Antipsychotic Drugs-The Ignored Link Between Mental disorders, Guns and mass Shootings

Written by Diana Chan R.Ph, BCNSP (Pharmacist, Board Certified Nutrition Support Pharmacist)

Since the beginning of 1980s, mass shootings have been on the rise with many of these mass shootings taking place at schools killing many innocent children within minutes due to the use of semi-automatic rifles. There are 115 major mass shootings from 1982 to 2019.  From 1982 to 2011, there were 1-5 mass shooting each year. Starting from 2012, the number of mass shooting started to escalate to 5 –12 per year. There were 12 mass shootings in 2018 and 8 in 2019 by the end of August 31, 2019.^{[1] [2]}

Each time after a mass shooting, there was fierce debate on how to put an end to mass shooting. There are two school of thoughts. Gun advocates always stand by The Second Amendment of the United States Constitution which states: “A well-regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” Gun advocates argue that guns do not pull the trigger, people pull the trigger. They believe the shooters are mentally ill and we need to spend more money on mental health.

Gun-control advocates believe we need to strengthen background check and ban automatic and semi-automatic rifles in order to put an end to mass shooting. Politicians have been debating this issue for decades and nothing has been resolved so far and meanwhile the number of mass shooting keeps escalating. Parents who send their children to school in the morning worry if they will see their children alive at the end of the day. I have been living in US since 1970, I notice over the years, one thing that is missing in public debates among politicians is “the link of psychotropic drugs & mass shootings”. Why is this link ignored? We might have to dig into some data and do some hard thinking here.

History of Antipsychotics / Antidepressants

1. If you have read the laundry list of all the modern-day pharmaceuticals for mental disorder, you will realize that the saga of the antipsychotics began in the 1950s, when the first drugs in this class, including chlorpromazine (Thorazine) and haloperidol (Haldol), were introduced. These products offered the ability to control symptoms of severe psychiatric disorders, such as schizophrenia, pharmacologically. Previously, patients had been treated with either long-term institutionalization, including frequent use of physical restraints or invasive surgery, such as lobotomy, with devastating effects

Second generation antipsychotics (SGA) aka Atypical antipsychotics (AAP) appeared on the US market in 1989 starting with the arrival of the clozapine for schizophrenia, hailed as “breakthrough” treatment”. We now have 11 SGAs. However, they are no longer regarded as “breakthrough” treatment” due to undesirable side effects that can affect many organ systems. We currently have 7 classes and around 50 anti-psychotic drugs in the psychiatric armamentarium and the list continues to grow with every passing month. Now all the antipsychotics/antidepressants carry a “black box warning”, which means an adverse reaction to the drug may lead to death or serious injury (which can mean suicide or homicide). Please refer to earlier writing. The question we must ask ourselves: Is it a co-incidence that mass shooting started to escalate starting in 1980s with all these antipsychotics/antidepressants flooding the market?

Why were all the lawsuits settled out of court?

2. Many lawsuits have been brought against pharmaceutical companies against anti-psychotic drugs and they were usually settled out of court, and as a result, the general public is not aware of them. Prozac is the first SSRI approved in 1987. Drug maker-Eli Lilly has faced multiple Prozac lawsuits filed by patients or loved ones of those who took Prozac and experienced serious injury, birth defects or death.The first major case is Joseph T. Wesbecker, a 47-year-old pressman. On September 14, 1989, he returned to Standard Gravure, his former place of work in Louisville, Kentucky, and shot twenty of his co-workers, killing eight and injuring twelve. The weapons he used for the mass shooting were an AK-47, three semiautomatic handguns, one rifle and one revolver. The case was settled out of court for a huge unknown amount of money averting the guilty verdict on Eli Lily.^[3] By 2000, Eli Lilly had reportedly paid more than $50 million to settle more than 30 Prozac lawsuits related to murders or suicides, which doesn’t include additional undisclosed settlement amounts.In 2003, Eli Lilly settled a case brought by the parents of a South Carolina teen who hanged himself just three weeks after he began taking the Prozac. All cases (too many to list here) against Eli Lily were settled out of court.

Lawsuits involving other SSRI side effects and injuries have been filed against the makers of Prozac, Zoloft and Paxil, based on allegations of design defect, failure to warn, breach of implied warranty and negligence, among other causes of action. There are claims still pending in the federal court system. GlaxoSmithKline, the maker of Paxil ultimately agreed to resolve more than 800 lawsuits regarding Paxil-related birth defects in 2010 after being ordered to pay a $2.5 million verdict in 2009. Each plaintiff secured roughly $1.2 million in the staggering $1.14 billion accord. The London-based manufacturer also settled Paxil cases involving suicide and attempted suicide to the tune of $390 million.^[4]

Atypical antipsychotics (such as Abilify, Geodon, Risperdal, Seroquel, Symbyax, Zyprexa and others), are a class of drugs used in the treatment of schizophrenia and bipolar disorder. The safety of antipsychotic drugs and the unlawful drug marketing tactics by drug manufacturers, (such as promoting “off-label” uses that have not been approved by FDA, hiding or downplaying known risks and allegation of paying indirect bribes to prescribing physicians) have generated many sentinel events that continues to grab headlines. The marketing of these drugs to medically vulnerable groups, like the very young and the very old has the tendency to cause powerful adverse reactions. 

