Editorial Note: See The Man who thought he was a Monster
He was born on a Sunday. He had an average background with few health, physical or mental problems. His main difficulty was a certain social anxiety.
He went to University to study Neuroscience – probably to try and understand people.
His first attempt to seek help was from the Student Mental Health Clinic on March 16, 2012. The intake worker noted that he seemed extremely anxious, and she mentioned a certain misanthropy.
The first medical contact was on March 21, 2012. The doctor viewed him as having a schizoid personality (socially isolated – loner) with marked anxiety and some homicidal ideation. She prescribed Klonopin (a benzodiazepine), and sertraline (Zoloft).
A week later, he complained of memory problems in class, and the Klonopin was swapped for Propranolol 10mg BD (a beta-blocker). His memory problems continued and the propranolol dose was reduced to 5mg BD.
Klonopin and Propranolol can cause memory problems. Both can also act as antidotes to the anxiety and agitation Zoloft can cause. SSRIs can also cause memory problems.
Meanwhile his dose of Zoloft was being increased in steps from 50mg to 100mg to 150mg per day.
He stopped Zoloft somewhere around June 30, 2012, unaware of the risks of a withdrawal syndrome.
On Zoloft, he had disinhibition, affective instability, altered sexual functioning, and thoughts of violence, and he became delusional.
One friend said: “He began to “loosen up a bit” on medication and “became more talkative to random people.”
In the notebook that has been made public, he clearly outlines that he lost his sense of fear while taking Zoloft.
In the notebook he refers to his having developed a “dysphoric mania.” This is an accurate description of the affective instability that SSRIs can cause. It generally refers to a state in which the person, in very quick succession, can feel energized, reckless and invincible, and then depressed and suicidal.
He linked this dysphoric mania to his impulses to spend excessively which were out of character for him.
In line with a majority of people taking an SSRI, he reported a degree of sexual dysfunction while on Zoloft. By his account, the higher the dose of treatment, the more marked these symptoms became.
He reported a degree of emotional numbing. This happened from early in treatment and became more marked as the dose of treatment with Zoloft increased. He reports that his anxiety “turned off.”
As per the notebook, he reported that his anxiety levels remained turned off even after he discontinued Zoloft.
Prior to going on Zoloft, he had rather non-specific global thoughts of harming others. He appears to have had a low opinion of the human race, expressed for instance, in thoughts that it might be no harm to “nuke” them. These thoughts seem consistent with his acknowledged social phobia. (Think Scrooge in the Christmas Carol – the Victorians once saw misanthropy as close to a virtue).
He expressed such thoughts to his doctors, and it is clear that they were concerned, and struggled to work out if he was exhibiting signs of psychosis.
But on Zoloft, he developed new thoughts centering on the possibility of specific homicidal acts. These were not the same as his former vague ideas of killing people. They were focused and specific, and “realistic.” They were entirely different to any ideas he had had before.
(In the case of people who have been regularly suicidal in the past, and who become suicidal on SSRIs, it is common to find them saying that the new ideas are quite unlike their usual suicidal ideas and indeed some can hold both sets of thoughts in their mind at the same time).
SSRIs like Zoloft can disrupt motivational hierarchies (our values and priorities) leading to alcoholism, violence and a range of other behaviors not usual for the person taking them.
He had a change in his motivational hierarchies. He did not just have thoughts that differed from those he had before, he had a different motivational link to his thoughts. The possibility of acting on these thoughts had emerged in a way that had not been present before.
He attempted to communicate this new state of affairs to his doctors and their failure to grasp it made the looming action even more real. The ideas became something that required action.
When he stopped Zoloft, he did so abruptly from a dose of 150mg. There is no indication he was told to taper (although the medication packaging comes with some warning). He was unaware Zoloft could produce dependence and a withdrawal syndrome.
He became confused on withdrawal – being both more and less depressed. He became emotionally labile – dysphoric mania as he described it.
