As the debate moves forward about how to keep events like the shooting in Newtown from happening, the inevitable topic that comes up is how to best detect and treat young people with mental illness.
Many of our politicians have opined on this subject, sometimes as a way of deflecting from the issue of gun control. While it is obvious that better screening and treatment of troubled adolescents can be of enormous benefit, we also have to exercise caution.
The reason for the note of caution is that when a typical young person is diagnosed with depression and/or a host of anti-social conditions, the standard treatment offered is SSRI’s [Selective Serotonin Uptake Inhibitors] also known as Prozac-like drugs. There has recently been a great deal of debate about the effectiveness of such medications.
But more relevant to the discussion, is that these very drugs we hope can treat mental illness are at the same time drugs that cause violent behavior including suicide and aggression toward others. In fact, SSRI’s are the leading drugs in a recent list compiled of the Top Ten Drugs that cause violent behavior.
It’s been well known that adolescents and young people have an increased risk of suicide when they begin to take SSRIs. But what we may forget is that suicide is an impulsive behavior that is turned against oneself. But impulses, particularly violent ones, can be turned against others.
An accompanying effect of SSRI’s is the dulling of feelings that cause depression—and one of the main feelings in this line is empathy. If empathy is dulled and violent impulses increase when young people are on SSRI’s, then certainly that is a recipe for causing harm to others.
It’s not that SSRI’s are not an important part of a mental-health practitioner’s arsenal against mental illness—they are. But it is important to understand that they are not panaceas and may even contribute to more violence.
It is possible that the SSRI’s were not properly prescribed and therefore were not working. But we also have to entertain the idea that those drugs may have directly or indirectly contributed to the violence that resulted.
After all, drugs are drugs—with effects and side effects. We need to know more about how these drugs work before we decide that the best policy is to get as many trouble adolescents on them as possible. The physician’s motto: “Do no harm” is more relevant than ever in this scenario.