before everyone rolls their eyes and thinks "Here we go again,"
This is a very important issue and it's a shame that the discussions are still the same: "Yes, ADs cause violent behavior." "No, they don't cause violent behavior."
I surrender. For the moment all the people claiming what SSRIs/SNRIs have caused is useless.
I agree:
These are wonder drugs that help millions of people and same lunatics claim the opposite because they cannot take responsibility for their actions or because they are delusional.
Increasing the dose helps them came to their senses.

I don't get it, the ideas of a chemical reactions in a human being brain. If you or I drink (excessive) alcohol, and crash a car, the alcohol was a factor. A junky taking crack or whatever drug who then robs a store under the influence of illegal drug is thought to be drug addled. But someone on legal drugs is not affected by chemical molecules the same way, because it is prescribed and medicinal. RIGHT. Not.

tight post Philip.

Sick, isn't it? The poor kid is being abused big time by his dad in one way or another; the mother is probably a bitch and they give the kid Prozac for "brain disease." Just who should have been "treated" in this scenario? Not the kid IMHO. Then they don't recognize the akathisia for what it potentially is and bingo someone's dead in no time. A ten year old committing murder. A ten year old being given what was undoubtedly an adult dose of Prozac. A ten year old's life ruined whatever happens. It's criminal.

This is rather puzzling, actually. The claim is that the unmedicated behaviors and thoughts are due to a chemical imbalance thus should be treated medically. However, if there are other difficulties after beginning psychotropic medications, those are due to being a bad person or external circumstances rather than biochemistry. It seems existing chemistry is the root of all problems but artificially changed chemistry cannot cause other/different problems. Anyone else see an error of logic??

"It seems existing chemistry is the root of all problems but artificially changed chemistry cannot cause other/different problems. Anyone else see an error of logic??"

Yes. Withdrawing patients from the drugs also has no apparent impact. Weird how that works, isn't it?

Brynhilde:

Who says that psychotropic medications "cannot cause other/different problems"? Please, find me one clinician or researcher who says that the problems that occur following psychotropic medication initiation are because someone is a "bad person". Please, just one example.

No-one doubts whether psychotropic medications have significant side effects that must be taken into consideration in a risk-benefit analysis involving the patient. The issue is not whether these adverse effects occur, but rather: (a) what are their frequency, (b) which are due to the medication, and (c) which are due to chance? After all, adverse effects are reported even in the placebo arm of controlled studies!

With regards to the case above, the murder had a multifactorial origin that included a dysfunctional family environment, and a possible history of sexual molestation. Yes, the chronology seems to imply that the Prozac may have been the tipping point, and that may be true. However, there are too many confounding factors to take into consideration, and so we will never really know whether any specific factor was definitive.

Yes brunhilde I was thinking about that all day yesterday but nowhere near as coherently as you put it. It seems we accept that psychotropics have the "cosmetic" outcome in creating shiny, happy people but no such thing as plastic surgery disasters?

I am not anti-med. After a dozen drug trials it worked out for me personally, anti-depressants were remarkably transformative mood elevators and fixed my whole personality, itself the cause of great celebration in my mental health treatment. Why is it so hard to accept that the same drugs can just as well go the other way and lead to remarkably nightmarish outcomes? To deny that is ridiculous.

Sara, I completely agree with you (all of it, but I would add one more thing:

The psychiatrist was negligent for not recognizing the abuse and doing something rational to ameliorate its effects or stop it.

It was the same case with poor Rebecca Riley. The psychiatrist was negligent in her diagnosis and ignoring the multiple CPS investigations initiated by the state. I could also easily guess both the mother and the father have severe personality problems, and were allegedly abusive.

No one in the media framed it that way unfortunately. Of course the drugs are dangerous for a 2 year old, and the psychiatrist is a typical psychiatrist-sophist-shill regarding all aspects of her care, but she was also negligent in not adressing the ongoing abuse. According to the Boston Globe, by the way, the medical examiner's report stated that she had organ damage due to the chronic admistartion of the multiple drugs she was taking. Imagine that. Two! It's hard to think about her this Christmas Season -- and simultaneously of Biederman and the psychiatric establishment, lining their soft pockets full of cash, like white middle age, bullys on the playground.

This poor kid. 10? He's gonna have to live with this shitstorm that has been foisted on him for the rest of his life.

My point is, if the psychiatrist did nothing to adress or ameliorate the ongoing suspected abuse in this case and instead noted symptoms of an unbearable situation and decided to throw prozac at it -- then he was negligent. Let's try to focus on that part for a moment. Forget the medications. That's one part. But this same situation played out in Rebecca Riley's media coverage and went unduly noted. Also, it's worth noting that this "negligent" care is probably standard among the majority of psychiatrists.

Could you imagine your psychiatrist doing anything else?

You are so right JC. I guess I meant that to be understood -- that the psychiatrist was negligent in not recommending that the whole family system needed some serious attention. In Rebecca Riley's case it was probably seriously confounded by the fact both her parents were medicated, seemed to rely on medication to address every problem they ever had and to know no other way of addressing problems. I am sure that they were throwing drugs at their child probably even more than the complicit psychiatrist whom they had on board egging them on recommended.

Has anyone even bothered to research this case? The mother fabricated the charges and convinced her son to kill his dad, it is an interesting case. Check out the 48 hours or Dateline episode of this case, pretty scary. Last I heard they were trying to bring charges against the mom. Apparently after the son shot his dad, he gave the ok sign to his mom. The younger brother witnessed all, and was removed from the custody of his mother, and placed in the grandparents custody(the dead father's parents). So I don't think the prozac had anything to do with this, this was a very bitter and angry mother.

Philip Dawdy responds: interesting points, but look whose version of events, evidence the appeals court believes.

