Besides withdrawal there is another important issue and that is what I call, for a lack of a better term, rebound or increased sensitization. This is a hypothesis but I have witnessed it personally in more than one case. This is how it works. The first time someone is put on an antidepressant it may or may not work, but if it does work, it is either by stimulation or blunting, not by "healing". For one reason or another the patient may eventually decide to go off. The problem comes not just from withdrawal but also from resumption of the same antidepressant or a different one at some later date. Even if the withdrawal goes relatively smoothly, problems can and do occur when there is a resumption of treatment. The second course of treatment can go very, very differently than the first course whether or not it's the same drug. It's as if the brain becomes sensitized in some way -- almost like an allergy. Yet each time one goes off there also can be a worsening of the underlying emotional disturbances too from the withdrawal and the chemical dependency effects of the treatment. So if you give an antidepressant for "anger management" rather than teaching behavioral techniques to improve the situation, there are a number of risks associated with that. The anger (or depression) is likely to get worse each time treatment is stopped and started because of drug effects, not necessarily because the person is actually getting angrier or unhappier. The STAR*D study actually demonstrated that each successive course of treatment led to less improvement and greater relapse rates rather than earlier courses. The NIU perpetrator appears to have had both these effects at work. The Prozac this time around was making him feel worse than ever (like a zombie -- no one, especially perhaps when they are bright and thoughtful, wants to feel like a zombie) so he stopped it -- probably abruptly. He may have felt hopeless and helpless that he could never overcome his "mental illness" because he only felt worse after every course of treatment and no one explained to him why this might be. One of the things that bothers me tremendously is the ignorance that is displayed by medical professionals in the wake of these tragedies and their reluctance to learn from them.

this phenomenon also occured to me on lexapro. i went off it and four months later was put back on it by my then-doc. it absolutely ripped me apart, my heart raced, i couldn't sleep etc. very weird.

I hope this does not turn into another bad rap for Prozac. I guess I should be the poster child for Prozac. I have taken Prozac for a while now. It has literally saved my life. The pole of depression was about to wipe me out. After trying several antidepressants my doctor said, "You know Prozac still gets people well." I was afraid to use the drug because of what I read in the news. I did not want to go into the hospital so I agreed to try. I have had to increase my dosage a couple of times and it takes a long time to work but it has done wonders for me.

I don't know. I have real difficulty settling for the explanation that it was withdrawal from prozac that caused the shooting rampage. He had ordered the guns a full 10 days before actually carrying out his massacre. Is such patience and forethought the act of an acutely psychotic person? It doesn't fit right for me.

Who knows. He had a history of psychiatric trouble. He was discharged from the military for psychological reasons. Why wasn't someone aware? If he was psychotic, he wouldn't have been on prozac.

He was working in a prison, and then quit his job there. Maybe the violence in the prison had an effect on him. I don't know.

I just think it's all too simple to blame his murders entirely on withdrawal from prozac. It's too easy; it sets a precedent for those with mental illness to not take responsibility for their actions; it allows an excuse for people taking psychiatric drugs to commit inexcusable acts.

I don't believe withdrawal from an SSRI leads to murder - especially such a pre-planned, premeditated murder. Irritation, anger, violent or suicidal thinking...yes. But not overt psychosis; not overt violence. It just doesn't work that way.

And I think the readiness of the american public, propogated by the readiness of people taking psychiatric medication, to accept this rationale is fairly worrisome.

Feeling worse might be an interesting factor. Especially when the doctor places the blame on the patient instead of themselves and the so called wonder drugs when they fail. How many times have you been told its in your head when it fact it has been a physical side effect? I wonder if the generic will come back has not being properly made with some cheaper "inert" ingredients or properly mixed. Not all companies and employees follow what they should do. If they just cut costs a little by each pill....