The reduction in fear he experienced while on Zoloft continued after he had stopped. Lots of people have continued emotional blunting or depersonalization – detachment from your thoughts or feelings – for months after stopping treatment with SSRIs.
The trial records show that on several occasions, he referred to the changes in his thinking, saying that if he told anyone what he was thinking they would then have to lock him up.
The medical response was that he was responsible for his own thoughts and actions.
I and my colleagues react to people threatening to kill themselves and others in exactly this way every week of the year – and for the most part this is the correct reaction and reduces the risk of violence to others. It is not the correct reaction to a new SSRI induced situation.
He appears to have attempted to communicate the changes he was experiencing in messages to friends, and classmates
There are difficulties in conveying alien thoughts of the kind that can be triggered by an SSRI.
On Friday July 20th 2012, 8986 days after he was born, he entered the movie theater.
He was arrested and hospitalized. Four months later, he became disturbed in hospital and was prescribed a variety of tranquilizers.
At the end of December, he was put on another SSRI for the first time since the end of June and 5 days afterwards attempted to kill himself. He was put on suicide watch.
The agitated reaction subsided sometime later. No-one thought to stop the SSRI. Every expert who interviewed him, interviewed a man who was on a cocktail of meds. He spoke reasonably but was blunted. Its not clear there were any delusions.
We now know he wasn’t give the death penalty. He may have preferred it.
This is precisely why we say something to you.
It may not be much, whistling in the wind, but, for this guy he was doomed from the minute he talked to the wrong people and tweets like this one, in particular, from GlaxoSmithKline, a few hours ago, from some harmless individual whose job is to maintain their PR presence and who is ignorant of their Seroxat and all because nobody has told him is really one of the sickest few words I can bring myself to read
GSK @GSK 14 hrs14 hours ago
Imagine medicine w/o pills
And, I agree with you…one day he might wake up…if he is unlucky with that….but, may be he won’t…and if he doesn’t wake up then he is better off with brain damage and the wiping of his memory…and if he does wake up…then living with that will be almost impossible and he will probably try and kill himself, but, either way, Andreas was better off going down with the plane……because several hundred angry relatives might have lynched him, themselves…..
medicine w/o pills.imagine
Can you explain the GSK tweet about 14 hours ? I’m unfamiliar with that and the meaning. Also who is Andreas ?
Andreas Lubitz – the pilot of the German Wings plane
He had a paradoxical reaction to the Zoloft. Even at 150 mg, he was unlikely to have much problem quitting something he’d only been on 13 weeks! And, tbh, so many of the details that come out in the press are wrong! The devil is in the details in this case. I’m not saying you’re wrong,I’m saying I doubt it.
Amazing recitation of psychological events. You mention the notebook. Do you have access to the notebook? What’s your source? Who is the writer of this blog?
The notebook can be found here
The wagons were circled by the university and the media during the trial this summer. In 2012 dozens of outlets ran the story of Holme’s psychiatrist’s trouble with the law over self-prescribing tranquilzers. In 2015 there was collective mutism.
An highly visible American psychiatrist went on record with his opinion that Holmes wasn’t mentally ill, cherry-picking his was through the diary egregiously.
The judge allowed to prosecution to stop the defense asking it’s own expert witness about sertraline and violence.
That and more is laid out here:
I’ve taken a look at James Holmes’ notebook online, and it’s quite stunning. Especially the part titled “The Shrinks”, starting around page 30. If I didn’t know better I would think it had been written after the shooting, to support a defense of “Zoloft-induced insanity.” Except of course that it was written beforehand – so it deserves to be taken seriously.
He says that a “fear of failure” motivated him to do well in life even more than a “fear of consequences.” The fear of failure – becoming a school dropout, or a weird loser socially, disappointing himself and his family – seems very much tied to caring about certain people and certain goals. Zoloft put an end to both types of fear, he says, which made him both “fearless” and uncaring. That gave the hostility room to grow and take over.