Stacey, I read more and I thank you for drawing our attention to the additional information. I agree that the mother does sound deranged. How very tragic for this young boy. I can still see how the Prozac played into this whole situation which was just waiting to explode.

I'm confused - the last I read on this was about how the boy was improperly interrogated, and was basically coerced into saying he killed his father. He did not have an advocate with him, or a lawyer when he "confessed". I am not entirely convinced this boy did it, regardless of what drugs he was taking for whatever condition they're trying to label him with.

And in most cases, if Prozac does not work in young people, aren't they more prone to suicide than homicide?

As a psychiatrist I have been weighing in on these matters on the Internet for more than 2 years, and I continue to appreciate, Philip, your candid and fresh summaries of these matters - glad you are still up and running.

There is no doubt that Prozac can significantly contribute to impulsive deterioration. I've seen such regressions in my own practice even asking all the 'right questions.' I do hesitate, in all fairness, to identify Prozac itself as primarily causal for the armed attack, when unidentified comorbid conditions may have been the pre-existing underlying actual/primary cause for this tragedy.

All antidepressants can dysregulate/down-regulate dopamine, the main neurotransmitter for the best function of the pre-frontal cortex. Dopamine down regulated regularly, very often, interferes with good judgment and 'executive function.'

This early note from one of my first posts [with many on this theme to follow as time has passed] highlights one of the most overlooked problems in my office, the challenge of identifying comorbid conditions with the depression at the outset with anyone, child or adult. In this post I briefly discuss comorbid ADD, but in many others have covered a variety of comorbid conditions which encourage 'acting out' with antidepressants - from anger to suicide to a variety of impulsive activities. See here and Google at CorePsychBlog for much more on the topic if misidentified depression, drug interactions, and the danger of missing comorbid diagnoses:

http://www.corepsychblog.com/2006/12/kids_and_antide.html

These notes here at Furious Seasons, and the subsequent comments characterize much of the current problem with psychiatry, that many who practice psychiatry already appreciate. The current nomenclature system is woefully inadequate.

The Diagnostic Manuel -DSM 4- looks at descriptive phenomenon, but does not deal effectively with underlying function. It's like treating the shirt, but not treating the person.

The public is angry with psychiatry and with pharmaceutical companies, with some good cause: both continue to use descriptive terminology to asses efficacy of medical intervention.

To paraphrase Taleb in "The Black Swan" we are shooting arrows at averages [the Gaussian Curve], not at precise people, at precise brain function events, and therein are the roots of any ongoing mistakes. We are treating biology, agreed upon biologic conditions seen on scans and measurement of neurotransmitter function, with phenomenology. Absurd, yes, but undeniably true.

This is the conundrum that makes no sense.

Said another way: the science of psychiatry is running on post-Freudian constructs that encourage researchers and practitioners alike to chase the Narrative Fallacy that 'description' alone will provide sufficient information for adequate treatment.

http://www.corepsychblog.com/2007/08/the-black-swan-.html

This hindsight bias, leaves us with categorical, reductionistic thinking: antidepressants correct depression. Yes, that statement is true, but what if that boy suffered with more than depression, is it absolutely true then? Likely not.

Thanks Philip for your valued efforts at enlarging the dialog,

These next years will mark a turn in these matters if we all continue to report on the undeniable complexity of the human mind, and then go measure it with the very best tools,

From both the top and the periphery of the Gaussian curve,
Chuck

The ruling you link to does include a number of interesting details, not the least of which is that the father had been treated for "intermittent explosive disorder" and had stopped taking his medication. One wonders if the mother was on something too because I think if one did a survey one would find that most parents who rush to medicate their kids at these young ages are also on the meds themselves. If the father had a history of stopping and starting psych drugs he could definitely have been a victim, not just of "relapse" but more importantly "rebound" -- some severe withdrawal and exacerbation of manic and psychotic behavior. I just raise this because in many of the horror stories that are now in the media, such as the My Space suicide, many of the players are "medicated," not just the victim or perpetrator, and there is a synergistic effect between all the medicated and blunted and impaired people involved. It really leads to some very explosive and dangerous situations.

Sorry you bloodthirsty people. I'm a firm believer in NO PROZAC especially to children. I've seen what it does to people first hand and the side effects on a normal brain are off the charts. I had a babysitter that forgot her meds for a couple of days because she thought she was feeling fine and didn't need them but then she wanted to kill herself almost immediately.

I'm appalled that parents have these drugs prescribed to their children. My son is now a teenager and two of his friends take an anti-depressant. I'm shocked at how readily doctors and parents hand these out to our youth as a means of fixing what mother nature can do by herself.

No problems loom over our heads to where we need these kinds of drugs. I see them as a nightmare waiting to happen.

This boy who killed his father was a direct result of negligence by our "system". Shame on us to let that child down.

Someone needs to study the case, rather than pick on a favorite whipping boy -- Prozac.

This is the son of a very disturbed woman who falsely accused (according to prosecutors) her ex-husband of child abuse, poisoned the son's mind against his father, left a loaded 40 cal weapon in the house, and failed to come to the aid of the dying man.

Their may be cases of fluoxetine causing serious side effects. Trying to implicate the drug in the bizarre case involving severe personality disorders strains common-sense logic and loses credibility.

Jess, the woman was undoubtedly on Prozac too. Few mothers put their ten year olds on it if they aren't already on it themselves. Prozac can still have a big role to play even when severe emotional disturbances are at play -- even more so, in fact. Let's not just brush the role of antidepressants under the rug just because there is a lot of evidence of dysfunction. All the more reason to understand even more carefully exactly how these drugs cause violence and bizarre behavior, emotional blunting and dissociation.