Something had to severely provoke him. Things were probably simmering for awhile

Knowing that there are effects and that they apply to you instead of some small percentage of limited cases may be an issue. How many people fully research something the doctors says is safe? How many times have you been told that the "anti" information out there isn't to be trusted and/or believed and that its by people with mental conditions? And by association should be discredited/ignored. Surely the FDA would never allow unsafe drugs and dangerous doctors to practice? No one believes the anti drug crowd until they'll live through it themselves. and they don't accept they level of corruption until they try to speak up and are told "the drugs don't do that"

As for being a cause it may not be the final thing like the last degree of heat that causes water to boil over but each degree plays a part in adding to the end result. The prior 211 degrees share as much to blame as the 212th degree of heat.

No one does anything drastic when things start going better.

All the stuff he purchased "X" so he must have been planning.... He could have purchased it for an enjoyable hobby with no ill intent. Restricting people's freedom's usually leads to opposition and that resistance to unjust oppression in a small group of people leads to violent opposition. You going along poking people till you poke the wrong one and they swing back. Where do you think your heroes come from? Its a matter of dates and outcomes that decide which were wrongful attacks and which were heroic acts. Or didn't you know everyone fights on the side of the good guys and believe what they're doing is just and right? Ends justify the means. Isn't that what shrinks tell us its for our own good......

And what if he was forced to live in this intoxicated state, make decisions providing researching and effecting lives, what of the damage he would have done then?

Whatever "drove him" to do the shooting, clearly he was of sound mind to make a decision to do it, and plan it.

Isn't that called pre-meditated murder?

Are we going to open files of all murderers in prisons now to see if they were on Prozac or an SSRI?

I wish people would stop saying that those of us who query the role of antidepressants in an incident of this sort are blaming it ENTIRELY on the drug. That is ridiculous. We are not doing that. But yes, we certainly do want a lot more information about exactly how these drugs work and what they do to vulnerable individuals who may already be manic or even psychotic. Also can we please get it through our heads that a drug can be a "proximate" cause of an incident without being the SOLE cause of it? As for prisoners, there are in fact hundreds of people who are in prison, even for life, for acts they committed while under the influence of antidepressants and I for one believe that many of them never would have committed the act if they hadn't been on the drug. Furthermore those prisoners that are now off the drugs are in many cases fine, upstanding individuals who have no understanding of how they committed such acts of atrocity. Should they be there? I'm not going to say I have the answer but I certainly think it is up for debate. The whole issue of free will and psychotropic drugs is something I have wrestled with a lot. Did my daughter CHOOSE to die? I really do NOT think she did. Did Christopher Pittman CHOOSE to murder his grandparents? Did he have any control over it at all? I'm not really sure. And if one more person who claims Prozac has "saved their life" therefore thinks that someone else had control over what they did while they were on Prozac I think I'm going to puke. This is not a simple black and white, the drug did it, the drug didn't do it, scenario. Unless we understand more precisely exactly what these drugs are doing we are not going to be able to prevent more of these episodes that are escalating in numbers exponentially from recurring.

Can't believe we have another "Prozac Saved My Life" person commenting on this page. It is such an insult to all the dead & dying victims of Prozac and related SSRIs. Where is the respect?

Dr. Martin Teicher, a top-notch Harvard psychiatrist, testified at three murder trials back in 1991. He, under oath, testified that Prozac can cause a change of personality, that the person becomes more aggressive & then suddenly becomes violent. He testified that he had seen it himself while he was conducting clinical trials for Prozac. People who were not suicidal became, not just suicidal, but violently suicidal according to Dr. Martin Teicher.

Also, when Dr. Teicher tried to speak to the FDA in 1991 he was given six minutes and was not allowed to use his slide projector. The opponents were allowed all the time they wanted.

How many school shootings did we have before Prozac was marketed? SSRIstories.com now has 30 school shootings/incidents listed on their Website where antidepressants were involved. It is a crime against humanity and it is an inhuman crime against our children.

just as as fyi to newer readers, i post comments from all sides on these issues and well recognize that anti-deps have had very beneficial effects for some, mixed effects for many, and very very nasty outcomes for some. so i have no trouble posting comments that prozac sucks or prozac saved me.

