Christopher Pittman seeks new trial

Christopher PittmanFrom Furious Seasons:

I simply don’t know what to make of the case of Christopher Pittman who was convicted of shooting his grandparents to death when he was 12-years-old–except that it argues for how risky it is to put young children on anti-depressants. Pittman, sentenced to 30 years in prison, is seeking a new trial and a hearing on that matter is underway in South Carolina.

You can read more about the Zoloft-rage/violence connection is relation to Pittman’s case.

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The Zoloft-rage connection

ZoloftI’ve received a lot of hits from people looking to find a connection between Zoloft and rage/violence/irritability. Here’s what I have so far:

Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

Zoloft and Lexapro came in first for a combination of effectiveness and fewer side effects, followed by Prozac (fluoxetine), Paxil (paroxetine), Cymbalta, and Luvox among others.

The first was efficacy — or how likely patients were to experience the desired effects of the drug.

Efficacy:

1. Remeron (Mirtazapine)
2. Lexapro (Escitalopram)
3. Effexor (Venlafaxine)
4. Zoloft (Sertraline)
5. Celexa (Citalopram)
6. Wellbutrin (Buproprion)
7. Paxil (Paroxetine)
8. Savella (Milnacipran)
9. Prozac (Fluoxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

The second was acceptability — the likelihood that a patient would continue using a drug for the duration of the study (it is generally assumed that a high ratio of patients dropping out indicates the presence of undesirable side effects for a drug).

Acceptability:

1. Zoloft (Sertraline)
2. Lexapro (Escitalopram)
3. Wellbutrin (Buproprion)
4. Celexa (Citalopram)
5. Prozac (Fluoxetine)
6. Savella (Milnacipran)
7.
Remeron (Mirtazapine)
8. Effexor (Venlafaxine)
9. Paxil (Paroxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

antidepressantsMy experience with Lexapro was a disaster and I’ve written about Zoloft’s connection with irritability and rage. Paxil’s side effects are especially rough (see Bob Fiddaman’s Seroxat page) while Effexor’s withdrawal effects proved to be significantly challgenging. Although Prozac offset Effexor’s withdrawal symptoms, it causes severe somnolence that can impair cognitive functioning. And last but not least, Cymbalta contributed to the unfortunate death of Traci Johnson who had no history of depression.

These drugs may be effective for many people but it’s still a guessing game. Dr. Mark I. Levy, quoted in ABC News’s article on the rankings, mentioned that while psychiatrists may not have much use for the rankings, he sees them as beneficial for primary care physicians. And Dr. Harold G. Koenig, a professor at Duke University Medical Center, adds:

“I would be likely to start patients on either Zoloft [because it’s cheaper] or Lexapro … Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the “new to medication” kind of patients,” he said.

I won’t rehash my thoughts on PCPs prescribing antidepressants and other psych meds. You can read about them here.

Loose Screws Mental Health News

Anti-smoking pill drug Chantix has been linked to mental illness, according to Attorney Daily.

Chantix’s safety is currently under fire, as similar stories of patients with suicidal thoughts, depression and aggressive behavior surface. The FDA received reports of 37 suicides and 491 cases in which people had suicidal thoughts. The FDA also said it “appears increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms.” An estimated 5 million people use the drug.

How scary is it that people are having mental health issues related to non-mental health drugs?

Steven Kazmierczak, the shooter at NIU, wrote about his problems with mental illness in his graduate school applications. He said he hoped he could be an encouragement to others. I find this interesting that he wrote about his struggle with mental illness considering that at the time, there appeared to be no official record of him having a mental illness.

Last but not least, here’s news that would make the TAC proud: Dr. Jeffrey Swanson, a medical sociologist from Duke says that people suffering from mental illness are three times as likely to commit violent acts than "normal" people. To his credit, he adds:

“It’s also correct to say that the large majority of people with mental illness don’t commit violent behavior,” he said.

Further down in the article, WRAL Health Team Physician Dr. Allen Mask answers where all the violent acts come from if not from the mentally ill.

“Dr. Swanson says that if we could eliminate drug and alcohol addiction, we would see violent crime go down by a third. We also have the issues of people being abused as children and children growing up in violent, impoverished environments. They’re at greater risk of becoming violent adults,” Mask said.

Maybe I’m wrong here but isn’t substance abuse classified as a mental illness?

Pittman, Zoloft, and akathisia revisited

Christopher PittmanI’ve written about Christopher Pittman, now 19, who confessed to shooting and killing his grandparents when he was on psych meds at the age of 12. He appealed for a Supreme Court hearing but was denied, CNN reported today. He — and his defenders — appealed on the grounds that his 30-year sentence was “excessive for someone that age” and that the dosage of his antidepressants at the time (200 mg) “sent his mind spinning out of control.” Pittman was tried as an adult and, his lawyers argue, “no other inmate in the United States is serving so severe a sentence for a crime committed at such an early age.”

In previous posts here and here, I’ve questioned the link between Zoloft and violence/rage. Pittman, in 2001, had been switched to Zoloft a few days before the murder of his grandparents. However, it sounds like there had been some emotional problems in Pittman’s life that may have given prosecutors a solid case:

At the time of the crime, the boy had bounced around homes for years, experiencing a half dozen family splits and divorces after his mother had twice abandoned him as a child. She has not been in Pittman’s life for years.

Joe Pittman, the boy’s father, raised Christopher Pittman and his sister for much of their lives, but the relationship between father and son deteriorated. A state psychologist later testified this was a “young man who’d had difficulty with the adults in his life.”

On November 28, 2001, Pittman was sent home early for fighting in school and sent to bed by the grandparents. The boy claimed his “Pop-Pop” also beat him with a belt as punishment.

