To Stop Mass School Shootings, Rethink Antidepressants
Multiple studies provide substantial evidence that paroxetine has a dangerous effect on young people, may provide clues about how to prevent future tragedies
Maybe in a world without guns, explosives, fertilizer, knives, and Molotov cocktails, all school violence can be stopped.
Maybe, short of that, metal detectors, armed guards or a few teachers or custodians with concealed pistols can minimize the resulting death and destruction.
And maybe with some improved counseling services, we can identify troubled teens ready to explode.
Gun control laws don’t work.
Mexico and Chicago both have highly restrictive laws about the purchase and ownership of guns and ammunition, but they have much higher murder rates than most of the U.S.
If you don't want to believe your lying eyes, perhaps you will accept the RAND Corp. finding that the overwhelming majority of studies show that gun control policies simply don't work.
RAND spent two years and $1 million on the analysis, searching for evidence of benefits from gun control policies. RAND's analysis looked to establish connections between gun policies and rates of homicide, suicide, self-defense gun use, hunting, and other categories. The vast majority of those categories went unaffected.
RAND's analysis found some evidence that laws aimed at keeping firearms out of the hands of small children had some effect on rates of suicide and accidental gun injuries.
In addition, RAND surveyed 95 gun policy experts on both sides of the debate, asking them to rank the ideal outcomes of any given gun control legislation. The outcomes included lowering homicides, suicides, and mass shootings, plus protecting privacy and enabling hunting and sport shooting.
The vast majority of the experts responded that cutting suicides and homicides should be the top priorities. Reasonable, right? What might work that hasn't been done to date?
It isn't going to be adding a few hundred more laws, rules and regulations to the current 50,000 passed in the last century. While schools are safer than they used to be, scientific evidence suggests another answer.
But if you want to get at the real cause of these horrific events, don't ignore the potential impact of a type of antidepressant medication that should probably not be given to teenagers at all, and has been associated with an increase in the type of violence seen at Columbine, Newtown, Aurora and — perhaps — at Parkland, Florida.
These and similar attacks have a common pair of elements: The assailants were all late adolescents or young adults, and they were all taking a particular type of antidepressant called an SSRI.
Correlation is not causation, but it should raise some major red flags in this debate. The lack of these incidents among other age groups, when these drugs are prescribed across the spectrum of ages, is extremely curious — and I believe troubling.
We have data, in the form of two studies. The first deals with an infamous Glaxo (GSK) study known as "329," which was related to the drug Paxil (paroxetine). The Department of Justice (DOJ) brought criminal charges against Glaxo.
The company ultimately paid a $3 billion fine for its marketing of the drug to children and adolescents — an off-label use that cannot be marketed under U.S. law, and which GSK claimed was supported by "remarkable efficacy and safety" demonstrated by this particular study.
The problem lies in what was found when the study data were reanalyzed. First, the effect of paroxetine was not significantly different from placebo for any prespecified primary or secondary outcome measure. Translation — the drug didn't work.
But it gets worse. Serious adverse events (defined as an event that "resulted in hospitalization, was associated with suicidal gestures, or was described by the treating physician as serious") were reported in 11 patients in the paroxetine group, five in the imipramine group, and two in the placebo group.
The rate of serious adverse events, including suicidal gestures, was more than five times higher in the group receiving the drug than those receiving the placebo.
In other words, the rate of serious adverse events, including suicidal gestures, was more than five times higher in the group receiving the drug than those receiving the placebo — on a drug that didn't work.
This paper was never retracted. No GSK executive went to jail for what certainly appears to be impossible to explain away as an "accident" or even "ordinary negligence"? But in typical DOJ fashion, GSK paid a $3 billion fine.
But there is more medical literature on antidepressants like Paxil (SSRIs) that is even more damning. A Swedish national registry extracted information on 856,493 individuals who were prescribed SSRIs, and subsequent violent crimes committed in Sweden during 2006 through 2009.
They compared the rate of violent crime while individuals were prescribed these medications with the rate in the same individuals while not receiving medication. Adjustments were made for other psychotropic medications.
Information on all medications was extracted from the Swedish Prescribed Drug Register, with complete national data on all dispensed medications. Information on violent crime convictions was extracted from the Swedish national crime register.
About 3 percent of those aged 15-24 who were prescribed these drugs had a violent crime conviction that appears to be linked to their taking the drug — a rate approximately double that of the next age cohort and double that of someone not consuming the drug at all. There was no statistical increase, however, in older patients.
Considering the seriousness of violent offenses and the fact that this measures only convictions (and we know not everyone who does something evil is caught or convicted), this is a huge increase in risk.
This is especially so when you combine it with the above study, which appears to show that at least one of the drugs in this class is not effective in patients of this age group.
So we have here a family of drugs that appear, from these studies, to provide no benefit but do create a material number of dangerous individuals. Oh, and they make the companies that produce these drugs and the physicians that prescribe them billions of dollars, too.
The government failures that led to 17 dead in Parkland aren't limited to the FBI and the Broward County Sheriff's Department. Perhaps if the drug company executives and doctors who allowed individuals under the age of 25 to get these drugs were criminally prosecuted, we wouldn't be having this conversation.
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a senior health care adviser to LifeZette.