Tuesday, December 18, 2012

The Deadly Combination of Mental Condition, Guns and Rx Drugs

As we learn more about the young man who killed 20 grade school children and 6 adults in Newtown, CT, a few issues have been discussed in the news accounts: (1) he had access to an arsenal of weapons that would be the envy of a Syrian rebel commander, (2) he was trained in how to use those weapons, and (3) he may have been taking medication for the treatment of Aspergers.

While I am told that Aspergers is NOT a mental illness, it certainly is a mental condition/syndrome that may be treated off-label with powerful drugs that "may improve specific symptoms — such as anxiety, depression or hyperactivity — that can occur in many children with Asperger's syndrome" (Mayo Clinic).

It seems that many other young men who go on a sudden killing rampage have also suffered from mental conditions/syndromes and may have been under some kind of medical care. But we hear very little about how that care (not the syndrome or condition) could have been a factor in causing the rampage.

A quick search of the Internet on "Aspergers drugs side effects" can inform you that kids with Aspergers are "often treated with antidepressant drugs such as fluoxetine (Prozac®, Sarafem®)." According to "My Aspergers Child" blog:

"It is important for parents to work closely with the youngster's health care provider and to fully understand how to monitor the youngster for side effects of antidepressant medication. In some kids and teenagers, these medications may increase suicidal thoughts and actions.

"Other side effects that should be reported to the youngster's health care provider immediately include the following:
  • Aggressive or impulsive behavior
  • Agitation or restlessness
  • Increased activity level
  • Increased chattiness
  • Increased depression or anxiety
  • Increased irritability
  • Panic attacks
  • Sleep difficulties
  • Strange moods or behavior changes"
Perhaps the Newtown mass murderer was taking an antidepressant that increased his "suicidal thoughts." Knowing what we know about the shooter's mother, she pulled her son from school to "home school" him in isolation of support groups in the community that may have helped him. She may have also taken him OFF his medication, which may have resulted in increased "aggressive" behavior due to withdrawal effects.

There is ample evidence and warnings from the FDA that certain antidepressants can increase suicidal behavior in teenagers. So medication -- or lack of medication -- may have been a factor in this and other similar cases. Especially if the medication is prescribed off-label by GPs with little or no experience with mental illness. Pharma companies have pushed these inexperienced physicians to prescribe drugs that should only be prescribed by mental health experts, IMHO.

There is a connection between this line of inquiry and pharma marketing. I just alluded to drug companies marketing anti-psychotic and antidepressants to GPs. Direct-to-Consumer (DTC) advertising also is a factor in the increased use of these medications, but also helps explain why we don't hear more debate about the role of Rx drugs in murderous/suicidal ramages. Most of the news we have access to -- such as the nightly news programs -- are funded to a large extent by drug company ads. While these news sources go on and on speculating about increasing the regulation of gun ownership, none that I know of speaks of closer regulation of anti-psychotic and anti-depressant drugs. There is, however, more focus on mental health in general, but most of the focus is on mental health practitioners, not the drugs they may prescribe.

Neither mental conditions, prescription drugs, nor guns alone causes these tragedies, but the combination of the three greatly increases the odds of their occurrence.

14 comments:

  1. Stop trying to defend big pharma. These mass shooting started in the early 1990's and have steadilly increased as the use of SSRIs, psycho-stimulants and neuroleptics have increased.

    70 million Americans are on an antidpressant. That's 14%. Depression occurs in les than 1% of the population. The only thing that has changed in the equation is prescription drug use.

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    1. It's amazing that you think I am trying to defend big pharma, as if you did not even read my post!

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  2. Please be careful in how you characterize Asperger's Syndrome. You said you did a search for "Aspergers drugs side effects" and then said that kids with Asperger's "are often treated with antidepressant drugs." Many readers may read this erroneously to conclude that there are drugs specifically approved for Asperger's or that doctors prescribe drugs to treat Asperger's itself or that all kids with Asperger's require medication. Any of these conclusions would be wrong, but somewhat logically derived from how you wrote this blog.

    First, to my knowledge, there is no drug indicated for Asperger's. To imply, even unintentionally, there are can help perpetuate myths and misconceptions about Asperger's.