Stephany, When your daughter jumped out of your moving vehicle, was she of sound mind and was this a planned out behavior on her part? Someone responding adversly to a medication is not of sound mind. And yes, someone should start looking into criminal backgrounds and see if there is a common demonator at work.

'I hope this does not turn into another bad rap for Prozac'

what an ignorant comment..How many more people have to die before the penny drops?
Weve had mass murder after mass murder, by people on or just off and so in withdrawal on these nasty drugs, which the medical profession continues to defend...for obvious fincial and legal reasons.

Its time they were banned, and the Lizzies of the world get better informed

Well, Philip, nice to see you are so equatable..However this is not marijauana! Its a set of drugs that have a reputation for turning mild people into mass murderers!
Even Michael Moore has come around to this view:
See the video here:
http://www.drugawareness.org/home.html

Jane, excuse me? never at one time have I written she jumped from my vehicle, and this is not a place to personally attack me, or for you to assume you know my life or my daughter's story, which is only in small bits in written form. Leave me alone.Thank you.

I have not spoken directly here toward a person , I asked a provocative question directed at no one.

"Can't believe we have another "Prozac Saved My Life" person commenting on this page. It is such an insult to all the dead & dying victims of Prozac and related SSRIs. Where is the respect?"

I've read and respected the personal stories of the many people who were seriously harmed by or died from use of and/or withdrawal from SSRI's. I would NEVER minimize, discount or disrespect the pain, hell, nightmares and suffering that such a person or their loved one has endured.

My own daughter has been helped and harmed by different meds and when she was on the wrong medication for her symptoms and brain chemistry, it was scary as hell --- for her and for me. When she was misdiagnosed or was given a medication that made her symptoms worse, I had to deal with getting her help, even when she raged and refused to go to the hospital. Her brief hospitalizations, controlled by the health insurer, were at best a band-aid approach. She was always discharged well before she was even close to being "stable." And when she was unstable and on the wrong meds, all reason, logic, intelligence, lucidity was gone. The person usually is unable to recognize their dire straits and then, on top of that, refuses help/treatment.

Yet millions of Americans have been taking anti-depressants and they have helped tremendously, Lizzie and myself included. My Mom and my 5 siblings also take medication for depression and anxiety that is extremely genetic in our family. We are all functional, caring human beings who are able to cope with our personal and professional challenges with the right anti-depressant/doseage and other cognitive/behavioral skills. We are teachers, librarians, horticulturalists, mothers, fathers; we are intelligent,compassionate, politically active and discerning. We did not hastily make the decision to take an SSRI and all of us would prefer to not be on any medications. I also take Aciphex for GERD and a tiny dose of Lipitor for slightly elevated lipids, knowing the risks and benefits. The quality of MY life is definitely better due to the benefits of the meds I take---and also, to my own willpower, attitude and healthy skepticism.

That being said, ALL medications---for cancer, heart disease, multiple sclerosis, rheumatoid arthritis, Parkinson's disease, etc come with risks, side effects and the potential for adverse and dangerous reactions. Starting a specific psychiatric drug, changing the dosage or discontinuing it should involve very careful and closely supervised monitoring by the MD prescribing the Rx, the patient and his/her family. SSRI's, mood stabilizers and anti-psychotics are powerful medications which can cause dangerous and deadly reactions, to the patient and/or to others.

Alas, this kind of tragedy adds to the stigma and fear re: mental illness.I've read everything in the newspapers and on-line re: Steven Kazmierczak, looking for some sort of explanation as to "why." Given the information that has been released to date, I agree with several comments posted here that while abrubtly stopping Prozac probably had something to do with his instability and actions, it is much more complex than that. The only thing that I'm certain of is the need for extreme vigilance on the part of the treating doctor, the patient and family/friends when psychiatric meds are started, changed or discontinued. In my own experience with my daughter, that rarely happened and we found ourselves in the ER way too often, scared shitless by what was happening as a result of a medication change.

