While that is impossible to verify without the release of medical records in all cases, enough have been confirmed to establish a link between SSRIs and violence, especially when the black box warnings on the medications mention the potential for violent side effects.
Mental Illness and Medications
Many psychiatrists and physicians use the physician's desk reference (PDR) in determining which medications to prescribe for patients. A hospital pharmacist with over 20 years of experience had this to say:
First of all, any real pharmacist knows that the PDR doesn't stand for physician's desk reference, it stands for poor drug reference. It's useless. SSRIs increase the effect of serotonin in the brain. Atypical anti-psychotic medications do the reverse in terms of serotonin release. They are dopamine-2 and serotonin receptor antagonists which mean that instead of regulating the release of these chemicals to brain cells, they allow the release, but block the reaction of brain cells. In both cases, these drugs artificially manipulate the chemistry of the brain.
The black box warning on many of these drugs list side effects such as, akathisia, aggression, apathy, sexual dysfunction, even death in the elderly -- to name a few. Another known side effect that the FDA does not require in the black box is suicidal tendencies. Drugs like that drive me nuts, mostly because of the overuse of them. Standard practice is to give patients a "drug-free holiday,' meaning that psych patients and Ritalin patients should periodically be taken off their meds to see how they are doing without medication, but only under close medical supervision. In other words, don't try that at home.
According to Lawyers and Settlements, an online legal news source, akathisia is the side effect "most likely to drive people to suicide or violence against others." The DSM-IV acknowledges the association of akathisia with suicidality and states: "Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts."
While it is uncertain exactly which personality disorders Adam Lanza had in addition to Asperger's syndrome, a registered nurse with 14 years of experience working with psychiatric patients speculates that it is most likely a form of fractured identity:
A part of personality lives in the shadow of the psyche due to its perceived trauma. That creates anger and feel for the need of vengeance. A person with fractured identity personality disorder should not be given a drug that allows integration of personality through opening a path in the brain without proper therapy. Any trauma at a young age, however seemingly minor to adults, is extreme when away from the security base of parents and home, such as a school.
Drugs that integrate the psyche without a healing for that part of what it suffered do not heal anything -- they bring that out, create insanity and are insanity. Patients need healing and therapy that is integrated with medication in order to prevent their violent personality from taking over. A personality in the shadow for so long is not controllable by any medication alone.
When I was in high school, I may have prevented a school shooting. I sat through a gym class with a misfit that had been incessantly picked on by boys and mostly girls. He was so distraught that all he could say was that he was going to bring a gun to school the next day and kill them all. I pleaded with him that it is not the solution and we can work it out in other ways. I insisted other students leave him alone as I talked to him. I convinced him not to bring a gun to school the next day. I then went to the gym teacher and told him that this guy is planning to bring a gun to school and kill people if the other students did not leave him alone. The gym teacher told me to "go play in the street." This was in 1987. Now I watch over patients that are overmedicated and I rarely have more than a few moments to speak with them.
Several inferences can be made from the above information. Adam Lanza and many other school shooters were being treated with medications for mental illnesses. That treatment is usually heavy on medication and light on therapy. The medications commonly prescribed in the treatment can cause violent behavior. Despite gun control laws already in place, the school shooters had relatively easy access to firearms.
Preventative Measures
It is clear that preventative measures need to be taken that reach much further than more gun control laws in order to reduce gun violence. It is also clear that some sort of compromise between firearm owners and those demanding stricter gun laws must be achieved.
President Obama acknowledged that authorities must work to make "access to mental health care at least as easy as access to a gun," and the country needs to tackle a "culture that all too often glorifies guns and violence." Lawmakers in Congress have proposed reinstating the assault weapons ban that expired in 2004 and banning the sale of high capacity magazines.
Wayne LaPierre of the NRA argued in a press conference today that bringing more guns and armed police officers into schools is the solution. He suggested that the problem is children exposed to violence in movies, video games and music and guns are the solution. Some states have gone as far as to propose requiring or allowing teachers to bring weapons into schools.
The assault weapons ban did not prevent the Columbine massacre. The more guns in schools approach ignores statistics that have proven more guns lead to more gun violence. America does not need more militarization of public institutions, such as turning schools into virtual prisons with armed guards.
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