Andrea Yates, the Houston mother recently sentenced to life in prison for drowning her five children in the bathtub, has become the latest horror story in an alarming string of domestic atrocities occurring in the wake of mental-health drug treatment. From the killer kids of Columbine, to the sickies of Springfield, Oregon, and Santee, California, to U.S. Capitol cop-killer Russell Eugene Weston runs an almost predictable pattern of antidepressant drug treatment (sometimes coupled with other psychotropic drugs intended to counter the side effects of the first or to deal with other alleged mental illnesses), followed by the loss of impulse control.
Maybe I’m missing the finer points of Mrs. Yates’ preparation for trial, but does this make sense? Here’s a woman who methodically drowned all five of her children, so doctors give her megadoses of psychotropic drugs until she is sane enough to stand trial for murders she committed while on megadoses of psychotropic drugs? If she is “sane” now, on the new drug regimen, how was anyone to know whether she was sane then on the old drug regimen?
Doesn’t this bring criminal justice to a whole new level? If someone does something illegal—anything at all, like speeding—while taking a prescription psychotropic drug, couldn’t lawyers just argue that, well, this person was prescribed thus-and-such drug by a doctor, and if the judge will simply order a revised drug regimen, the accused would be happy to drive down the same street again at the posted speed limit?
Of course, Mrs. Yates was said to be suffering from a particularly severe form of postpartum depression. Some hypothesized that her husband was partly to blame by keeping his wife continually pregnant, resulting in physical and emotional exhaustion. Others presumed some causal link between the “social isolation of homeschooling” and the simultaneous stress of infant care. Yet I could find no recorded incident of this magnitude in the days before birth control, modern anesthetics, and “opportunities” for women—when large families, long hours, and few amenities were the norm. Given the money the Yates family spent on mental-health treatment, including on psychiatrist Muhammad Saaed and various drugs prescribed over the years, Mrs. Yates could have hired some help at home. She could have had her “tubes tied”—a simple outpatient procedure—had she been desperate to avoid further pregnancies. But by all accounts, she loved her children and her husband dearly. Something else had to be going on.
There has been a shift in the ethical winds in the field of medicine. Psychotropic drugs do not appear to be held to the same standard as other medications. Whether this is because of profiteering by drug manufacturers or whether people have been so taken in by the promise of feel-good medications and insist upon having them is unclear. What is clear is that the safety criteria for mental-health products are not as rigorous as for those aimed at physical well-being, like antibiotics and painkillers.
Fifteen years ago, I was prescribed a painkiller called Zomax following dental surgery. It stopped the throbbing immediately; didn’t make me sleepy, “spacey,” or nauseous; and wasn’t habit-forming. Two years later, I was under the knife again for an abscessed tooth. I expected another Zomax prescription. I was told it had been pulled from the market. The substitute medication I was given not only didn’t work but made me sick. Pacing the floor with a throbbing jaw, I was furious. Why did a perfectly good drug get pulled?
One person apparently had died from it, my dentist said.
“One person?” I spat. “One person, and a drug line gets pulled?” That seemed a huge overreaction, until I thought about it. I guess that’s why we have a Food and Drug Administration. Only in America would the death of one person warrant rethinking an entire product line—except in the case of psychotropic drugs.
Of course, one expects individual (“idiosyncratic”) reactions to most drugs. But when the brain is the target of treatment, not only is the patient at risk of adverse reactions, so is society.
There are two schools of thought concerning the use of psychotropic drugs. One, from the mental-health industry, insists that troubled individuals who see a psychiatrist and are prescribed drugs simply evidence their need of them. The failure of the substances in question to control violent impulses is viewed not as a failure of the drugs per se but as a failure of society to impose mandatory early-detection programs—for example, postnatal counseling for new mothers and behavioral screening for schoolchildren—the way schools and insurance companies demand physical examinations.
An opposing view—increasingly prevalent among pediatricians, neurologists, nutritionists, and allergists—is that mood-altering drugs are insufficiently tested and so unpredictable that they can push even normal adults over the edge, not to mention troubled individuals and children. These experts complain of pressure to attribute the physical complaints of patients to mental causes whenever a diagnosis is elusive, time-consuming, or costly.
Ann Blake Tracy, author and executive director of the International Coalition for Drug Awareness, points to a new level of suicides in recent years among patients prescribed antidepressants—not your typical sleeping-pill, wrist-slitting, carbon-monoxide variety, but grisly, masochistic methods like dismemberment with a chain saw. While antidepressant drugs are not supposed to be habit-forming, getting off of them, she says, frequently results in “strange and terrible thoughts,” including suicide, which last long after the drug or drug cocktail is stopped.
Depression and anger appear to be a particularly volatile mix. Both tend to be treated with antidepressants, based on the theory that chronic anger is a form of depression. But what if anger and depression are not two sides of the same coin? Suppose the worst possible thing an angry person could do is to take an antidepressant. It’s certainly beginning to look that way, especially when the antidepressant is combined with a powerful antipsychotic drug such as Haldol, which was prescribed for Mrs. Yates.
Most psychotropic drugs haven’t been around long enough to determine even the short-term effects, much less long-term ones, a fact that’s obvious from the pharmaceutical literature on antidepressant drugs. Yet they are marketed for everything from compulsive shopping to discomfort in crowds. Children are particularly vulnerable to side effects because their brain circuitry and hormones are still developing. For example, if some 90 percent of adults experience sexual dysfunction while on such drugs as Prozac, Paxil, and Luvox, what about adolescents and toddlers?
Columbine killers Eric Harris and Dylan Klebold were rumored to be either gay or uninterested in dating and sex. Since no one could confirm the conflicting rumors, they didn’t get much press. But given the side effects of drugs like Prozac and Luvox, it would not be surprising to see sexual confusion fluctuating between utter disinterest and hypersexuality.
Antidepressant use, especially among children, has also been linked to the inability to enter deep sleep. Sleep deprivation is known to produce paranoia, heightened irritability (anger), and even psychotic outbreaks—one reason for its use as a method of torture.
While none of this exempts anyone from responsibility for his own conduct or that of family members who are on prescription drugs, it does, perhaps, shed light on the grotesque (and even out-of-character) nature of the rampages committed by individuals on antidepressants—especially in combination with other psychotropic substances.
Researchers are understandably anxious to be on the cutting edge of science, including medicine. But today we see the merging of social psychology—a controversial field notorious for its ambiguous advice—with hard sciences such as biology and chemistry, in an effort to alter human behavior and even personality. Everything possible is being done to institutionalize this merger—from prime-time advertising to legislation aimed at achieving parity between physical and mental-health treatments. Difficult life experiences are deemed a disease.
Before we travel too far down this road, we need to stand back, take a deep breath, and tell the officials at the FDA to take a page out of pop-psychology texts: Maybe it’s time to declare a “time out” for antidepressant drugs, pending a more thorough investigation of long-term side-effects and drug interactions.