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Ahead of a BBC Panorama documentary about whether antidepressants can lead to people becoming violent and potentially homicidal, there have been a number of news articles exploring antidepressants and their side effects.
Prof. Wendy Burn, President of The Royal College of Psychiatrists, said:
“We are disappointed with recent coverage about antidepressants, especially since the reporting so far has not included a comment from the College.
“For many milder episodes of depression talking therapies will be recommended as the first line of treatment. For moderate to severe depression, antidepressants are an evidence based treatment. Their prescription should be reviewed regularly in line with clear national guidance. We know that more of the people living with mental illness now seek medical advice and we believe this explains the increase in the number of people being prescribed antidepressants. For many, these drugs have had a beneficial effect on mood and have helped reduce suicidal thoughts or self-harm.
“In all treatments – from Cancer to heart disease – medicines which do good can also do harm. This applies in psychiatry. Current evidence from large scale studies continues to show that for antidepressants the benefits outweigh the risks, which is why it is important to highlight that the experience raised by the author in the recent Sunday Times article is extremely rare.
“Any patient who is unsettled by this media coverage, or feels pressurised to stop taking an antidepressant drug, should not abruptly discontinue their prescribed treatment. Instead, they should make an appointment with their family doctor or mental health professional to discuss any concerns they might have. They should together make a joint decision about whether to continue antidepressant treatment.
“This decision should be made on their own individual experience and should be informed by how effective their treatment has been in helping to reduce depressive and anxiety symptoms, any side effects which might have occurred, and the risks of a recurrence of illness, if treatment is stopped prematurely.”
Prof. Shirley Reynolds, Professor of Evidence Based Psychological Therapies, Director of Charlie Waller Institute, University of Reading, said:
“If the Sunday Times article is correct then the upcoming Panorama (A Prescription for Murder?) focuses on a BMJ study that came out last year that looked at suicidality and aggression during antidepressant treatment. Unfortunately, as we wrote in our letter published in The BMJ, that study had flaws in presentation and logic and the results were further misrepresented by the BMJ press release.
“The term ‘suicide’ was used when the data actually only referred to ‘suicidal behaviour which is a hugely important difference. The data in the study didn’t actually show any instances of suicide in children or adolescents. The authors also stated that antidepressants are known to increase the risk of suicide in children and adolescents, which is not factually correct and the references cited do not support their assertion.
“Furthermore neither the paper itself nor the editorial actually pointed out the significant fact that of the five antidepressants mentioned in the article only two (fluoxetine and sertraline) are currently recommended by the National Institute for Health and Care Excellence for the treatment of depression in young people.
“This matters because if people stop taking their drugs then that really can lead to an increase in suicides. A review of 574 youth suicides reported that only 1.6% had received antidepressants.
“Young people need access to a range of individualised evidence based treatments. The possible risks of harm from antidepressants (or psychological therapy) must always be balanced against the benefits of treatment and the increased risk of suicide in severe, untreated depression, but we must be very careful about turning people away from the very therapies that can help them.”
Prof. Carmine Pariante, Professor of Biological Psychiatry, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said:
“There is no good evidence that antidepressants increase the risk of violent behaviour, and the extremely rare (and tragic) cases that are cited in support of this theory could be explained by chance: antidepressants are prescribed relatively widely, and so by chance someone on antidepressants will commit a violent act. Moreover, people on antidepressants may be suffering from some forms of mental disorder or distress that may, albeit very occasionally, increase the risk of reacting impulsively or violently.
“With 7% of the UK population and 11% of the US population currently taking an antidepressant, we would have clearly seen an increased risk of violence if there was one. With alcohol, for example, there is a clear evidence that it is linked to at least half of all cases of violent assaults, child abuse, domestic violence as well as homicides and murders.
“In contrast, we know very well that every time an alarm reduces the rates of prescription for antidepressants, suicide rates increase, including in adolescent and young adults. The risk of suicide attempt in patients treated with the commonly use ‘SSRI’ antidepressants is approximately one-third that of patients who are not treated with an SSRI. And this is without even considering the life-saving effects that these medications have on patients’ recovery from their mental health problems.”
Prof. Allan Young, Professor of Mood Disorders, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience and Chair of the Psychopharmacology Special Committee
“Antidepressants are widely used and at the same time that the MHRA is constantly monitoring reports, scientists are continually doing studies looking into any side-effects. We have to be really careful that there is good evidence for the claims we make and if we find serious effects then we shout about them because we want to help patients.
“If there was good evidence of antidepressants turning people into murderers then we would certainly be looking into that. It is an extremely strong claim and therefore needs to be backed by strong evidence. So many people take antidepressants that we will always be able to find some coincidences, but it takes a lot more evidence to mean it’s more than that.”
Prof. Seena Fazel, Professor of Forensic Psychiatry, University of Oxford, said:
“I have spent some years looking at the impact of psychiatric disorders and treatments on violent behaviour and the data is quite complex. The first thing to say is that there is no clear evidence of a link between antidepressants and violent behaviour in older people. In young people the latest stats do show something, but we cannot say that antidepressants are making people more aggressive as we can’t tease apart whether it’s the antidepressants or the fact that young people on antidepressants are also using alcohol, and some actually have severe personality problems which can make them more violent in the first place.
“The whole picture is further complicated by the fact that we don’t have much really high quality data and most data comes from trials which are actually looking at things like verbal aggression, rather than actual violent acts. We are trying to get round this by looking at data from countries where national crime registers can be linked to records of individuals with depression. We can then look for any differences in individuals who are prescribed SSRIs versus those who are not. You can also compare the same person twice – once when they use antidepressants and once when they don’t.
“With colleagues at the Karolinska Institute, we did one such study based on all people in Sweden from 2006 to 2009, which amounted to around 850,000 individuals taking SSRIs. What we found was a complex picture although two patterns emerged – for 80% of individuals who were prescribed SSRIs and were aged over 25 years, there was no clear association with violent crime. In those aged 15-24 years old, there was an association with increased rates of violent crimes (and also violent arrests and non-fatal accidents), however that’s not as clear as it sound as this association was stronger in those receiving sub-therapeutic doses of SSRIs, suggesting that partial treatment of the underlying depression may be one explanation for this link in younger people.”
* As reported in the Sunday Times, Daily Mail and The Sun
We also have a factsheet on antidepressants.
Declared interests
Prof. Reynolds: “My post at the University of Reading is partly funded by the Charlie Waller Memorial Trust and Berkshire NHS Foundation Trust. I am co-director of the Oxford Academic Health Science Network Anxiety and Depression programme. I have received grant funding for research from NIHR and MRC.”
Prof. Young: “Receipt of grants/research supports: Investigator initiated studies from AZ, Eli Lilly and Lundbeck. Receipt of honoraria or consultation fees: Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders.”
Prof. Fazel: “No grants from any pharma, but on one occasion I did receive a speaker’s fee from Janssen (who make an antipsychotic) that I donated to charity.”
Others: None declared