Many people believe there's so much danger of psychiatric medications causing violent behavior that these drugs should be banned. A huge 2011 study found that there is indeed a connection between some of these drugs and violence.
However, does the study provide evidence that there's enough reason to ban selective serotonin reuptake inhibitor (SSRI) antidepressants (the class of drugs most targeted by groups opposed to psychiatric drugs) or any others based on incidence of violent acts? The answer is no.
Facts and Figures Regarding Drugs and Violence
In the study, called "Prescription Drugs Associated with Reports of Violence Towards Others," researchers reviewed five years worth of reporting data. First they selected drugs that had 200 or more "serious adverse events" reported. These events included:
Death
Disability
Hospitalization
Life-threatening events
Events requiring medical intervention to prevent harm
Other serious medical conditions
Violence events
At this stage they had found 484 drugs that fit the above criteria. Among those drugs there were reports of 1,937 cases of violence toward others in these categories:
387 homicides
404 physical assaults
27 physical abuse
896 homicidal ideation (envisioning killing someone - compare suicidal ideation)
223 violence-related symptoms
Violence cases accounted for 0.25% of all adverse events - meaning that 99.75% of the total number of serious issues fell into the other categories. Seventy-nine percent, or 1,530, of those violent incidents were linked to 31 specific drugs, meaning that those particular drugs had the highest likelihood of being associated with violence.
The data came from the U.S. Food and Drug Administration's database that tracks reports of all serious problems with prescription drugs. It doesn't include any minor side effects or figures on how many people take a particular drug and have no side effects.
Much has been made out of the numbers the researchers came up with - but in more than one way, these numbers are misleading. Let's use the highest-scoring drug on the list, Chantix, as an example. Buy Xanax/Alprazolam (5mg, 10mg) online at extremely low price.
Chantix/Varenicline: No. 1 on the List
The anti-smoking drug Chantix was found to account for the highest percentage of violence reports out of all the serious adverse events reported. By a complex series of calculations, the researchers found that Chantix is, in fact, 18 times more likely to be connected with violence as all the rest of the 484 drugs that were included in the study. BUT - out of all those adverse events reported for Chantix, the violent events accounted for just 2.62%. And remember, this is still only the proportion of violent events to other serious events. It doesn't take into account all the people using Chantix who have minor or no side effects.
Still, and for good reason, Chantix does bear a strong warning about the danger of serious or worsening psychiatric symptoms with its use. It should also be noted that those who already have a psychiatric disorder are at increased risk.
Antidepressants
Eleven antidepressants were included in the list. Of the SSRIs, Prozac was found to be 10.9 times more likely than all the other drugs in the study to be associated with violent behavior. Here's a list of how the SSRIs scored:
Prozac (fluoxetine) - 10.9 times
Paxil (paroxetine) - 10.3
Luvox (fluvoxamine) - 8.4
Zoloft (sertraline) - 6.7
Lexapro (escitalopram) - 5.0
Celexa (citalopram) - 4.3
As with Chantix, though, these figures don't tell the whole story. Prozac's score of 10.9 has nothing to do with the number of violent events occurring in all patients taking Prozac.
Making Sense of the Drug Violence Score Figures
Simply put, you can't really get a good idea of what the figures mean without knowing how many people are taking a particular drug in the study. So let's take a fictional drug called Petricox, which has the same figures making up the 10.9 score as Prozac. In the United States, 12 million people take Petricox. This works out to about one in 1,000 people taking Petricox who have any of the serious problems listed above, and about six out every million people whose serious problem was violence. That's a pretty low percentage overall.
Now, this is not to say that the figures mean nothing. They do. It's true that a small group of 31 drugs accounts for most of the cases of violence reported, and 21 of those drugs are commonly prescribed for psychiatric illnesses such as bipolar disorder, depression and schizophrenia. Out of the 484 drugs that qualified for the study, the serious events reported for those 31 were anywhere from two to 18 times more likely to be violent than for all the other drugs put together.
But there are a couple of issues with these results. First, as I mentioned, they don't give any indication of how many people, out of all those taking a given drug, are likely to become violent. And second, although there are no conflicts of interest in funding the study, all the researchers themselves have in the past received money from litigators in trials where the defendants claimed prescription drugs affected their violent behavior. Whether this affected the design of the study itself is unknown but possible. I am not making accusations, merely pointing out the potential for bias.
What it boils down to at this point is - if you are taking Chantix or any psychiatric medication, including medications for attention deficit hyperactivity disorder (ADHD), tell your doctor about any unusual hostile or violent thoughts or actions before they become serious. If you care for someone on such a drug, take any negative changes in behavior seriously.
The 31 drugs that were scored in the study are listed in the table on Page 2. Some other antidepressants were excluded because there were not enough data. Of the drugs used as mood stabilizers, the two drugs that scored high enough to be included are used off-label for bipolar disorder and much more often for other conditions.
On Page 1 of this article we discussed the study "Prescription Drugs Associated with Reports of Violence Towards Others," which looks at prescription medications and their association with violent behavior. Of 484 drugs where violent behavior was reported, 31 of those accounted for 79% of the violent events. The table below lists the drugs found by the study to have an increased risk of violent behavior. See Page 1 of this article for discussion of the results. More information is available at PanicAnxietyDisorders.com
It is my opinion that except for the highest-listed medication, the anti-smoking drug Chantix, none of these medications needs to be avoided by those with psychiatric illnesses just because they appear in the table.
The study authors noted: "The aggression/violence case series for varenicline [Chantix] ... revealed other features that may or may not occur in cases attributed to other drugs. These features include early onset of psychiatric symptoms (usually within a few days), a senseless act of aggression/violence directed at anyone who happened to be nearby, and resolution of the symptoms upon discontinuation."
