The Zoloft-rage/violence connection

[This post is quite lengthy so I suggest you grab a cup of coffee or tea and sit down and read it. The following is not for the faint of heart (or those with a lack of time).]

It’s been amazing to me that I’ve received numerous comments on Zoloft inducing rage. I’m humbled by having a Pittman supporter visit my site and post some comments from the ChristopherPittman.org forums. Read the following:

In my senior year in high school I was diagnosed as being severely depressed and put on medication. The first medication that I was on I took for 5 months and it made me really aggressive. My friends and family noticed the change and I told my doctor about it and she changed my meds. After that I was fine. I am normally a very passive person and will let just about anything fly. But the medication made me really aggravated and aggressive toward my friends and family and it seemed that I wasn’t overcoming my depression. I just got done watching the 48 hours investigation on the Discovery Times Channel and felt a connection with Chris. I felt that I had to write this to let you know that Chris is not the only one out there that had these side effects. I think there should be a study done to see how many people that take antidepressants have increased aggression. The problem is that the pharmaceutical industry has deep pockets and many lobbyists. I hope this helps in some way.

And another:

I remember the case when it happened.

At the time I thought, “Zoloft right”.

Let me tell you my physician put me on Zoloft and it took about three weeks for my to become psychotic and I’m a 50 year old woman.

I have three children and I don’t make a lot of money but please let me know if I can do anything for the Pittman boy.

The jury should have been placed on Zoloft before they made they decision. Unless you’ve experience it you simply cannot believe its’ effect.

Brynn and Phil HartmanI did a bit of quick reading/research into Zoloft triggering violence in people who otherwise would have never been violent and it seems that are a few stories out there to support the assertion. I found a few comments on depressionblog.com that mentioned a link between Zoloft and rage fits. A Salon.com article published a story antidepressants inducing rage in 1999. Apparently, Brynn Hartman, the wife of famous comedian Phil Hartman, killed herself and her husband while taking Zoloft. While close friends attribute the sudden behavior on the antidepressant, others attribute it to a combination of the medication with cocaine and alcohol in her system. (Zoloft does have a warning against alcohol use in conjunction with the drug.)

One interesting thing I learned from the article is that this kind of behavior is often labeled under the name akathisia on patient safety guides. Most – if not all – of the major antidepressants list akathisia as a side effect. Here’s the initial description of this condition from Wikipedia:

Akathisia, or acathisia, is an unpleasant subjective sensation of “inner” restlessness that manifests itself with an inability to sit still or remain motionless… Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), and rarely, antidepressants.

Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom).

No real mention of extreme anger or irritability mentioned there. But if you read on…

The 2006 U.K. study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as “agitation, emotional lability, and hyperkinesis (overactivity)”. The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et. al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can “exacerbate psychopathology.” The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).

Read the rest of this entry »

Suicide: Understanding and Intervening – Part I

Black’s Common Features of Suicidal Thinking

  1. Bitterness
  2. Anger
  3. An unwillingness to forgive
  4. The “last word” in argument
  5. A way to punish someone

“Romans 1 suggests that a person – believer or unbeliever – who contemplates suicide must actively suppress the Spirit’s testimony that he is a creature made in the image of God, living in dependence on him.”

“Actively suppress” is a strong statement. If it means a person is aware of this suppression, then I’d disagree. Some people may be aware of this but that isn’t always the case. Black emphasizes suicidal believers are made in the image of God and insinuates that suicidal attempts are willful acts of disobedience:

“We want to demolish the idea that someone who takes his life is a sad, wounded, and weakened victim, and that suicide is a noble expression of his fragility and God’s failure to rescue him.”

While suicide is not a noble expression of fragility, suicide shows a suicidal person and those around him how weak he is. This is not “weak” that describes someone with a character flaw; those referred to as weak are those who need emotional help. Those who are emotionally stronger are able to encourage someone who is emotionally weak. A man who takes his life may have been sad, may have been wounded, and may have been weak – but God’s grace was not beyond him and what is perceived as God’s “failure” to rescue him was still within God’s control. (I won’t get into the fine details of why He allows some people to live and some to die in this post.)

Mean behavior isn't always mental illness

OK – I continue my streak of NYTimesing (lookee! A verb!) and post a link to an essay by Dr. Richard Friedman about how chronically "mean" people may not have a mental illness. They are just… well, mean.

Friedman raises an interesting point about how psychiatry and psychology try to explain away so much of people’s behaviors via diagnosis that people aren’t left any room to be "normal." Mean people don’t need to be lumped into a category of "anger disorder" or some crazy nonsense like that. Perhaps there are people who have extreme issues with anger and need to learn behavioral techniques to get it under control. But other people at their very core like to hurt, manipulate, and demean others. This is not a mental illness. This is a human, sinful nature.