Lawsuits of the atypical anti-psychotic medications have resulted in some of the largest settlements ever seen in pharmaceutical litigation. Pfizer holds the uncertain record of paying $2.3 billion, including  $1.3 billion as a criminal fine, in 2009 involving Geodon and other drugs.

The same year, Eli Lilly paid a $1.4-billion settlement for a suit involving Zyprexa, including a $515 million criminal assessment. Bristol-Myers Squibb paid $515 million in 2007 to settle charges concerning the promotion of Abilify. Novartis agreed in 2010 to pay $422.5 million in an enforcement action involving the epilepsy drug oxcarbazepine (Trileptal, Novartis). Also, in 2010, AstraZeneca paid $520 million to settle charges related to the marketing of Seroquel.^[5]

You might ask: Why were all the lawsuits settled out of court? The answer is simple and easy to understand. When a case is settled out of court, the drug manufacturers averted the guilty verdict and the general public will not hear about it in the main stream media. This allows the drug involved in the lawsuit to stay on the market and continues to make billions from unwitting consumers. It might sound very expansive to settle these lawsuits, but settlements represent only a fraction of the revenues that have been generated from these drugs. For example, AstraZeneca made $21.6 billion from Seroquel between 1997 and 2009. Its $520 million payment is only 2.4% of that sum.^{[6] [7]}

If drug manufacturers do not settle, that would be equivalent to killing the goose that lays the golden eggs for them. So, it is better to share some of the golden eggs with the victims than to have the goose killed.

We have spent billions of tax payers’ money each year on mental health, with most of that money gone to the coffers of the pharmaceutical companies and yet mental health continues to deteriorate and mass shooting continues to rise.

Why aren’t politicians talking about the link between antipsychotics and mass shooting and why aren’t some of these dangerous antipsychotics taken off the market?

The answer is pretty simple and obvious. Big pharmaceutical companies have deep pockets and therefore have huge lobbing power and influence on the policy making process in our government.

3. There are a group of people who argue that there is no link between mass shooting and the side effects of antipsychotic drugs because there are millions of people taking the antipsychotic drugs and not all of them turn into mass shooters. And they also argue that there are no clinical studies that prove these drugs would turn people into murderers. That argument does not prove that some people, especially young people, will not be converted to murderer due to the side effects, especially when they are suffering from serotonin syndrome. These effects are similar to the symptoms of people under the influence of methamphetamine.^[8]

Wonder why there is no clinical studies that prove antipsychotic drugs would turn people into murderers.

I would like to point out, first of all, that the clinical studies done before FDA approval are usually very short term, sometimes just months if they were approved through Fast Track. Secondly, will anyone conduct a clinical study using healthy volunteers, making them take the drug for years to find out how many of them will turn out to be murderer? Will you volunteer to be that guinea pig if you know that is goal of the study?

The sad truth is that all consumers became unwitting volunteers in the post marketing study (Phase 4 study) of a new drug. All those adverse drugs reports from consumers, which can result in lawsuits, are the proof of the dangerous side effects a new drug in a long-term study.  FDA continues to add warnings of additional side effects according to the post marketing study.

How to access Drug Adverse Event reports

You can access Drug Adverse Event reports in The FDA Adverse Event Reporting System (FAERS), which is a database that contains information on adverse event and medication error reports submitted to FDA. The database is designed to support the FDA’s post-marketing safety surveillance program for drug and therapeutic biologic products.

You may also read user reviews in www.drugs.com. Just type in the drug name and click “User Reviews”. There you will read a variety of experience of many different users. Don’t be shocked to see rating as low as 1 or as high as 10.

Conclusion on Antipsychotic Drugs-The Ignored Link to Mass Shootings

I found it hard to believe that the politicians are debating if gun control alone or management of mental disorder alone can fix the mass shooting problem we have in this country. If you examine the causes of all the mass shootings that happened in the last 40 years, you should realize that the causes are multifaceted and therefore, we need a multifaceted approach to solve the problem.

Wonder why most of the mass shooters are young people?

Most of the mass shooters are young male and most of them are on some sort of antipsychotic drugs. What that means is these young people started out having mental illness/depression either because they were born into dysfunctional families or they were offsprings of women who might have been addicted to illicit drugs or addicting prescription drugs which predispose these young people to psychological problems. For children given Ritalin/Adderall due to the diagnosis of ADHD, very likely, they will grow up as drug addicts.

