From the May 2002 Chronicles Magazine
CULTURAL REVOLUTIONS
“TIME-OUT” FOR
ANTIDEPRESSANT DRUGS
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A Texas jury spared the
life of Andrea Yates, deliberating 40 minutes
before sentencing her to life in prison instead
of the death penalty. She will be eligible for
parole in 40 years. The jurors deliberated for
three hours and 40 minutes before finding Yates
guilty of murder in the drowning deaths of her
children.
Yates pleaded not guilty
by reason of insanity to two counts of capital
murder in the deaths of three of the children,
Noah, 7, John, 5, and Mary, 6 months. She was
not on trial for the drowning of Luke, 3, and
Paul, 2. Her attorneys argued that Yates was
insane when she drowned the children but
prosecutors said Yates knew what she was doing
was wrong. |
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 psychiatric drugs intended to
counter the side-effects of the first or to deal
with other alleged mental illnesses), followed by
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 psychiatric drugs
until she is sane enough to stand trial for
murders she committed while on megadoses of
psychiatric drugs? If she’s “sane” now, on the new
drug regimen, how was anyone to know whether she
was sane then on the old drug
regimen?
I mean, 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
post-partum 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
home-schooling” 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 the
various drugs prescribed over the years, Mrs. Yates
could have hired some help at home. She could
have had her “tubes tied” — a simple out-patient
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. In
particular, psychotropic drugs do not appear to be
held to the same standard as other medications.
Whether this is due to profiteering by drug
manufacturers or whether people have been so taken
in by 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
pain-killers.
Fifteen years ago, I got a
prescription pain-killer 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 legal 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, post-natal
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 whole 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, lasting 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 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 combined with a
powerful antipsychotic drug such as Haldol, which
was prescribed for Mrs. Yates.
Most psychiatric 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 with drugs like 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 fully confirm the conflicting rumors, they
didn’t get much press. But given the
side-effect of drugs like Prozac and Luvox, it
would not be surprising to see sexual confusion
fluctuating between utter disinterest and
hypersexuality.
Antidepressant use, especially in
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 entirely
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 appealing,
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, maybe 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.
— B. K. Eakman
B. K. Eakman, a former teacher turned
speechwriter, is executive director of the National
Education Consortium and the author of Cloning of the
American Mind:ÿ Eradicating Morality Through
Education.ÿ (Huntington House)
Source
Did Drugs Cause Mom to Drown Her Five Children?
By
Kelly
Patricia O'Meara
Andrea Yates' crime shocked the nation.
Did mind-altering drugs prescribed to treat her
depression actually drive this young mother of five
to drown the children she loved?
Only weeks ago, Houston wife
and mother Andrea Pia Yates
methodically drowned
each of her five children. One by one Yates forced
her children, ages 6 months to 7 years, into the
family's bathtub and held their struggling bodies
under the water until each fell limp.
Whatever possessed the
36-year-old mother to commit these unconscionable
acts remains murky. Depression and postpartum
syndrome topped early speculation, but there has been
little discussion about the possible effects of the
powerful mind-altering drugs
she was taking.
Although Texas District Judge
Belinda Hill issued a gag order concerning the case,
family members have released disturbing facts about
Yates' psychiatric treatment that specialists say may
account for her state of mind at the time of the
murders.
During a two-year period, Yates
was prescribed
four extremely potent
mind-altering drugs intended to help her through two
episodes of severe depression that began after the
birth of her fourth child.
The first of these
psychopharmacological cocktails included
Haldol,
an antipsychotic most often used to treat
schizophrenia;
Effexor, an antidepressant very similar to
selective serotonin reuptake inhibitors (SSRIs); and
Wellbutrin,
a unique antidepressant that has amphetaminelike
effects.
ccording to Yates' husband,
Russell, his wife appeared to respond well to this
treatment regimen and, after a short time, became her
"old self."
At the onset of the second
episode of depression following the birth of her
fifth child, and the subsequent death of her father,
Yates again was prescribed a psychopharmacological
cocktail. This one contained
Effexor
and, at the end,
Remeron.
While information about the
Remeron dosage was not made public, Yates' husband
has said that his wife was given Effexor at
a dosage nearly twice the
recommended maximum limit. Just
days before the murders, the Effexor was for some
reason reduced to just slightly more than the
recommended maximum dosage of 225 mg per day and the
Remeron was added.
Psychiatrist
Peter Breggin,
court-qualified medical expert and author of numerous
books, including
Talking Back to Prozac and the recently released
The Anti-Depressant Fact Book, tells
Insight:
"The mixture of Remeron and
Effexor would tend to be extremely agitating and
certainly could lead to behavioral disturbances.
The mixture of Haldol, Wellbutrin and Effexor is
unpredictable in its effects.
Haldol actually can cause depression, and putting
the three drugs together is somewhat experimental."
Breggin continues: "Haldol is a
very blunting drug. It's difficult to come to any
definitive conclusions with so little data about her
state of mind at the time. However, Haldol is a drug
that produces what can only be referred to as a
chemical lobotomy that tends to make a person more
docile and robotic."
Many Americans who have read or
heard reports about this case have little doubt that
Yates was "out of her mind" when she killed her
children. What appears to be developing, however, is
an argument within the medical community about
whether the mother's
homicidal state of mindwas triggered by the depth of her depression
or by the mind-altering drugs prescribed to her.
Were these the actions of a
severely depressed woman who "lost it," or did the
mind-altering drugs push this emotionally distraught
woman over the edge? Should the latter be established
in the criminal court, it could raise an even greater
issue: Who was responsible? Was it a chemically
poisoned mother who carried out the crazed act, the
physician who prescribed the mind-altering cocktails
or the pharmaceutical companies that manufactured and
marketed the treatment?