On the RxISK Patient Narrative Page for Zoloft is a report from another man who lost his fear of consequences. His story is much more prosaic, but pretty alarming in its own way. He stopped paying his bills, and was forced to retire early from his job, because he lost all “normal” anxiety. He then spent his whole retirement account in a few years and neglected to pay the real estate taxes on his house as well, so he’s pretty much flat broke. Now that he’s off the meds he feels acutely what a fool he was – but in reality he knew what he was doing all along. He was just unable to care.
To one degree or another this may happen to everyone on SSRIs. It’s why some people who are “much too sensitive” emotionally find them helpful. It’s ironic, because on the surface of it, letting your bills pile up and your kitchen sink overflow with dirty dishes are typical symptoms of “depression.” If this guy’s doctor did not listen carefully he may have missed the fact that his patient did not feel sad or exhausted – he may have been out having fun while neglecting his chores. He just didn’t care, and the “treatment” was the real problem.
It sounds like undiagnosed bipolar disorder or perhaps schizoaffective disorder (due to the original schizoid personality disorder dx).
Are you anti-psychiatry as a whole? Do you believe that SSRIs should *ever* be prescribed? Do you feel the same way about MAOIs and tricyclics? Under what circumstances is antidepressant prescribing warranted?
Sertraline isn’t the “bad guy” here. That role goes to his doctors and his doctors alone.
I’m not remotely anti-psychiatry. Read http://davidhealy.org/shock-mutilate-and-poison-the-medical-mission/ and comments.
Sertraline is clearly just sertraline – but what about Pfizer who produced it? Can you blame doctors if the company conceals the data from them?
There are so many factors that point to Zoloft being a causative factor in this very tragic case. Furthermore, if David Healy has put his head above the parapet, as he has done here, the Holmes case must be very clearly drug-induced. There are many cases where Zoloft has been indicated in homicide cases, including 12 year old Christopher Pittman who murdered his grandparents. In my opinion the doctors who prescribed this child Paxil and then Zoloft should have been imprisoned, not Christopher Pittman; likewise in the Holmes case. Ignorance, whether through naively trusting the drug company studies or the friendly sales-rep, is still ignorance and inexcusable.
I don’t proclaim to have the insight that psychopharmacologist David Healy has, but a recent UK case proved how dangerous Zoloft can be..
In 2013 Ison Harrison, a law firm based in Leeds, negotiated a settlement for their client. A pharmacy had mistakenly dispensed Zoloft to a woman instead of her usual migraine medication. As a result, she suffered adverse effects such as severe abdominal cramps, diarrhoea and becoming uncoordinated, but the worst effect was feeling suicidal. This is a clear indication that Zoloft, and not the underlying illness (migraine), can induce a person to become suicidal.
And still the lies keep coming. Faith in the medical profession, the drugs companies, the judicial system? Don’t make me laugh. Ironically, it’s depressing!
A thing I often wonder is, as soon as a patient (or perhaps victim would be a better title) has been given a pill, how does one differentiate between what might be symptoms of a so called disease named depression and the effects of the drug? Further, in the study of this set of observed traits/feelings/experiences/etc., bundled together as “symptoms” and placed in a box named the “disease of depression”, how many of the subjects being studied have not already been subjected to one or more of the psychoactive “medicines” and how does one therefore differentiate between “this is the progress of the disease” and “this is what the drugs have done”? Perhaps the so called symptoms of a progressing depression aren’t the “illness” at all, but are the progressing effects of the drugs themselves. It would seem to me that certainty in this regard must be very hard to come by. Also, when faced with an industry and a profession that denies that even brain zaps exist, how can we have any faith whatsoever in anything they have to say about the drugs or the “disease”? Brain zaps are an undeniable fact and anyone expounding on the efficacy and effects of the drugs who denies the existence of brain zaps has no credibility at all. They are either ignorant, rather than expert, or they are simply being mendacious.
