SSRIs and violence
[NOTE: In yesterday’s thread on the school shooting in Bend, I noticed that the topic of SSRIs and violence came up. So I think it makes sense to repeat the following post, which I wrote in 2023.]
Every time there’s a school shooting or any sort of mass violence, the subject of SSRIs comes up from one commenter or another.
Sometimes people also bring up the subject of fatherlessness and mass shooters, which I wrote about at length in this post, the gist of which is that there is no connection although it’s popularly thought that there is.
Now, on to SSRIs. It is notoriously difficult to do research on whether SSRIs trigger more violence, have no effect, or help prevent violence, and if so in what populations. It’s a popular internet meme that they trigger violence, but the evidence is not at all clear that that is so, and as I said it’s very difficult to design a good study. One obvious reason is that such people are often at higher risk for violence in the first place, and drugs are not given randomly. There is almost certainly something already different about the people who get them and those who don’t.
This is one of the better-designed studies, and as you can see if you read it it’s very hard to tell what it all means, if anything. For example:
As is often the case, the authors of the study themselves are rather cautious. While obviously concerned that it is possible that SSRIs may actually cause violent behavior in a small minority of people, they fully recognize that other explanations are possible. These include the possibility that what is driving the violent behavior is medication undertreatment, based on the finding that the risk with violence was only found among individuals who were likely taking subtherapeutic doses. As reported by MedScape, one of the study authors, Seena Fazel, states: “Our own view is that some evidence suggests that it’s a bit more complicated than that, because we found a link with subtherapeutic doses of SSRIs, and that would suggest to us that it may be that it’s actually a lack of treatment [and] it could be residual symptoms that are driving this link.” At the same time, if antidepressants really worked wonders for young people, we should see that therapeutic SSRI usage was associated with a reduced risk of violent behavior, which it wasn’t.
A couple other factors also deserve mention. The idea of comparing periods on and off medication within the same individual is a clever design, because many individual factors that might be related to risk of violence, like one’s socioeconomic status or DNA, are held constant. However, because the period of medication use was not randomized (and couldn’t be), it introduces the very likely complicating issue that individuals were taking medications during times when they were feeling more depressed, anxious, and angry to start with, and thus at higher risk of acting violently. Finally, it is important to note that a statistically significant association certainly does not mean that most people taking antidepressants are out there hurting others. When taking SSRI medications, the conviction rate of violent crimes was at a 1.0% rate compared to 0.6% without medications.
Our study encompassed nationwide data over a 15-year period. In this period, the homicide rate per 100,000 remained fairly constant, with a moderate decline in recent years, leading to an average of 160 homicide victims per year. The suicide rate decreased steadily from 10.26 (approximately 1,500 victims) in 1994 to 8.77 (approximately 1,400 victims) per 100,000 in 2008. The homicide–suicide rate remained relatively stable, averaging at 0.05 per 100,000 (varying from 4 to 14 victims per year, see Fig. 1). In the same period, the rate of total antidepressant use increased considerably, from 3,038.81 in 1994 to 5,650.58 per 100,000 in 2008. A similar increase was observed for the rate of SSRI use alone, which more than doubled from 1,482.25 in 1994 to 3,161.15 per 100,000 in 2008 as well as the rate of SSRI use including venlafaxine, with an increase of 1,486.81 in 1994 to 3,904.20 per 100,000 in 2008. Over the same period, the number of defined daily doses used rose from 59.6 million in 1994 to 245.3 million in 2008: a fourfold increase. This indicates that not only more people used antidepressants, but also that the mean duration or intensity of the treatment grew…
Rates of the use of SSRIs including venlafaxine were also found to be negatively associated with both homicide rates and suicide rates. No significant independent association was found between rates of SSRIs including venlafaxine and homicide–suicide.
Here’s an article about suicide and SSRIs for young people:
The 2004 study examined the clinical trial data that had been collected on two types of medications, selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitors (SNRI). The results of the study prompted the Food and Drug Administration (FDA) to issue a black box warning, the most serious level of warning in prescription drug labeling, for the risk of suicides in children and adolescents being treated with antidepressants in 2004. The warning was extended to young adults ages 18 to 25 years in 2006.
The researchers in the current study performed a meta-analysis of 41 studies, reviewing the data on a total of 9,185 youths, adults, and geriatric patients who were treated with fluoxetine (Prozac is one common brand) and venlafaxine (Effexor) immediate (IR) and extended release (ER) preparations…
In all three age groups, treatment with fluoxetine and with venlafaxine IR and ER resulted in a statistically significant improvement in depressive symptoms when compared to treatment with placebo. The decline in depressive symptoms was also faster for patients treated with medication than control group patients. In the adult and geriatric patients who were treated with fluoxetine or venlafaxine, suicidal thoughts and behaviors decreased over time.
