Pre­scrip­tion for vi­o­lence

An­tide­pres­sants make some young peo­ple more likely to com­mit crime: Swedish study

SundayXtra - - ONCE OVER - By Karen Ka­plan

RE­SEARCHERS have iden­ti­fied a trou­bling side­ef­fect of a widely pre­scribed class of an­tide­pres­sants — they may make some pa­tients more likely to com­mit vi­o­lent crime.

Data from Swe­den show young adults be­tween the ages of 15 and 24 who had filled pre­scrip­tions for the drugs were more likely to be con­victed of a homi­cide, as­sault, rob­bery, ar­son, kid­nap­ping, sex­ual of­fence or other vi­o­lent crime when they were tak­ing the med­i­ca­tions than when they weren’t. The re­searchers found no link be­tween an­tide­pres­sant use and crim­i­nal ac­tiv­ity for older pa­tients.

The find­ings, pub­lished in the jour­nal PLOS Medicine, build on other ev­i­dence the an­tide­pres­sants — known as se­lec­tive sero­tonin re­up­take in­hibitors, or SSRIs — work dif­fer­ently in the brains of ado­les­cents and adults. For ex­am­ple, sev­eral stud­ies have shown the drugs in­crease the risk of sui­ci­dal thoughts in chil­dren, teens and young adults, but not in older adults.

The link be­tween SSRIs and crime is less clear. One anal­y­sis of trends in the U.S. found the “great Amer­i­can crime de­cline” that be­gan in the 1990s co­in­cided with the emer­gence of SSRIs, in­clud­ing Prozac, Celexa, Paxil and Zoloft. But re­views of safety data sub­mit­ted to the U.S. Food and Drug Ad­min­is­tra­tion have found SSRI use was as­so­ci­ated with an in­creased risk of vi­o­lent be­hav­iour.

SSRIs help cells in the brain com­mu­ni­cate with one another by mak­ing bet­ter use of a chem­i­cal called sero­tonin. This chem­i­cal is nec­es­sary for send­ing a mes­sage from one brain cell to another. Sci­en­tists be­lieve with more avail­able sero­tonin, the brain cir­cuits that con­trol mood stand a bet­ter chance of func­tion­ing prop­erly.

To get a clearer pic­ture of the po­ten­tial risks as­so­ci­ated with SSRIs, re­searchers from the Karolin­ska In­sti­tute in Stock­holm and the Univer­sity of Ox­ford in Eng­land turned to na­tional data from Swe­den, where the gov­ern­ment keeps track of pre­scrip­tions that are filled as well as crim­i­nal con­vic­tions.

In Swe­den, the jus­tice sys­tem treats peo­ple as adults once they turn 15. So the re­searchers ex­am­ined records for nearly eight mil­lion Swedes who were at least 15 years old in 2006. They found more than 850,000 of them had been pre­scribed an SSRI be­tween 2006 and 2009. That amounted to 14.1 per cent of all Swedish women and 7.5 per cent of all Swedish men.

Among all of the peo­ple who got pre­scrip­tions for SSRIs, one per cent were con­victed of com­mit­ting some type of vi­o­lent crime be­tween 2006 and 2009. The re­searchers fo­cused on these 8,377 peo­ple and com­pared their crim­i­nal ac­tiv­ity when they had an SSRI pre­scrip­tion to the pe­ri­ods when they did not.

The ini­tial anal­y­sis found the risk of a vi­o­lent crime con­vic­tion was 19 per cent higher when peo­ple were tak­ing the an­tide­pres­sants than when they weren’t. The in­crease in risk was es­sen­tially the same when the re­searchers fac­tored in the in­flu­ence of other psy­chotropic drugs.

When they broke down the num­bers ac­cord­ing to age, they found the risk was con­cen­trated among the youngest group of peo­ple. For adults be­tween the ages of 15 and 24, the risk of be­ing con­victed of a vi­o­lent crime was 43 per cent greater when they were tak­ing an SSRI than when they weren’t.

Then the re­searchers con­sid­ered the men in this age group sep­a­rately from the women. Among men, tak­ing SSRIs was linked with a 40 per cent in­creased risk of be­ing con­victed of a vi­o­lent crime; among women, the risk in­creased by 75 per cent, the study states.

The study doesn’t prove the SSRIs were re­spon­si­ble for the ob­served in­crease in crim­i­nal vi­o­lence among teens and young adults, the re­searchers said. How­ever, it does add to ev­i­dence “the ado­les­cent brain may be par­tic­u­larly sen­si­tive to phar­ma­co­log­i­cal in­ter­fer­ence,” they wrote.

Even if it turns out the an­tide­pres­sants do make young peo­ple more likely to com­mit vi­o­lent crimes, does that mean doc­tors should stop pre­scrib­ing them? The an­swer is not ob­vi­ous, the re­searchers wrote. Di­al­ing back on SSRIs may cause vi­o­lence to go down, but then sui­cides may go up.

“From a public health per­spec­tive,” they wrote, it may be bet­ter to keep on us­ing the drugs “as long as po­ten­tial risks are dis­closed.”


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