Because of this, Chantix should only be used under the close supervision of your psychiatrist.
However, does the study provide evidence that there's enough reason to ban selective serotonin reuptake inhibitor (SSRI) antidepressants (the class of drugs most targeted by groups opposed to psychiatric drugs) or any others based on incidence of violent acts? The answer is no.
Facts and Figures Regarding Drugs and Violence
In the study, called "Prescription Drugs Associated with Reports of Violence Towards Others," researchers reviewed five years worth of reporting data. First they selected drugs that had 200 or more "serious adverse events" reported. These events included:
Death
Disability
Hospitalization
Life-threatening events
Events requiring medical intervention to prevent harm
Other serious medical conditions
Violence events
At this stage they had found 484 drugs that fit the above criteria. Among those drugs there were reports of 1,937 cases of violence toward others in these categories:
387 homicides
404 physical assaults
27 physical abuse
896 homicidal ideation (envisioning killing someone - compare suicidal ideation)
223 violence-related symptoms
Violence cases accounted for 0.25% of all adverse events - meaning that 99.75% of the total number of serious issues fell into the other categories. Seventy-nine percent, or 1,530, of those violent incidents were linked to 31 specific drugs, meaning that those particular drugs had the highest likelihood of being associated with violence.
The data came from the U.S. Food and Drug Administration's database that tracks reports of all serious problems with prescription drugs. It doesn't include any minor side effects or figures on how many people take a particular drug and have no side effects.
Much has been made out of the numbers the researchers came up with - but in more than one way, these numbers are misleading. Let's use the highest-scoring drug on the list, Chantix, as an example. Buy Xanax/Alprazolam (5mg, 10mg) online at extremely low price.
Chantix/Varenicline: No. 1 on the List
The anti-smoking drug Chantix was found to account for the highest percentage of violence reports out of all the serious adverse events reported. By a complex series of calculations, the researchers found that Chantix is, in fact, 18 times more likely to be connected with violence as all the rest of the 484 drugs that were included in the study. BUT - out of all those adverse events reported for Chantix, the violent events accounted for just 2.62%. And remember, this is still only the proportion of violent events to other serious events. It doesn't take into account all the people using Chantix who have minor or no side effects.
Still, and for good reason, Chantix does bear a strong warning about the danger of serious or worsening psychiatric symptoms with its use. It should also be noted that those who already have a psychiatric disorder are at increased risk.
Antidepressants
Eleven antidepressants were included in the list. Of the SSRIs, Prozac was found to be 10.9 times more likely than all the other drugs in the study to be associated with violent behavior. Here's a list of how the SSRIs scored:
Prozac (fluoxetine) - 10.9 times
Paxil (paroxetine) - 10.3
Luvox (fluvoxamine) - 8.4
Zoloft (sertraline) - 6.7
Lexapro (escitalopram) - 5.0
Celexa (citalopram) - 4.3
As with Chantix, though, these figures don't tell the whole story. Prozac's score of 10.9 has nothing to do with the number of violent events occurring in all patients taking Prozac.
Making Sense of the Drug Violence Score Figures
Simply put, you can't really get a good idea of what the figures mean without knowing how many people are taking a particular drug in the study. So let's take a fictional drug called Petricox, which has the same figures making up the 10.9 score as Prozac. In the United States, 12 million people take Petricox. This works out to about one in 1,000 people taking Petricox who have any of the serious problems listed above, and about six out every million people whose serious problem was violence. That's a pretty low percentage overall.
Now, this is not to say that the figures mean nothing. They do. It's true that a small group of 31 drugs accounts for most of the cases of violence reported, and 21 of those drugs are commonly prescribed for psychiatric illnesses such as bipolar disorder, depression and schizophrenia. Out of the 484 drugs that qualified for the study, the serious events reported for those 31 were anywhere from two to 18 times more likely to be violent than for all the other drugs put together.
But there are a couple of issues with these results. First, as I mentioned, they don't give any indication of how many people, out of all those taking a given drug, are likely to become violent. And second, although there are no conflicts of interest in funding the study, all the researchers themselves have in the past received money from litigators in trials where the defendants claimed prescription drugs affected their violent behavior. Whether this affected the design of the study itself is unknown but possible. I am not making accusations, merely pointing out the potential for bias.
What it boils down to at this point is - if you are taking Chantix or any psychiatric medication, including medications for attention deficit hyperactivity disorder (ADHD), tell your doctor about any unusual hostile or violent thoughts or actions before they become serious. If you care for someone on such a drug, take any negative changes in behavior seriously.
The 31 drugs that were scored in the study are listed in the table on Page 2. Some other antidepressants were excluded because there were not enough data. Of the drugs used as mood stabilizers, the two drugs that scored high enough to be included are used off-label for bipolar disorder and much more often for other conditions.
On Page 1 of this article we discussed the study "Prescription Drugs Associated with Reports of Violence Towards Others," which looks at prescription medications and their association with violent behavior. Of 484 drugs where violent behavior was reported, 31 of those accounted for 79% of the violent events. The table below lists the drugs found by the study to have an increased risk of violent behavior. See Page 1 of this article for discussion of the results. More information is available at PanicAnxietyDisorders.com
It is my opinion that except for the highest-listed medication, the anti-smoking drug Chantix, none of these medications needs to be avoided by those with psychiatric illnesses just because they appear in the table.
The study authors noted: "The aggression/violence case series for varenicline [Chantix] ... revealed other features that may or may not occur in cases attributed to other drugs. These features include early onset of psychiatric symptoms (usually within a few days), a senseless act of aggression/violence directed at anyone who happened to be nearby, and resolution of the symptoms upon discontinuation."
Because of this, Chantix should only be used under the close supervision of your psychiatrist.
No comments:
Post a Comment