So I have personally dealt with the benefits and dangers of psych meds. But I refuse to attack or belittle anybody's personal story/journey. I understand anger, betrayal and rage towards professional incompetence & misinformation and suppression of facts on the part of the drug companies. But I find comments such as "It's time they (AD's) were banned, and the Lizzies of the world get better informed" extreme, incendiary and deeply biased.

As usual, I appreciate Philip's forum and respect his efforts to ask questions, provide information and invite a healthy exchange of ideas and viewpoints.

'But I find comments such as "It's time they (AD's) were banned, and the Lizzies of the world get better informed" extreme, incendiary and deeply biased. '

The comment was not incendiary, extreme or deeply biased, other than against a set of drugs with a well deserveed nasty reputation for causing bizarre behavior, harm, homicide and suicide. Your attitude, Nancy, is that the benefits of ssris outweigh their 'risks. Not so
Until they are banned, expect more Steven Kazmierczaks to appear.

When the doc added Prozac to the mix I was on (I cannot remember what else he had me on at the time) I immediately felt very agitated & angry. I mentioned this to my doc & he wanted to add an antipsychotic. I told him he wasn't listening to me that this was the drug & I needed to be off of it. I remember sitting in the waiting room before my appointment listening to two women talk about their hair & I wanted to scream at them to shut up. It made absolutely not sense. I'm not that way AT ALL. I had to go stand outside because I felt like I was going to lose it and start screaming at people. Since my doc wasn't interested in stopping Prozac, I stopped it immeditely. Cold turkey. I'm not recommending people stop their meds cold turkey, but I will say in this one instance I did the right thing. I immediately felt better. The agitation disappeared as the drug disappeared. I guess my point is it's difficult to know what to do sometimes.

Has anyone here (currently on medication for depression) ever been tested for Celiac disease or genetic susceptibility for gluten sensitive enteropathy? I have found a correlation between gluten intolerance and pyroluria, a vitamin/mineral deficiency condition that causes depression and anxiety. Perhaps some are genetically susceptible to depression through a leaky gut, and no amount of medication will cure that if you are continually eating the food that is making you depressed. Just a thought. We are very quick to fix major health problems with drugs in this country. Maybe the underlying cause is in the food we eat, the first 'medicine' or 'toxin' we feed our bodies.

A new study was just released that connects major depression to leaky gut syndrome.... and gluten intolerance/celiac is known to cause leaky gut....
"The gut-brain barrier in major depression: Intestinal mucosal dysfunction with an increased translocation of LPS from gram negative
enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression."

Maes M, Kubera M, Leunis JC.

M-Care4U Outpatient Clinics, and the Clinical Research Center for Mental
Health, Belgium. crc.mh@telenet.be.

There is now evidence that major depression (MDD) is accompanied by an activation of the inflammatory response system (IRS) and that
pro-inflammatory cytokines and lipopolysacharide (LPS) may induce depressive symptoms. The aim of the present study was to examine whether
an increased gastrointestinal permeability with an increased translocation of LPS from gram negative bacteria may play a role in the pathophysiology of MDD. Toward this end, the present study examines the serum concentrations of IgM and IgA against LPS of the gram-negative enterobacteria, Hafnia Alvei, Pseudomonas Aeruginosa, Morganella
Morganii, Pseudomonas Putida, Citrobacter Koseri, and Klebsielle Pneumoniae in MDD patients and normal controls. We found that the prevalences and median values for serum IgM and IgA against LPS of
enterobacteria are significantly greater in patients with MDD than in normal volunteers. These differences are significant to the extent that
a significant diagnostic performance is obtained, i.e. the area under the ROC curve is 90.1%. The symptom profiles of increased IgM and IgA
levels are fatigue, autonomic and gastro-intestinal symptoms and a subjective feeling of infection. The results show that intestinal mucosal dysfunction characterized by an increased translocation of gram-negative bacteria (leaky gut) plays a role in the inflammatory
pathophysiology of depression. It is suggested that the increased LPS translocation may mount an immune response and thus IRS activation in
some patients with MDD and may induce specific "sickness behaviour" symptoms. It is suggested that patients with MDD should be checked for
leaky gut by means of the IgM and IgA panel used in the present study and accordingly should be treated for leaky gut.