As the patients became less depressed, they had fewer suicidal thoughts and attempts. Although the youths who were treated with medication showed the same statistically significant decrease in depressive symptoms as the older populations, they did not show a decrease in suicidal ideation and actions.
“In kids, we don’t see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide,” said the study’s lead author…
The newest analysis did not support the idea that there was an increased risk of suicide in children and adolescents taking fluoxetine, an SSRI. In explaining the difference in their findings, the researchers note that these original meta-analyses included fewer studies and the studies were of shorter term than the longitudinal data they analyzed.
There probably will be a number of readers here who say something like this: “It’s all lies promulgated to cover up the damage drug companies do and to preserve their profits.” You’re welcome to that point of view, and certainly during the COVID years the CDC and many other official entities have earned our distrust. But if you throw out all research, including older studies such as these, you are left with internet memes and paranoia. That’s not science, either. I believe that most of these studies are attempts at valid research on a subject that is inherently difficult to study, and that the bulk of the evidence indicates that SSRIs do not increase violent behavior.
My personal experience in dealing with people who are addicted to their SSRI’s is that it causes radical changes in personality, none of them good.
The single biggest effect I see is that after several years, in some cases decades, on these psychotomimetic drug is that people who used to be functional, productive adults have become uncaring nonproductive parasites. Lots of people will whine that they aren’t causing psychosis, but they really are. The people on them might have been slightly depressed when they were initially given them, and now they are completely unable to get off them. AND THEY DON’T CARE. It seems as if the SSRI’s have wrapped them up in a big cotton ball where nothing that occurs is of any importance.
I’ve watched a few, very few, people succeed in kicking them. It requires an extensive weaning-off period before they can stop; I’ve seen NO ONE successfully kick them by going cold-turkey. In my estimation being able to kick the addiction to SSRI’s is at about the same level as kicking heroin.
It is my further opinion that they have been so massively over-prescribed because doctors simply want to get people out of their offices as soon as possible to move on to the next patient. Rather than addressing underlying problems, they just hand ’em a pill. It’s evil.
Blackwing1:
I know plenty of people on SSRIs and not a single one fits that description.
However, there is a sometimes a certain blurting of emotional reactions to things. They tend to experience this as relief from very intense negative feelings.
When humans think they know the answer it would be instructive to ask: Why are they’re nutria in the waterways of central texas and why are the deer smaller in texas especially around llano.
The range of this question is staggering.
I’ve long thought it has more to do with the muddled thinking that led to the prescription in the first place.
“Dr.Fauchi” and the medical community’s behaviors and responses during COVID have, by some large measure, essentially destroyed what used to be a certain reverence for “scientists,” for the pronouncements and plans of public health officials, and for medical experts and their opinions.
The drug companies didn’t cover themselves with glory either, and don’t even get me started on the responses of governments.
Thus, there is now that great mass of, I’d say, well-earned skepticism, just sitting there, waiting to be overcome.
I think that a real barrier to getting at the truth on this issue is the obvious and immense power of the pharmaceutical industry, the enormous amounts of money, of profit involved, and their ability to put their fingers on the scales, so that you can never be sure that you are getting the actual, the whole truth, or that there wasn’t some more damning research which the pharmaceutical “powers that be” made sure either never got funded and started, or saw the light of day.
What comes to mind is the saga of the tobacco industry, and research on the negative effects of cigarettes.
I’m conflicted about depression meds. I’ve never known anyone who benefited from them. Both of my sisters were quite obtunded, and I never could shake the idea that they were trying to get through hard circumstances by numbing themselves.
I’ve felt desperately low from time to time, but it always seemed clear to me that the cause was situational rather than biochemical. There are ways to change your life and stop existing in a state of paralyzed conflict. At one point I experienced intrusive fantasies of moving to another town and faking amnesia, which I think many professionals would call “depression.” Did I need drugs, or did I need to change the job I couldn’t bear to show up at for even one more day? Apparently the latter.
But having never experienced what’s described as the true depression state, I could be way off-base.
I’ve been on various SSRI’s/SNRI’s at different times, and they’ve been mildly helpful in giving my mood a bit of a lift and tamping down anxiety. Getting off them, a couple in particular, took some effort and I experienced “brain zaps” for many months afterwards. But like Neo I never experienced anything like what Blackwing describes nor have I ever observed any radical personality changes in others.
All of which being true, or not ; this didn’t used to happen..
The introduction of SSRIs 30 years ago cause the damn, dour nation of Denmark to bring down the suicide rates. And later become famous throughout the world as among the happiest nations.
While that doesn’t directly answer the violence query above, I believe data like that proves how life-saving SSRIs are.
I’ve followed the story of SSRIs since the 90s when I noticed how many people, especially women, I knew were on them and my therapist was pushing them hard at me when I was depressed.
I did have an old college roommate commit suicide on them, violently. He slit his own throat with a Japanese sword at dawn on the beach. But he had been obsessed with suicide for years.
