Does Prozac promote murder and suicide?

24 May 2002

Published in The Age

There’s growing international concern that the “selective serotonin re-uptake inhibitors” (SSRIs) - the most famous of which is the antidepressant Prozac - are making some people who take them homicidal or suicidal.

Prozac, released in 1988, has been taken by an estimated 38 million people worldwide. It is prescribed to 12-month-old infants, geriatrics, and everyone in between. One in ten Americans had taken it over the last decade.

The SSRIs work by blocking the body’s reabsorption of the neurotransmitter serotonin - leaving more of it in the brain - which results in the famed mood alterations the drugs produce.

But in the US, the SSRIs have been blamed for far darker consequences, including suicides, murders and mass murders. “In fact,” claims Dr Ann Blake Tracy - author of Prozac: Panacea or Pandora? “Every single school shooting from Littleton, Colorado to the most recent in Santee, California can be traced to the use of these drugs.”

There are several anti-Prozac websites, including the Prozac Survivors Support Group.

Harvard Medical School psychiatrist Dr Joseph Glenmullen advances evidence linking Prozac with “intense, violent suicidal preoccupation”, and the SSRIs in general with anxiety, agitation, violence and suicide attempts, as well as major withdrawal side-effects. Sexual dysfunction is also extremely common in SSRI users.

Internationally known British psychiatrist Dr David Healy recently hit the headlines by estimating that 250,000 users worldwide had attempted suicide because of Prozac, 25,000 of them successfully.

In 2000, a study was published in Primary Care Psychiatry by Dr Healy and colleagues, in which they gave 20 psychologically healthy volunteers the SSRI Zoloft. Two of the 20 became suicidal.

One of the two “followed a thought that had [seemingly] been planted in her brain by some alien force. She suddenly decided she should go and throw herself in front of a car... She didn’t think of her partner or child. She was walking out the door when the phone went. This stopped the tunnel of suicidal ideation.”

In the Healy study, for the first time damaging behaviours could not be blamed on subjects’ psychological disorders. They must have come from the drug.

Can the Zoloft study be extrapolated to Prozac and other SSRIs?

Dr Healy told The Age: “There is an excess of suicidal acts on each of the SSRIs compared to placebo, in the clinical trials lodged with the regulators for licensing. So yes, you can extrapolate.”

Eli Lilly, Prozac’s manufacturer, says that the Healy study “involved sertraline [Zoloft]...not Prozac... Any extrapolation of these study results to Prozac is inappropriate and wrong.”

Professor Lorraine Dennerstein from the Department of Psychiatry at Melbourne University comments: “In my clinical experience with Prozac and other SSRIs I have not found that they increase patients’ suicidality.”

Australia’s Therapeutic Goods Administration does not list suicidality as a risk from taking Prozac per se, but it counsels “close supervision of high risk patients” taking the drug.

Regarding violent and suicidal behaviours, Eli Lilly told The Age there is “published scientific evidence showing that Prozac and medicines like it actually protect against such behaviours.”

But disturbingly, some suggest that findings linking SSRIs to suicide are being suppressed by drug companies.

In 2000 Dr Healy was headhunted from the University of Wales by the University of Toronto, which offered him a Professorship of Psychiatry. The University’s Centre for Addiction and Mental Health offered him a five-year contract as a clinical director.

Throughout 2000, arrangements for immigration and family schooling were made between Dr Healy and the university. An employment contract was finalised on September 13.

On November 30, Dr Healy gave a lecture at the university suggesting that Prozac can lead to an increased rate of suicide.

On December 7, his employment contract was abruptly cancelled.

Eli Lilly, Prozac’s manufacturer, is a multi-million dollar donor to Dr Healy’s prospective employer, Toronto University’s Centre for for Addiction and Mental Health.

The incident attracted considerable media interest in Canada, and protests from professional groups. The reputation of the University of Toronto has been badly battered by the affair.

Dr Tracy, the Utah-based author of Prozac: Panacea or Pandora?, writes:

“Drug companies go to great lengths to get new drugs approved... Physicians who could lose their next drug research project, and therefore their livelihood, feel pressured to defend drugs. The University of Utah Mood Disorders Clinic exists because of the millions it brings in for the university in drug research money. Prescription drugs are now the third leading cause of death in America - between 200,000 to 250,000 deaths per year.”

In 2000, Marcia Angell, former editor of the New England Journal of Medicine, expanded on the subject:

"Researchers serve as consultants to companies whose products they are studying, join advisory boards and speakers' bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in the companies."

Eli Lilly stated: “To suggest that medical schools or their researchers are in the sway of pharmaceutical companies is to completely misrepresent how drug research and development, and scientific communication, is conducted.

“Clinical trials follow careful protocols reviewed and approved by medical centres and their institutional review boards. Trial results are carefully reviewed by investigators, the trial sponsor and the Federal Drug Administration before the FDA alone decides to approve or reject a drug for marketing.”

Though they’re its best-known critics, Drs Healy and Glenmullen are at pains to point out they still prescribe Prozac and other SSRIs where warranted.

Dr Healy said: “The prescription of Prozac or Zoloft or any SSRIs can be warranted even in the case of mild depressions if there are very clear benefits to the person... My concerns are with the fact that treatment comes without warnings that SSRIs may agitate you to the point where you may become suicidal, and is often unmonitored and continued even when there are no clear benefits.”

US neuro-scientist Professor Candace Pert - discoverer of the brain’s opiate receptor, and former head of brain chemistry at the National Institutes of Health - told Time magazine in 1997:

"I am alarmed at the monster that Johns Hopkins neuro-scientist Solomon Snyder and I created when we discovered the simple binding assay for drug receptors 25 years ago... The public is being misinformed about the precision of these selective serotonin-uptake inhibitors when the medical profession oversimplifies their action in the brain... A new paradigm has evolved, with implications that lifestyle changes such as diet and exercise can offer profound, safe and natural mood elevation."

Professor Pert told The Age:

“There’s an epidemic of over-medication. There’s this increasing violence in the culture where people are going ‘postal’ [berserk]. Doesn’t anyone ask what’s causing that? You know, a woman drowns her five children - these kinds of things never happened before. A common thread is that people are on some of these psychiatric drugs. They’re supposed to help people - but they actually cause violence. There’s a scientific literature that supports that. But it gets kind of swept aside. There’s too much money in the drugs. Prozac alone netts $US13 million a day. It netts it! It’s an unbelievable figure.”