Homicidal Ideation Causally Related to Therapeutic Medications

Homicidal Ideation Causally Related to Therapeutic Medications

https://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs447

Ethical Human Psychology and Psychiatry, Volume 10, Number 3, 2008

Donald H. Marks, MD, PhD Cooper Green Mercy Hospital, Birmingham, AL Wallace Kettering Neuroscience Institute, Kettering, OH

Peter R. Breggin, MD Ithaca, New York

Derek Braslow, Esq Pogust, Braslow & Millrood, LLC Conshohocken, PA

Five patients with hepatitis C (HCV), three of whom were treated with peginterferon alfa-2 (IFN) and two who were not treated with IFN, developed homicidal ideation (HI) during a 4-year period. Following accepted rules for determining causation, there appeared to be a causal relatedness between IFN use and the development of homicidal ideation for those patients taking IFN. None of these patients attempted a homicidal act while on treatment with IFN, nor in the follow-up period after treatment. The incidence of HI while treated with IFN in our patient population is estimated to be less than 1%. The abil- ity of prescription medication to cause homicidal ideation is reviewed, and legal implica- tions are discussed.

Keywords: homicide; murder; violence; adverse effect; interferon T

he (Brunton, ple, ability medications of Lazo, medications & designed Lazo, to 2005). to affect treat In the seizures, some central cases, depression, nervous the effects system or Alzheimer’s are (CNS) desired—for is well disease. known exam- In other cases, the effects are unwanted—for example, decreased coordination and problems when operating machinery when taking anxiolytics. Recently, there has been an increased awareness of the ability of antidepressant medications to cause a paradoxical increase in depression and, in some cases, suicidal ideation (SI) (Breggin, 2003, 2008; Food and Drug Administration, 2005a; Healey, Herxheimer, & Menkes, 2006; Khan, 2002; Marks, 2004). The clinical pharmacology and mechanism of the later effect may be related to the known ability of medications in the SSRI class to cause or exacerbate levels of anxiety, agitation, irritability, akathisia, aggression, hostility, emotional blunting, and disinhibition. Clini- cally all of these phenomena have been associated with violence. It is reasonable from a psychological perspective to understand how a medication that can induce or increase feel- ings of anxiety, agitation, akathisia, aggression, hostility, irritability, and/or disinhibition could lead toward self-directed or outwardly directed violence in a predisposed individual. In at least one product liability case ( Tobin v. SmithKline Beecham, 164 F. Supp.2d 1278

134 © 2008 Springer Publishing Company DOI: 10.1891/1559-4343.10.3.134