    Second, if a doctor prescribes an antidepressant for a child with Asperger's, the doctor’s intent typically is not to treat the Syndrome (which, by definition, involves an array of manifestations), but to treat one or more symptoms (e.g., OCD tendencies) that may be displayed by the Asperger's child. Thus, Asperger’s child who receives an antidepressant is no different from a child without Asperger's who has symptoms that might be responsive to an antidepressant.

    Third, many Asperger's children require no medication. Your blog, as I said, failed to give "fair balance" (to use an FDA marketing rule term) to this fact.

    Fourth, Asperger's, to my knowledge, is not considered a mental illness. Rather, it describes a spectrum of symptoms and behavior. To imply, even unintentionally, that it is a mental illness confuses the issues and unfairly stigmatizes those with Asperger’s.

    I write this because, after Newtown, we must be very cautious not to jump to conclusions as to why the shooter did what he did or to ascribe responsibility in a manner that casts a shadow over an entire subpopulation just because they may bear a label that the shooter may have also borne (and whether he had Asperger's remains to be resolved).

    Indeed, because of the confusion and potential for harm to children (and adults) that have Asperger's that may be arising out of the rush to lay blame for Newtown, and the real fear that people might wrongly conclude, without proof, that Asperger's (or a drug to treat its symptoms), might be to blame, the Asperger's Association of New England issued a well-written statement on this issue. Unfortunately, space limitations prevent me from quoting it in entirety in this comment, but it can be read at the following URL:

    Source: http://www.aane.org/make_difference/conn_tragedy.html
    At this time of national tragedy, I invite you, as a blogger, to exercise a bit greater care in your approach to an issue. While the issue of drug side effects is certainly something we should not overlook in any situation where they might be involved, let us do so in a balanced manner.
    Thank you.

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    1. Regardless of what we call this guy's mental state, the fact is he was probably being treated by a drug with dangerous side effects. Whether or not this treatment was warranted, on-label, or off-label, my opinion remains the same: a combination of guns and drugs used to treat "mentaL' conditions increases the odds of this tragedy happening again and again.

      P.S. My blog is not, nor has it ever claimed to be "balanced." It is my opinion and I'm sticking to it. This is not a medical journal.

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  3. Here is the full text of the Asperger's Association of New England statement:

    "Statement to the Community Regarding the Connecticut Tragedy"

    December 15, 2012

    At the Asperger's Association of New England, we share the horror and sadness of people across the world. The shootings in Newtown, Connecticut, were a terrible and incomprehensible act of violence. We convey our deepest sympathy to the victims, their families and friends, and their community.

    Early reports have suggested that the suspect, Adam Lanza, might have been diagnosed with Asperger syndrome or a mental health condition. This has not yet been confirmed. Having Asperger syndrome does not preclude acts of violence, just as having any other condition, or no condition, does not preclude acts of violence. Some people with autism spectrum disorders have co-existing mental health conditions or other complex issues. Nevertheless, violence is not part of the Asperger or autism profile. People with Asperger syndrome or any other form of autism are far more likely to be the victims than the perpetrators of violence. Although it is impossible to conceive of a mass shooting as a mentally healthy act, the vast majority of mental health issues are not associated with violence.

    Our overwhelming concern is for the families of the victims through their deep, enduring grief and devastation. We hope too that the conversation around Adam Lanza will be thoughtful and considerate of people who have Asperger syndrome or other forms of autism and their families. When myths and misunderstandings are perpetuated, nonviolent people with the same condition suffer. It is painful and frightening to feel associated by virtue of a diagnosis with someone who has committed such a horrific crime.

    Discussing this tragedy is challenging for families and very upsetting for children who have Asperger syndrome. Our staff is available to give advice or support relating to this issue during normal business hours: (617) 393-3824. We are exploring ways to provide additional support around any concerns relating to the terrible loss of these innocent lives. If there is a way that we can support the families and friends of the victims or the Newtown community, we will be here for them."