In terms of the numbers, however, I don’t see the evidence against SSRIs for violence or self-violence. There was an uptick for strokes on SSRIs reported, but that remains controversial.
Nonetheless, there are real problems with SSRIs:
* Emotional blunting
* Sexual dysfunction
* Weight gain
* Sleep disturbance
* Agitation
* Gastrointestinal problems
* Sweating and tremors
But there is also a real problem, assuming one doesn’t wish to live with such side-effects forever — it’s damn hard to get off SSRIs. They are a sort of Roach Motel in that regard.
My sister has been on them since the 90s.
If SSRIs were a major contributor to violence, wouldn’t we expect to see it in other countries? But we don’t.
SSRIs have been widely available pretty much everywhere, and inexpensively, for decades — yet, one does not see school shootings, for example, in Canada, South America, Europe, Asia, Africa, Japan, Australia, New Zealand … like we see in the U.S.
By contrast, alcohol and crack cocaine are universally accepted as contributors to violence, everywhere.
—
One way to avoid bar fights — regardless of the exact step-by-step mechanism(s) — is to avoid bars. And alcohol.
One way to avoid school shootings — regardless of the exact step-by-step mechanism(s) — is to avoid schools. Home-school your children.
See this:
https://www.midwesterndoctor.com/p/the-evidence-ssri-antidepressants?utm_source=substack&utm_medium=email
And this:
https://www.youtube.com/watch?v=WlnMOee82gA
Here are 2 people I find highly worthwhile when it comes to examining the truth of SSRI’s. The science is questionable, beginning with the fact that there isn’t a distinction in serotonin levels between those suffering depression and not suffering depression. And there is a lot more. The psychiatrist in the 1st link states that 75% of his practice is helping people off of them, which he states is more difficult than heroin. His YT discussing Jordan Peterson’s rare side effects is interesting and sad.
https://taperclinic.com/start-your-taper/?utm_source=youtube&utm_medium=channel-links&utm_campaign=start-your-taper&utm_content=yt-links-evergreen
https://youtu.be/s_iFfQ8ceMY?si=xQrTT-4wF-keEuGn
Blackwing1:
I know plenty of people on SSRIs and not a single one fits that description.
However, there is a sometimes a certain blurting of emotional reactions to things. They tend to experience this as relief from very intense negative feelings.
I am guardian of a person who is EXACTLY as blackwing describes neo.
Just because none of your friends or family have become incapacitated by them doesn’t mean it doesn’t happen as he’s described.
It just means you haven’t seen it yet.
My guess is the people you know are in a group that educates itself, avails itself of the things that truly impact depression–nutrition, outdoor exercise, journalling, cognitive therapy, addressing the cause–so are unlikely to become the multi- medicated zombies who look to pills to address their issue AND are prescribed them, by any and everybody with a prescription pad–or computer.
Women used to get post partum tubal ligations under mask administered GA.
Until it was found 5% of them aspirated, and some of them died. It was the leading cause of post partum maternal deaths.
But it was only found by looking at tens of thousands of deliveries that it was found the practice was killing mommas.
Any given anesthesiologist though could take years before an aspiration would occur under their care. IF even then.
“I’ve never seen it” doesn’t matter.
Search engines still skew and censor, which undoubtedly greatly influences what you are accessing.
I believe you posted during the Lindsay Clancey trial Josef Witt-Doerring’s work on SSRIs. His practice is named Taper Clinic–for a reason.
A midwestern doctor on substack has a lengthy referenced review as well.
Peter Breggins has spent his life documenting the harms and failure of drug therapy to treat depression. One of his many books:
https://www.amazon.com/Anti-Depressant-Fact-Book-Doctor-Prozac/dp/073820451X/ref=sr_1_9?crid=2015A59CKJ2C&dib=eyJ2IjoiMSJ9.Xb8oH8lq9hQnEn2UKce74LmZjYo2fXGx21ikZrcyF_4vik_5BV2Tn54wfBs5tJWeYLzWx3mrIK9eGZQHhag79cLizqFV1lnjegYm68Wg_zalqXc0nHOy3wjXZLtQkxdUCfKn8BXAILBSZXMBaQ12cUl1jHreD5hcNO8Kpvc_Le3p1fsP-YCU243HR6lrn8AnOMAHgyzb5pDUbk9xt4zx1-Ze1Q4RuLBrwSZM6oSMNic.l7tO6EV5t6MCbKenDCcR1NrbbXJJiSnaA55NXmFSEwI&dib_tag=se&keywords=Peter+Breggins&qid=1792411797&sprefix=peter+%2Caps%2C3053&sr=8-9
One of the most enlightening books I have read about psychiatry and the treatment of depression is. https://www.amazon.com/dp/0143127748/?bestFormat=true&k=the%20body%20keeps%20the%20score&crid=29OK17QGXINTJ&sprefix=The%20body%20kee