Only recently have
pharmaceutical companies been held responsible for
violent behavior associated with their product lines
of mind-altering drugs. A case in point is a June
trial in which a jury in Cheyenne, Wyo., found that
the antidepressant
Paxil, one of the newer SSRIs distributed
by GlaxoSmithKline PLC, "can cause some individuals
to commit suicide and/or homicide."
The jury said
Paxil caused Donald
Schell, a retired oil-rig worker, to shoot and kill
his wife, daughter and granddaughter
before turning the gun on himself. Schell had been on
the mind-altering drug only two days.
The jury awarded surviving
family members $8 million in damages, finding that 80
percent of the fault lay with the drugmaker. Andy
Vickery of the Houston law firm of Vickery & Waldner,
lead attorney in the Wyoming case, has taken dozens
of similar cases seeking to hold responsible those
dispensing and manufacturing these drugs.
"The important thing," Vickery
explains, "is to lay the
responsibility and
accountability at the doorstep of
those who ought to have it and those who could and
should do something about it. Whether it's criminal
or civil responsibility, there isn't a lot of
difference."
As Vickery puts it, "Look, if I
give you a loaded gun and for whatever reason it's
likely that you're going to shoot someone, then I'm
an accessory before the fact of murder. Shouldn't the
drug company that's encouraging doctors to prescribe
a drug and is aware that these drugs cause adverse
reactions be held responsible?
No one can believe that a
mother would do such a thing. It's too horrible. But
the fact is these people get
completely out of
touch with realitybecause of these drugs. Unfortunately, in most
of the cases that I get involved with, we never know
if the people committing the violence knew what they
were doing when they did it because they also killed
themselves."
Although alcoholic-beverage
distillers have yet to be held responsible for the
overwhelming number of fatalities resulting from
alcohol abuse, in many states bartenders are held
civilly and criminally liable when customers get
drunk and cause automobile fatalities. With the
growing number of physicians and psychiatrists
prescribing mind-altering drugs and the alarming data
filtering out about adverse reactions to them, tort
lawyers are asking if medically trained dispensers of
psychotropic drugs shouldn't also be held liable.
For example, Yates'
psychiatrist, Muhammad Saaed, reportedly prescribed
at least one mind-altering drug (Effexor) at almost
twice the maximum recommended dose as part of a
cocktail of mind-altering drugs that also included
Haldol and Wellbutrin during her first bout with
severe depression.
A cautionary note in the
Physicians Desk Reference says Effexor negatively
interacts with Haldol. Apparently, Effexor hinders
Haldol's drug clearance by a factor of more than 40
percent and can cause Haldol concentration levels to
increase by nearly 90 percent, creating toxicity.
Did Saaed know the
contraindications associated with the cocktail he
prescribed? If the psychiatrist was unaware of the
toxic mix,
would ignorance of the
potential poisoning make him any less liable
than if he had known and prescribed the mind-altering
drugs anyway? These are just a few of the questions
Saaed may be asked should he have to defend his
treatment under oath.
According to Ann Blake Tracy, executive director of
the
International Coalition for Drug Awareness and
author of the recently updated book
Prozac: Panacea or Pandora?, there is little
doubt about Saaed's culpability.
Tracy, a doctor of health
sciences specializing in adverse reactions to
serotonergic medications, tells Insight that "when
doctors start prescribing 'off label' outside the FDA
[Food and Drug Administration] guidelines, they run
the risk of being sued for
malpractice.
In the case of Yates, her psychiatrist already had
her on superhigh doses, and on the Monday before the
tragedy he dropped the Effexor back to almost the
maximum dosage, then added Remeron.
It's well-documented that when
doses are increased or decreased, patients experience
negative reactions. A great many of the court cases,
but certainly not all of them, are a result of the
drastic change in the medication."
According to Tracy, "There's a
lot of science to demonstrate that
depression is the result of an
inability to metabolize serotonin,
but somehow the drug companies have got the world
believing that an increase in serotonin, rather than
an increase in serotonin metabolism, is what the
depressed person needs. This is the exact opposite of
what research on depression shows and, if you look at
the research over the last 50 years it is clear that
there has been a horrible mistake.
There is such a wanton
disregard for life. Why can't these doctors at least
read the package inserts so they know how to
prescribe the drugs properly? They're not supposed to
prescribe over the maximum doses, and they know that
they are at toxic levels at that point. That's why
they have maximum-dose information; that's why the
Food and Drug Administration puts a maximum dose on
the packaging. They do it to show that over the
allowable dose level, a person becomes toxic and it's
extremely dangerous."
When asked what questions she
might have for Yates' psychiatrist, Tracy tells
Insight: "I'd want to know how he could have
ignored so many warnings and
contraindications in [reportedly] giving this poor
woman this dangerous drug cocktail. I'd also like to
know which sleeping pill he uses to knock himself out
at night when those five children's faces run over
and over again through his mind?"
Harsh words? It appears this is
just the beginning. Many who follow such matters say
that because of the high profile of the likely trial
of Yates for capital murder, it may turn into a
landmark case pitting the pharmaceutical giants
against the medical practitioners and vice versa,
perhaps even dragging in the American Psychiatric
Association.
George Parnham, Yates'
attorney, has reported that he will enter a
not-guilty plea on behalf of his client for reasons
of insanity. After meeting with Yates and speaking
with psychiatrists that had examined her, Parnham
told reporters, "I've accumulated evidence in the
last 24 hours that strongly suggests that the mental
status of my client will be the issue."
Just what Parnham has discerned
is anyone's guess, including whether he'll defend his
client by challenging the pharmaceutical companies
and his client's psychiatrist. In the meantime,
sources close to the case report that Yates still is
being medicated. Saaed has turned his files on Yates
over to the court and has, to date, made no public
statement.
Insight Magazine July 2001