PMID: 18283240 [PubMed - as supplied by publisher]

"Your attitude, Nancy, is that the benefits of ssris outweigh their 'risks. Not so
Until they are banned, expect more Steven Kazmierczaks to appear."

Brian, I know through personal experience with my daughter that use of SSRI's with an unidentified mood disorder can be extremely dangerous and even deadly, to the patient and others. I also know that SSRI's are alarming over-prescribed. Thus, the need for viligant monitoring, transparency of all the risks, adverse reactions and deadly dangers, more informed pdocs, etc, etc,

The complexities of a person's unique brain chemistry coupled with a whole host of environmental, family and other outside triggers make the use of SSRI's and other psych drugs very unpredictable. Still, I am extremely offended by your almost fascist stance to ban all the SSRI's from the market. That is an intolerable, blind & arrogant statement towards Lizzie, my sisters, mother, brother and me-----and thousands of others, who have benefited from SSRI meds. I have NEVER underestimated the risks ---- I witnessed horrific things took place when my daughter was on an SSRI w/o a mood stabilizer and I am still angry at doctors who dismissed my deep concerns that the AD was making her WORSE instead of better. So I have never stated that the benefits outweigh the risks. Every single case is different and being informed, skeptical, pro-active, assertive and trusting your gut are the best defense.

Nancy,

I have to wonder why you would not want a drug banned if, as you say, it's risks outweigh its benefits. I think these drugs should be left legal and treated as recreational. I think that anyone who wants a gun should be drug tested. If there are ssri's in their system they should not be allowed to have a gun. I also think that anyone discovered to have a gun should be drug tested and if it is determined that they are on ssri's, there should be some law in place to punish them, sort of like driving under the influence of alcohol. Of course, as I've stated before, I think that people on SSRI's should not be allowed to drive or to have custody of children.

Unfortunately, none of these reforms can be instituted until the public is made aware of the risks of these drugs and until we are certain no one is spreading the false information that the benefits of these drugs outweigh their risks. Once the public is educated, I do think SSRI use should remain legal, as they, like alcohol, and tobacco, do make life more pleasurable for some people. People who choose to take the drugs should agree and pay to be monitored for mood and thought disorders. No one should ever be forced to take these drugs and they should not be prescribed by doctors, but they should only be sold in doctors' offices and sold in conjunction with medical supervision.

But there's nothing fascist about recommending they be banned.

My 46 year old son has lived in my home for the last 10 years. Due to a horrendous auto accident in 1987 he has endured constant head pain. The accidnent caused three skull fracture plus 100 fracture of the bones in the front of his face. His skull was wired back into place. The constant pain in his head caused major depression so a Doctor prescribed Prozac.
Since taking the prozac he has had a complete change of personality, from being the most intelligent, caring, loving son a mother could ever hope for, into being the most heinous, filthy mouthed, hateful, scary, frieghtening human being I have ever encountered. It's like he is now two entirely differnt people with greater depression than ever with constant suicidal ideation
My son's behavior finally became so frightening I went to the Salem Psychiatric Crisis Center seeking help for him. I was referred to the Salem Police Department where they issued a Restraining Order on him.
Instead of getting any kind of medical help for my son,although my son has never laid a finger on me. the Polk County Sheriff's office wants to put him in jail for his abusive verbal behavior toward me.
My son should not go to jail because his brain has been altered by a prescription drug. It would be more appropriate for the Doctor who gave the suicidal/murderous prescription to go to jail.
Since I was aware of the murderous side effects of Prozac before my son started taking the drug I warned him about it and he assured me he would stop taking it if he noticed the side effects. Apparently Prozac totally destroys judgement and is so addictive that my son continues to feel he needs it.