolar diagnosis noted:
“Substance use disorders and bipolar disorders are associated with mutually increased risk… Patients with the combination are more impulsive and are at greater risk for suicidal or violent behavior than are subjects with either illness alone…those with combined disorders have earlier onset of illness… 
This study took as a given that substance abuse and bipolar are strongly related. Taking into account Whitaker’s observation, this begs the question of the extent to which medicating children led to both their bipolar problems and their substance abuse.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiologic Survey on Alcohol and Related Conditions, one of the largest surveys of its kind ever performed, and found, among other things, that:¸
“People who are dependent on drugs are more likely to have an alcohol use disorder than people with alcoholism are to have a drug use disorder.” 
The NIAAA was referring to illegal drugs, but the finding leads one to wonder if perhaps something in drug use increases peoples’ inclination to drink.
Anne Marie’s March 15 2012 Blog, on DavidHealy.org: Out of My Mind, Driven to Drink points out that many people taking SSRIs develop a craving for alcohol. Then, when they do drink, the combination of the drug and alcohol magnifies the effects of both substances. Once she described her own experience, many people came forward verifying that this had also happened to them, or to someone they know. So, while alcohol may be the direct trigger for problems, SSRIs lead some individuals to alcoholism who never had a drinking problem before.
Problems of withdrawal
Negative reactions caused by these medications are most likely to occur upon starting, following a dose change, and when a person stops taking the medication. Stopping these medications can cause serious withdrawal effects. The anger, irritability and even rage associated with withdrawal can lead to extreme overreactions. This is acknowledged in internet blog posts and SSRI withdrawal forums:
- “The most distressing symptom for myself was severe mood swings, which have only worsened since coming off the [citalopram] completely. Usually a calm person, I am now incredibly short-tempered and irritable. I can snap at the drop of a hat, and just become a completely different person.”
- “Anger is a normal human emotion…we’ve developed sophisticated ways of expressing and dealing with anger. We use discussion and logic to make anger
serve us in productive ways. SSRI withdrawal turns this normal process on its head. In withdrawal, anger forms independently in the mind. Instead of rising in response to an external event, withdrawal causes anger without context. You’re just angry. There’s no event or emotion preceding it, it just pops into your head.”
- “I have been taking Lexapro for GAD for around 4 years. I have tried going off of it before (gradually and cold turkey) because I felt I didn’t need it due to finally being diagnosed and treated for narcolepsy. I also don’t enjoy the side effects (no sex drive, difficulty achieving orgasm, etc). However, every time I get withdrawal symptoms of extreme anger and rage after being Lexapro free for about a month. I’ve never had anger issues before.”
- “…the withdrawal symptoms of Zoloft were brutal…I would move and my brain would stand still. It would spin, I became very angry and agitated. I still lash out at my husband for no reason. It is horrible.”
- “…then I dropped the Effexor completely and continued the Wellbutrin. Within 2 days I began to have ringing in my ears, a chugging sensation in my head, diarrhea, cold sweats — and that’s not the 1/2 of it. The irritability, fits of rage, overwhelming sadness, thoughts of death, nightmares and more are the hard part.”
- “There have been times when I have ran out [of Paxil] due to procrastination and suffered horrible withdrawal effects just like everyone else listing here has. Without Paxil I feel constant anxiety, RAGE–MAJOR anger over petty things, paranoia, black depression and utter hopelessness.”
- “SSRI withdrawals are some of the worst I’ve ever had and I’ve had a fair variety and experience of withdrawals over the years. Physically it’s unpleasant enough, but mentally I was fuckin’ insane. I was pretty much psychotic at points – quite hysterical and seeing/”communicating with” things that weren’t there. Awake for days on end. Losing my rag with anybody and everybody over anything and everything. Cutting bizarre, nihilistic “words of wisdom” into my flesh with glass/razors. Was seriously nasty.”
These are just a small selection of comments on the subject of SSRI-withdrawal-induced anger. It would be hard to read such comments and not wonder about the connection between SSRI withdrawal and violent acts committed in fits of sudden and senseless rage. Still, news articles seldom point this out when they report a violent act, even if they mention that the perpetrator recently stopped taking antidepressant medication.
Medication withdrawal effects are important to sustaining the illusion. A few experts have spoken out for years about how difficult withdrawal from SSRIs can be. However, until recently, the official story was that these meds are not addictive, the effects of withdrawing are short-lived and easily managed, and the worst potential consequence of withdrawal is relapse into the original depression. Harvard Health provides a typical example of this information.  So, when people stop taking a medication and become violent, this is interpreted as proof that without their medication, they cannot function normally. The withdrawal effects are perceived as “the real person”.
Recently, research has acknowledged that withdrawal effects can be long-lasting, worse than the original condition for which the SSRIs were prescribed, and often include new symptoms.  Withdrawal symptoms include confusion, aggression, disorientation, agitation, panic, irritability, anger, depersonalization and mood swings. Less common, but not rare, symptoms include intensification of suicidal ideation and psychosis. 
- Anatomy of an Epidemic, Crown Publishers. 2010 by Robert Whitaker, covers this phenomenon extensively
- Ibid Page 242
- Ibid Page 243
- Bipolar disorder and substance abuse: two disorders or one?, by Alan Swann, Journal of Dual Diagnosis, 1(3), 2005, pp.9-23.
- Alcohol Alert, July 2008, EPIDEMIOLOGY: How common is alcohol and other drug addiction?http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm
- See Going off antidepressants, Harvard Women’s Health Watch http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
- Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review, Psychotherapy and Psychosomatics 2015; 84:72-81, Fava et al.
- New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal, Psychotherapy and Psychosomatics 2015;84:63-71, Chouinard G.