When young people do not receive the love they need growing up due to environmental factors, such as living in dysfunctional households, experiencing bullying in school or workplace, being discriminated due to race or social status, they eventually grow up to be young adults feeling hopeless and carrying a lot of anger inside. They are waiting for opportunity to unload this anger to get even with society as a whole or whoever they perceive as having created their pain and suffering. They do not care who they kill to get even, especially if the drugs they are taking have turned them into zombies-creatures with no feeling or empathy for others. After reading about all the antipsychotics side effects and the warnings in the black box, you should realize that our researchers have admitted and warned: “Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment”. Putting these young people, who already have suicidal thoughts, on these drugs would push them over the edge. Mass shooting is a form of suicide in addition to revenge because the mass shooter usually killed himself at the end or getting killed by police. Have you ever heard of “suicide by cop“? ^[9] It is a term used by law enforcement officers to describe an incident in which a suicidal individual intentionally engages in life-threatening and criminal behavior with a lethal weapon or what appears to be a lethal weapon toward law enforcement officers or civilians to specifically provoke officers to shoot the suicidal individual in self-defense or to protect civilians.

There is a chain that ties mental disorder- antipsychotics, guns and mass shooting together. My argument is that we need to break this chain in more than one place. We not only need to take care of these disadvantaged youngers by helping their families, giving them and their family members psychotherapy instead of drugs, assisting schools with means other than just drugging them. We also need to have ways to prevent these potential mass shooters to have access to firearms with mass destructive power. What is “Second Amendment of the United States Constitution” good for except making money for the gun manufacturers, if our children have to go to school in fear of getting shot, parents have to worry if they will see their children alive at the end of the day or people have to worry about surviving participation in social events?  Our elected politicians are elected by people to serve and protect us all. We need to break the third hook of the chain!

Let’s explore some of the ways we can break the 3^rd hook of the chain that leads to mass shootings. I agree that guns do not pull the triggers, people do. We need to remove the opportunity for the potential mass shooters to pull the trigger.  

1. Second Amendment was ratified in December 1791. It is 230 years old. Our current society is quite different from 230 years ago. As a society, we should have the collective wisdom and power to amend it again to protect our peaceful living condition and our future generation.

Obviously, how we should amend the Second Amendment would be a huge political debate. Should we make it illegal for all people diagnosed with mental disorders to own any firearm? Mental disorders are so pervasive. There are many people who claim antipsychotics/ antidepressants help them deal with their problems and make them normal. The dilemma is that how do we decide which group of people with certain mental disorder diagnosis can be responsible gun owners and which one cannot?

2. Background check alone is not enough because we might not be able to identify the potential mass shooters since they have no record of wrong doing in their past. Most of them are first offenders.
3. Under current federal law minimum age for gun possession: Subject to limited exceptions, federal law prohibits the possession of a handgun or handgun ammunition by any person under the age of 18. Federal law provides no minimum age for the possession of long guns or long gun ammunition. Unlicensed persons may sell, deliver, or otherwise transfer a long gun or long gun ammunition to a person of any age.

Purchasing and possessing a lethal weapon is a serious responsibility and one that should not be taken lightly. Our country sets minimum ages for driving, voting, and drinking alcohol to encourage responsible behavior in order to protect young people and the general public. Because young adults are more prone to attempting suicide and engaging in violent behaviors, strengthening minimum age laws for purchasing and possessing guns will help protect young people and the public at large.^[10]

We should heed the warnings in the “Black Box” of antipsychotics and perhaps raise the minimum age to bear arms to at least 25 or higher.

4. Another idea is gun registration to identify gun ownership. We must register car or boat ownership, why not guns? The question is: would this solve the mass shooting problem we have? Young people not qualified to own guns can steal guns from parents or other gun owners to commit murder. But at least, gun ownership registration makes it a little harder for young people with suicidal ideation and violent behaviors to get hold of guns.

5. Another idea is personalization of guns. We have the technology to make guns personal items. In order words, guns are programed to recognize the registered owners either by finger prints or hand size or other means. So, under-aged people will not be able to operate guns they steal from other gun owners. 
   

6. Voluntary buy-back program will help to reduce the lethal weapons floating around in this country. If the goal of owning guns is for self- defense or hunting, how many guns do you need? Do you need an automatic or semi-automatic rifle for self-defense? You can go hunting the old fashion way with bows and arrows. 
   

The last thing I want to say on the subject of mass shooting is: Just focusing on one solution is not enough. Since the causes are multifaceted and therefore, we need a multifaceted approach to solve the problem. United States needs leaders who have the courage and humanity to make changes to protect its citizens instead of succumbing to special interest groups and weapon manufacturers who don’t care to do anything except shedding a few fake tear drops when the next mass shooting occur.

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References:

[1] https://www.motherjones.com/politics/2012/12/mass-shootings-mother-jones-full-data/

[2] https://www.statista.com/statistics/476409/mass-shootings-in-the-us-by-weapon-types-used/

[3] Cornwell, John. The Power to Harm . Penguin Publishing Group. Kindle Edition.

[4] https://thesandersfirm.com/dangerous-drugs/ssri-antidepressant-lawsuits/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993073/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993073/

[7] Zekaria S. Astra settles claims related to Seroquel. The Wall Street Journal. 2010 Aug 10

[8] https://www.addictioncenter.com/drugs/meth/symptoms-signs/

[9] https://www.ncbi.nlm.nih.gov/pubmed/9832661

[10] https://lawcenter.giffords.org/gun-laws/policy-areas/who-can-have-a-gun/minimum-age/

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