SSRI-Induced Akathisia's Link To Suicide and Violence
Washington, DC: Medical
experts have long known that the side effect associated with the class
of antidepressants known as the selective serotonin reuptake inhibitors
most likely to drive people to suicide or violence against others is
Akathisia is but one in a long list of side effects that SSRI makers
were able to keep hidden, as they settled thousands of lawsuits out of
court, by obtaining court orders to seal documents produced in
litigation. For instance, a 1984 Eli Lilly document showed akathisia
occurred in at least 1% of patients long before Prozac was approved.
a paper entitled, "Suicides and Homicides in Patients Taking Paxil,
Prozac, and Zoloft: Why They Keep Happening - And Why They Will
Continue," Dr Jay Cohen points out that, as soon SSRI's arrived on the
market in the late 1980s, reports of sudden, unexpected suicides and
homicides by patients taking the drugs began to come in.
The DSM-IV acknowledges the association of akathisia with suicidality
and states: "Akathisia may be associated with dysphoria, irritability,
aggression, or suicide attempts."
According to Dr Cohen, SSRI's can create a combination of side effects
that reduce impulse control and cause severe agitation or restlessness
that may become intolerable. He says, impulsive behavior coupled with
impaired cognitive functioning can be dangerous.
A 1998 article on akathisia associated with Prozac and its link to
suicidal ideation in the Journal of Psychopharmacology, by Roger Lane,
who was working for Pfizer at the time, states in part:
"It may be less of a question of patients experiencing
fluoxetine-induced suicidal ideation than patients feeling that 'death
is a welcome result' when the acutely discomforting symptoms of
akathisia are experienced on top of already distressing disorders.
"Hamilton and Opler (1992) stated that the term 'suicidal ideation' to
describe the apparent suicidality associated with akathisia was
misleading, as the 'suicidal ideation' reported in patients receiving
fluoxetine was a reaction to the side-effect of akathisia (i.e.,
unbearable discomfort and restlessness) and not true suicidal ideation
as is typically described by depressed patients experiencing suicidal
Dr Joseph Glenmullen, author of "Prozac Backlash" and "The
Antidepressant Solution," obtained a Lilly document dated November 13,
1990, from Claude Bouchy, a Lilly employee in Germany, to three
executives at Lilly's Indianapolis headquarters, complaining about
directions to change the identification of events as they are reported
to doctors from "suicide attempt" to "overdose" and "suicidal ideation"
"I do not think I could explain to the BGA, to a judge, to a reporter or
even to my family," Mr Bouchy wrote, "why we would do this especially
on the sensitive issue of suicide and suicide ideation."
Dr Glenmullen says akathisia makes people profoundly agitated,
uncomfortable in their own skin and impulsive. It erodes judgment and
can lower their threshold to become violent toward themselves or others,
Dr Martin Teicher, an associate professor at Harvard Medical School and
McLean Hospital researcher at the time, co-authored a paper with
psychiatrist and psychopharmacologist Jonathan Cole on the link between
Prozac and suicide back in 1990, which found that 3.5% of patients on
Prozac either attempted or committed suicide due to severe agitation
In the paper, the authors discussed 6 cases of patients who became
intensely preoccupied with suicide after taking Prozac. Dr Cole said, in
an affidavit submitted in litigation on April 20, 2000, "Our purpose in
writing this article was to alert the profession to an alarming,
probable drug side effect which we had observed."
"There was a very clear association," he said, "not merely temporal,
between the ingestion of Prozac and the patients' suicidality."
"I have also seen patients and reviewed cases," Dr Cole stated, "where
an SSRI unmistakably precipitated a driven preoccupation with suicide."
"The SSRI drugs, as a class," he advised, "clearly have the potential to
cause, and in reasonable medical probability or certainty do cause,
akathisia in some patients."
"Although in 1997," Dr Cole notes, "practicing physicians undoubtedly
varied in their level of sophistication and knowledge about the
phenomenon, the potential to cause akathisia and its potential, in turn,
to trigger suicidal behavior."
Additional evidence showing Lilly knew about the akathisia-induced
suicide surfaced in an application for a patent for a second-generation
Prozac pill which claimed that the new-and-improved Prozac would
decrease the side effects of, "inner restlessness (akathisia), suicidal
thoughts and self-mutilation."
Besides the concealment of this adverse effect by the drug companies,
another major problem in getting the word out, according to Vince Boehm,
who tracks all studies and research published on SSRI's, is that the
FDA refuses to fully acknowledge the role of drug-induced akathisia in
what he refers to as "this hideous equation."
"Akathisia is up to 6 times more likely to trigger a suicide," he
states, "than any form of depression caused by life's circumstances
"The minds inner turmoil is so intense that a person will do anything to escape it," he says.
"The Brits, the Aussies, Canada, and the European Union," he points out,
"have all gone on record recognizing this phenomenon for all age
Judging by internal FDA documents which have surfaced in litigation, Mr
Boehm appears to be correct. For instance, in a September 11, 1990,
memo, FDA scientist Dr David Graham found that Lilly's data on Prozac
was insufficient to prove the drug was safe, stating: "Because of
apparent large-scale underreporting, the firm's analysis cannot be
considered as proving that fluoxetine and violent behavior are
A more recent study in the September 2006 journal Public Library of
Science (PLoS) has further verified the warnings made by many other
experts, when it reported that, in addition to self-harm, SSRI's cause
some patients to become violent and homicidal.
Dr David Healy, described as "one of the three most eminent academic
clinical psychiatrists in the UK," professor David Menkes, from Cardiff
University in Britain, and Andrew Herxheimer, from the Cochrane Centre,
did the study to determine the risk of violent behavior in people taking
As part of their investigation, the researchers reviewed all available
clinical data on SSRI's and summarized a series of "medico-legal" court
cases involving patients who had became violent on SSRI's.
One case discussed dated back to 2001, when Dr Healy testified at a
wrongful death trial in Wyoming, after a 60-year-old man on Paxil shot
and killed his wife, daughter and infant granddaughter before turning
the gun on himself in 1998.
At trial, the jury returned a verdict for the man's son-in-law after Dr
Healy presented the jury with a summary of an unpublished company study
that found incidents of serious aggression in 80 patients on Paxil,
including 25 that involved homicide, and proved that the drug maker knew
about the violence and suicide risks before the 1998 shootings.
Dr Healy points out a rechallenge study by Rothschild and Locke in
McLean Hospital where the authors found Prozac-induced emergent
suicidality associated with akathisia in several patients. In order to
test whether suicidality was coincidental or associated with Prozac,
they withdrew Prozac, then re-administered it, and in all three cases,
the patients experienced the exact same effect. "All three patients
developed severe akathisia during treatment with fluoxetine and stated
that the development of the akathisia made them feel suicidal and that
it had precipitated their prior suicide attempts."
However, even more alarming, one set of patients who became suicidal on
Prozac were described as follows: "[n]one had a history of significant
suicidal behavior; all described their distress as an intense and novel
somatic-emotional state; all reported an urge to pace that paralleled
the intensity of the distress; all experienced suicidal thoughts at the
peak of their restless agitation; and all experienced a remission of
their agitation, restlessness, pacing urge, and suicidality after the
fluoxetine was discontinued."
Source: Lawyers and Settlements.com