The question of drug or disease as a cause is a tough one. Self-report is low on the list of credible evidence, unfortunately.
The changes seem to be overnight, or same day, when a drug’s to blame. That doesn’t prove much in one individual, but when hundreds report the same thing, it’s noteworthy. I guess you’d then have to look for the rate of similar changes in depressed people who’ve never been on the drugs.
The internet, for better or worse, is a useful measurement tool. If someone’s a regular poster on any social media sites, it’s easy to tell when they’ve gone off the deep end, and heaven knows how many deleted posts there are that would tell the story.
I was keeping a gardening log in blog form for many months, then stopped posting. The gap occurred between a cancer diagnosis and six months after I had become manic in Effexor withdrawal (see below). When I returned to “blogging,” my posts had little to do with plants, and were expletive-laden, “non-narrative” in form, and altogether diagnostic of something between mania and psychosis.
My Twitter account is less helpful because I’d only Tweeted a few things before madness set in. But once I started…I’m surprised I didn’t get a welfare visit or a 5150 (danger to self and others) commitment.
I found something especially interesting in a recent document sent my my mortgage lender.
2008 I was not a psychiatric patient and had only sought help from counselors in the past. I was stressed by a difficult course of treatment for advanced cancer that came with a 10% chance of surviving two years, full-time work with a one hour each way commute, a house-bound 50-year old husband, once my kind, funny, helpful constant companion, by then incoherent with early-onset dementia, and the expense of his caregivers.
2009 Nurses’ error in hospital after a surgery meant abrupt discontinuation of the Effexor they had prescribed for “adjustment disorder” because I was arguing that a treatment decision was wrong (and it was–hence the surgery), not because I was depressed. Mania with overnight onset ensued, so bad that I didn’t return to work and wasted 10s of 1000s of our savings. It lasted from April to a crisis point in January 2010. No one was watching over me, and because I didn’t run out of money, I created no problems for anyone. Tricky, that.
2010 Found some Effexor and resumed. Within 2-3 days, delivered to county mental hospital by police-ordered ambulance. Diagnosed with PTSD, and asymptomatic in hospital. When leaving a few days later, jokingly asked by the head nurse to come back and work there. Discharge instructions were to see a psychiatrist. Diagnosed with bipolar [1? 2?] by friend’s psychiatrist, who was on probation for drug addiction, self-prescribing, selling pot to a patient, sexual relations with a client he’d just given unidentified pills to, and who described the sex as rape, and incompetence, I recently learned.* I was started on Trileptal, and everything under the sun in every combination, none of which did any good. (Trileptal (anticonvulsant), Abilify, Seroquel, maybe Effexor, Lithium.) I was diagnosed with “other forms of epilepsy and recurrent seizures, with intractable epilepsy” (ICD 345.81) in March of 2013, after three years of that kind of “treatment” lead to some impressive seizures, one of which left me with a painful injury that plagues me to this day. At that point I quit psychiatrists and suffered mightily in withdrawal for almost two years.
My mortgage payment history was flawless in 2008, and 2009. Not a single late pay or bounced check despite the mania and wild spending of 2009. I made the January 2010 payment on time, too.
From February 2010 until, frankly, the present, I have spent $600 to $800 dollars in penalties per year, with 8 to 15 late-pays or bounces per year. (Recently, just late-pays.) It’s alarming to see that despite being drug free since early 2013, I have not recovered the money management skills I’d always had, even as a wildly spending maniac in 2010. My judgment is sound; I’ve accrued no credit card bills whatsoever. I have plenty of free time. I just can’t manage to remember to pay my mortgage by the 17th of the month. That’s 17 days of not remembering that I even have a mortgage.
I have an online friend with a similar (but worse) history. We both regret that we have had good verbal skills all our lives. When you are still articulate (most of the time–my typing’s gone to heck) it’s hard to convince anyone your brain is damaged. The better you are at describing your deficits, the less likely anyone is to believe you have them.