Oklahoma experts look at antidepressants
Recent violence in Fort Hood, Nichols Hills has some looking at links with medication

BY SONYA COLBERG
Published: November 22, 2009

As soon as news hit that the alleged Fort Hood, Texas, shooter was a military psychiatrist, a disturbing thought struck Oklahoma psychologist Gail Poyner.

"I wondered if....

"I think it would be interesting to know if he had been taking an SSRI (antidepressant). It seems, based on news reports, that he was very depressed. He may have taken an SSRI and that may have played a part. Hopefully that will be investigated to determine,” said Poyner, a Ph.D. with a practice in Choctaw.

Poyner was out of state and was shocked to hear of the local allegations against Dr. Stephen Paul Wolf, jailed on murder and assault complaints in connection with the recent stabbing death of his 9-year-old son, Tommy. The Nichols Hills doctor told the medical licensure board that he took antidepressants, records show.

Wolf told the board he was hospitalized for depression and under psychotherapy until his 1988 graduation from medical school at the University of Oklahoma.

He told the board in 1996 that he was hospitalized again for three days in 1995 for acute depression.

"I suffered this as a result of all of the stress in my busy practice of internal medicine and all the demands in making the final arrangements for my marriage,” Wolf wrote in a letter to the board. "I returned to work after my hospitalization on adjusted dosages of antidepressants.”

It is unclear whether antidepressant usage might have played any role in the Nov. 16 stabbing.

"Crimes that involve this horrendous departure from one’s character and typical behavior may warrant an investigation,” Poyner said. "Investigators may want to look into a possible connection between his behavior and a recent introduction or increase in an antidepressant.”

She added that every crime committed by someone taking an antidepressant isn’t necessarily related to the antidepressant. A small percentage of people have a genetic abnormality that can cause a violent reaction to certain antidepressants, she said.

"We’re finding there are cases of criminal behavior, especially violent and out-of-character criminal behavior, that may be linked to these antidepressants,” Poyner said.

If there’s blood on someone’s hands, investigate whether antidepressants were in their systems, some experts say. The drugs are considered particularly dangerous when certain patients are just beginning antidepressants, increasing the dosage or getting off antidepressants, Poyner said.

But other experts say there’s no clear evidence that antidepressants and violence go hand-in-hand.

Fort Hood raises questions
Dr. Peter Breggin, a medical doctor, former Johns Hopkins University faculty associate and author of "Medication Madness: The Role of Psychiatric Drugs in Violence, Suicide and Murder,” said he immediately wondered if Maj. Nidal Hasan was self-medicating.

"I think it was very likely,” Breggin said.

Hasan was charged recently with 13 premeditated murder counts stemming from the shootings. Investigators have made allegations about Hasan exchanging e-mail with a radical imam, connecting with al-Qaida members, lionizing suicide bombings and yelling "Allahu Akbar!” as the shootings began. But Breggin said something more subtle might have been missed.

"It’s very possible that if he was ... self-medicating, it could have been Xanax. I would say not that the drug did it but it might have pushed him over. But we don’t know,” Breggin said.

He said that, as a psychiatrist, Hasan could have easily taken antidepressant samples, and he could write his own prescriptions for antidepressants. The FBI removed possible evidence from Hasan’s apartment and then allowed media into the dingy rooms. Among the things reported left behind were bottles of medications, including some that he prescribed to himself.

Some call studies inconclusive
For some people, Breggin said, newer antidepressants are "a virtual prescription for violence.”

Dr. Jayson Hymes, though, said the studies are somewhat inconclusive. Some research suggests the newer family of antidepressants, SSRIs (selective serotonin reuptake inhibitors), might have a role in causing violence. But British studies show they decrease the likelihood, he noted.

"Walking past a bottle of antidepressants is not going to do anything,” Hymes said. "It sounds to me, in this situation, that a lot of things just got missed by a lot of people.”

He said the drugs under question are those antidepressants that have become popular in the past 10 or 15 years: drugs such as Zoloft and Celexa. Probably the most violent behavior is a desire in some people to commit suicide, he said.

A personal theory Hymes has developed indicates that along with the suicidal thoughts come fatigue and the inability to make a decision and act on it. The SSRIs work fast so the person’s energy level increases more quickly than the mood elevation, he said. So the patient, particularly children and young people, may still feel depressed and suicidal but suddenly has the energy to act out.

Researcher claims violence tie
Breggin studied medical and other records of 50 cases of the newer antidepressants and violence, suicide or disruptive behavior for his book, he said.

In one case, a man on an antidepressant wanted to die so badly that he ran into a police officer with his car so he could knock him down, get his gun and try to shoot himself. Breggin said the police officer didn’t press for a lengthy jail sentence because he thought the drug had essentially driven the man crazy.

He said there is no question that antidepressants can lead to violence.

But Hymes said controversy over antidepressants can lead to frightening people away from drugs that they may need.

"People can ... moan about antidepressants all day until they look at a loved one lying on the couch, only able to get up and go to the bathroom and that’s it. In which case, it’s like, ‘Where’s that antidepressant?’” Hymes said.

Oklahoma’s Poyner recently testified as an expert witness in a murder case in which the defendant had been on antidepressants. In the weeks leading up to the trial she examined studies and stories on the correlation of antidepressants and violence. That research opened her eyes to the possibilities of some famous cases such as housewife Andrea Yates’ drowning of her five children in 2001. But she remains shocked about the horrible nature of such crimes, she said.

Are claims just an excuse?
Poyner said she’s aware that critics will charge that antidepressant claims merely offer criminals an excuse.

"I know that and I would have said the same thing until I read this research,” Poyner said. "I worked in prisons. I’ve treated inmates and so I tend to be very skeptical of somebody trying to blame something on something else, especially a medication that is prescribed by a doctor. But now I’m taking a second look at that thought and saying, ‘Wait a minute.’”