    Source: http://www.aane.org/make_difference/conn_tragedy.html


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    1. Thanks for this. But I have not blamed Aspergers for this tragedy. I have blamed the treatment he may have been getting for Aspergers. In my closing, I have generalized the discussion to include many other "mental" conditions that may be treated with these drugs, rightly or wrongly.

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  4. Leslie Ramsey12:18 PM

    I'm sorry John, but I have to take issue with your post as well. Michael explained it so much better than I could, but as a mother of a child with Asperger's Syndrome, I'd like to express concern about the way the media (including bloggers)are implying--intentionally or not--that autism is a mental illness. Autism is a neural development disorder, not an illness or disease. There is no treatment for autism, which is as it should be. There is nothing wrong with the hundreds of thousands of individuals (1 in 85 people in the US are on the autism spectrum)that needs to be "fixed." Indeed, autistic individuals are often highly intelligent and creative and contribute a great deal to society. Think of Einstein and Van Gogh and perhaps Steve Jobs, all of whom had characteristics typical of autism. The danger in equating autism with mental illness is that it creates a false public perception that can damage decades of efforts towards making autistic individuals understood and accepted by society. My 16-year-old daughter is bright, beautiful, compassionate and creative. She wants to be an archaeologist and writes amazing stories well beyond the level of the typical teen. She is not defined by her autism, she is not "broken," and she is not mentally ill.

    I'm sure you didn't mean your comments to be taken as an indictment of autism, but you hit a very sensitive spot, and we autism advocates are a vocal lot! My comments aren't intended to be a criticism of your work--which I enjoy--but more to inform your readers and correct misperceptions. Thanks for the opportunity to express my views.

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    1. I have edited my statements and included a lot of "maybes" and "perhaps" and noted that any treatment for Aspergers would be "off-label." I have also deleted reference to Aspergers as a "mental illness" but have described it as "abnormal" or a "mental condition." The main point is that I do not blame Aspergers, but the treatment. Even though treatment may be off-label, drug companies have often been caught promoting drugs for off-lable use, especially in situations involving mental/behavioral difficulties.

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  5. Leslie Ramsey12:53 PM

    Thanks, John. As I said in my comment above, I appreciate the opportunity to "sound off" on a subject about which I feel strongly. Hope it didn't cause you too much trouble. By the way, the fact that Michael Swit and I are associated with the same company is purely coincidental.

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    1. Ha, I didn't realize that! Anyway, it's never trouble when I can learn something. It would be interesting to know how many children with Aspergers are treated with antidepressants and other drugs off-label.

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  6. To build on Leslie Ramsey's comments (and, in the small world category, we know each other, but did not coordinate our comments,but are fond readers of your blog), a couple additional points. And, while I recognize your right to write whatever you want and to not have "fair balance" in your own blog, I also invite you to consider that many people read your blog. Thus, let's not call "fire" (as these words are for some) in a locked theater unless there really is a fire.

    First, as Leslie pointed out, Asperger's is not even a "mental condition." That label should go.

    Second, why use "abnormal?" That has a very negative connotation. Words are powerful, both positively and negatively. I would content that my son, who is one the autistic spectrum, is not abnormal. He is simply wonderfully different.

    Best,
    Michael

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    1. I'm not an expert on what is "normal" or "abnormal," but realize that there are many "shades of gray" here. Obviously, the shooter in this case is "abnormal" in almost every respect I can think of. Normal people don't go on shooting sprees. I should have left "Aspergers" out of this altogether because it has little bearing on my main argument regarding the treatment the shooter may have been receiving. Will we ever know for certain what drugs he may have been taking? I don't think so because such information is cloistered. Instead, most people will most likely blame Aspergers and thus prove the point you are trying to make. I am sorry if I contributed to that impression.

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  7. Leslie Ramsey1:33 PM

    Commonly used terms include typical vs. atypical or autistic vs. neurotypical.

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  8. Anonymous5:03 PM

    Hi, this is Leslie's daughter. Please, try to spread word that aspergers doesnt mean violence, because the media seems to be saying that. I'd rather not be looked at as a terrorist, when I really wish I could punch Adam Lanza for doing what he did. If he even did have anything, that's not an escuse to kill 20 first graders and 6 teachers.

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