South Carolina prosecutors may easily have set Pittman up as a disturbed young man, which he very well may have been. But there are indications that this disturbance transcended his emotional state into his mental health:

After threatening to harm himself and suffering other emotional incidents, the boy was diagnosed as clinically depressed. His lawyers said Pittman was then given Paxil, a mild antidepressant no longer recommended for those under 18.

Just days before [shooting his grandparents], a doctor had begun prescribing Zoloft, another antidepressant. The family contends the abrupt substitution of drugs caused a bad chemical reaction, triggering violent outbursts.

At trial, a parade of psychiatrists offered conflicting testimony on whether the boy’s emotional problems excused his criminal behavior. Prosecutors called the Zoloft defense a “smokescreen.”

Juror Steven Platt later told CNN the crime appeared deliberate. “It always seemed like the defense was grasping at straws,” he said. “Just because you take prescription medicine doesn’t mean you can’t be held accountable for your actions.”

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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%).

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A classic case of twisting the words of someone who supposedly shot the messenger

The subject title is long, but – I think – apropos.

The Treatment Advocacy Center’s post, “A classic case of shooting the messenger,” has been bothering me all day. I’ve been wanting to do further research on their claim that “patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public.” Funny thing is, I didn’t have to look far.

The TAC links to a summary of the CATIE violence study and surprisingly, it contradicts the TAC’s post. I couldn’t help but chuckle once I realized I could easily debunk their claims from what they considered supporting evidence.

USPRA: “Violence is no more prevalent among individuals with mental illness than the general public”
Fact: The CATIE violence study found that patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public (19.1% vs. 2% in the general population).

MY TAKE:Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia. Of the 1,140 participants in this analysis, 80.9 percent reported no violence, while 3.6 percent reported engaging in serious violence in the past six months. Serious violence was defined as assault resulting in injury, use of a lethal weapon, or sexual assault. During the same period, 15.5 percent of participants reported engaging in minor violence, such as simple assault without injury or weapon. By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period, according to the NIMH-funded Epidemiologic Catchment Area Study.”

This data is a little skewed here. (CLPsych or Philip Dawdy could do a better job at clarifying this for me.) First of all, “about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period.” How many people does this constitute? The sentence doesn’t specify ‘without schizophrenia’; it says “without psychiatric disorder.” That means Americans who do not suffer at any given time from depression, bipolar disorder, psychosis, anxiety, schizophrenia, obsessive-compulsive disorder, postpartum depression, and the list goes on and on. Can anyone compile complete data of Americans who suffer from a psychiatric disorder? (Why do I have the funny feeling that Americans without psychiatric disorders are becoming the minority?)

In the January 1994 issue of the Archives of General Psychiatry, results of the National Comorbidity Study were released. Diagnoses from the DSM-III were applied to the participants ranging from ages 15-54. The study found that 50 percent of participants reported “one lifetime disorder” and 30 percent said they had “at least one 12-month disorder.”

That was January 1994. The American population has grown significantly since then, so I have a hunch that there's an increase in diagnosing people with psychiatric illnesses. But like I said, that’s, uh, just a hunch. (Keep in mind that the study does not include children ranging from ages 4-14 who are likely to receive ADHD and/or bipolar diagnoses.)

Humor me: Let’s take the NC study’s findings and apply it to the current estimated U.S. population (assuming that the percentage of those with a lifetime disorder has remained the same). Out of nearly 300 million Americans (July ’06 estimate), that means about 150 million Americans have at least some form of a psychiatric disorder. If 1 percent of the general population suffers from schizophrenia, that comes out to 3 million people. If we apply CATIE’s violence percentages, TAC’s right; 19.1 percent of schizophrenic patients engage in violent behavior of any kind. However, the CATIE study also says that two percent of the general population without psychiatric disorder engages in violent behavior. That means out of the remaining 150 million, 2 percent of that would be —*drumroll please* — 3 million Americans! Maybe it’s just me, but doesn’t seem 10 times likely. I could always be wrong.

Read the rest of this entry »

Loose Screws Mental Health News

I haven’t done this for a while so hopefully I can pick this up again a little more regularly. (crosses fingers)


Read a heart-wrenching story in the UK Daily Mail about a mother whose postpartum depression led her to begin slitting her wrists.

Tom ChaplinTom Chaplin, singer for the band Keane, has admitted to contemplating suicide.

Tom – who was taking up to two grams of cocaine a day – revealed to Britain’s Q Magazine: “I was at the end of my tether in Japan. I was tired of my life and feeling pretty suicidal. I got off the plane and called my dad. I’d told him that I’d left the band and that I was falling apart. I checked myself into The Priory.”

Chaplin’s interesting view:

Despite his own drugs hell, Tom says it’s a personal decision to experiment with substances. He claims troubled rock star Pete Doherty should be left to take all the drugs he wants.

Tom said: “No-one’s got any right to stop him killing himself.”

An article in the Chicago Tribune on how VNS is beginning to show benefits for some patients. Which reminds me, browse on over to VNSdepression.com to learn more.

Nicholas Vakkur must have read the Treatment Advocacy Center’s post on how the CATIE study shows an increase in violent offenses by mentally ill patients (namely those with psychosis and schizophrenia). He refutes this idea on dissidentvoice.org:

Individuals with a mental illness are far more likely to be the victims, rather than the perpetrators of violence, while the vast majority of people who commit acts of violence against others are not in fact mentally ill.

This rush to stereotype individuals suffering from psychiatric illness as likely murderers is reckless and lacks credulity. Mental illness has no role in the majority of violent crimes committed in our society. Alcohol and substance abuse far outweigh mental illness as factors contributing to violence, while the strongest predictor of violent and/or criminal behavior is a past history of violence and criminality, not a major mental illness.