Do SSRI Antidepressants Cause Violence?

What's the reality behind the hype?

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Do antidepressant drugs cause violence? This question haunts many people for whom such medications are essential tools for mood management. It does seem clear that there is an association between antidepressants and violent behavior.  But evidence that antidepressants actually cause violence is very slight indeed.

Association Versus Causation

The difference between association and causation is the difference between circumstantial and solid evidence.

It is very easy to find associations -- but much harder to prove cause. That's because many, many things happen in the same time and place with absolutely no causal connection.

For example -- The number of cell phone towers in the United States has increased dramatically. At the same time, interest in superhero movies also increased dramatically. These two facts are associated, meaning that they occurred in the same time frame in the same place -- but there is no causal link!

In order to prove that cell towers lead to a fascination with all things Marvel Comic related, it would be necessary to conduct carefully constructed research studies. Does living near a cell phone tower increase the likelihood that a family will own Thor posters and attend midnight showings of new Avengers movies? A proper study would include a control group as well as two comparison groups -- with all groups carefully selected to represent a proper sampling of the population.

Only when such a study was completed and then replicated by credentialed groups of researchers -- and then published in a peer-reviewed journal -- could such a cause/effect be claimed.

The fact that no such studies have been conducted, however, doesn't stop people from looking at graphs showing associations and making logical leaps.

Are Antidepressants Associated with Violence?

The answer to this question is Yes. More people who take antidepressants commit violent acts than people who do not take antidepressants. According to one article in Time.com, "certain medications — most notably, some antidepressants like Prozac — have also been linked to increased risk for violent, even homicidal behavior."

There are also many anecdotal stories suggesting a connection between antidepressants and violence. A website called "SSRI Stories" purports to list more than 5,800 cases of criminal behavior by people who were taking antidepressants, mostly SSRIs (selective serotonin reuptake inhibitors). The focus is on blaming the antidepressants for violent, hypersexual, bizarre or suicidal behavior.

Do Antidepressants Cause Violence?

The answer to this question is "probably not." In fact, the same Time article cited above says, in the next paragraph, "Please note that this does not necessarily mean that these drugs cause violent behavior.

... In the case of antipsychotics, the drugs may be given in an attempt to reduce violence by people suffering from schizophrenia and other psychotic disorders — so the drugs here might not be causing violence, but could be linked to it because they’re used to try to stop it."

A recent study led by led by Seena Fazel of Britain's Oxford University found that there was no greater likelihood of violent behavior among people taking SSRI's except among people aged 15-25. Within that group, somewhat surprisingly, higher doses of SSRI's were found to reduce the level of violent behavior.

Do Antidepressants Cause Mental Illness?

While there are some sites that push this theory, there is no solid evidence to support it. In fact, many studies have found that medication along with cognitive therapy is very effective in treating mental illness.

"SSRI Stories" comments, "It is the opinion of SSRI Stories advocates that the majority of these 'bipolar' cases are caused by the massive use of antidepressants in this country. Many of these 'bipolar' patients began taking an antidepressant, become manic/psychotic, and then are diagnosed as 'bipolar'."

Besides being only an opinion, this statement belies medical and historical facts. Bipolar disorder was first described in antiquity, and the symptoms have been recorded down through the centuries. Manic depression, as it was called until the very late 1900s, existed millennia before antidepressant drugs -- let alone SSRI antidepressants in particular -- were developed. The above comment appears to suggest that "bipolar" doesn't exist, or that it is almost all "caused" by antidepressant drugs, which is patently untrue.

Why the Association Between Antidepressants and Violence?

At this point, there are theories -- but no hard evidence. A few of the theories:

  • There may be a real but not-yet-proven causal connection between SSRI use and teen/young adult violence.
  • There may be no causal connection -- but because people who use SSRI's are, by definition, suffering from mood-related disorders, those people may be more prone to behaving violently.
  • There may be problems related to the misuse of SSRI's, either as a result of incorrect diagnosis and prescription of the drugs or because of incorrect use of the drugs by patients.
  • There may be not-yet-studied problems with the usual amounts of SSRI prescribed to young adults, as suggested in one study.

None of these theories has been proven; any or none may be correct.

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