Antidepressants and Mass Killings

"I can’t really see a plausible explanation for Lubitz’s ‘kamikaze’ act other than drugs like antidepressants" Psychiatrist David Healy about the involvement of those drugs in rampages

On March 24, 2015, Germanwings co-pilot Andreas Günter Lubitz according to the investigations on his amok flight 4U9525 he crashed the Airbus A320 intentionally against a mountain - an insane act that especially for the victims but also for the relatives was a horror of unimaginable proportions.

Five months later, in the German small town Haltern am See a memorial has been consecrated at the local cemetary a memorial in the presence of the dependants of the deceased.

With this, an important foundation of the mourning has been layed, but in order that the world in future is going to be spared as possible from these kind of catastrophes it would be crucial to determine the underlying cause(s). The renowned psychiatrist David Healy outlines in this interview why medication such as antidepressants can play a decisive role in rampages such as the one of Lubitz or the one of "Batman" shooter James Holmes who has been sentenced to life imprisonment recently in the States.

In this context the German Society of Psychiatry, Psychosomatics and Neurology (DGPPN) says upon request that "the DGPPN has a high interest in an investigation of the Germanwings crash in which the medication aspects are going to be examined as well."1

"It is almost certain that in some mass killings these drugs in fact do play a part."

Dear Mr. Healy, what did you first think and feel when you heard about the "kamikaze" act of Germanwings co-pilot Andreas Lubitz on March 24 this year that led to the death of all 150 plane occupants?

David Healy: First of all, I was very sad and felt great compassion for the dead and their families. And once it became clear that this was a "kamikaze" act, my first thoughts, as I am sure the first thoughts of many were, was to wonder whether an antidepressant or other psychotropic drug would be involved. Shortly after Lubitz has run amok I have written down some thoughts concerning this matter in my article "Winging it: Antidepressants and Plane Crashes" published on my blog under Davidhealy.org.

Which are your most important arguments for your thesis that antidepressants or drugs with similar side effects may be the main cause for Lubitz’s insane act?

David Healy: Without knowing exactly what Andreas Lubitz was taking and also what his clinical state was in the week or two leading up to the crash, it is difficult to be certain that the drugs he may have been on actually did cause the problem.

But it is clear that drugs like the ones he appears to have been taking can cause people to become homicidal and violent and to contemplate mass killing and there have been so many of these episodes of mass killing in people who have been taking psychotropic drugs of this kind that it is almost certain that in some mass killings these drugs in fact do play a part.

Can you substantiate it with scientific evidence or studies?

David Healy: The FDA has a considerable body of data on the capacity of antidepressants to cause violence. The Canadian regulators, for example, included violence in their warnings for suicide and related behaviors.2 And in 2006, with colleagues I published on just this issue giving controlled trial data on the capacity of antidepressants called Selective Serotonin Re-uptake Inhibitors, in short SSRIs, to cause violence.

In 2013, I have published on my website a list of dozens of drugs that can trigger and cause suicide or homicide, from the most popular antidepressants and antipsychotics via benzodiazepines such as Valium and anti-smoking and anti-asthma drugs and antihistamines through to stimulants such as Ritalin.

Are these drugs listed as a matter of personal judgement?

David Healy: No. They are either drugs that companies are obliged to state can cause suicide or for which there is convincing evidence that they have in fact caused suicide. There are likely many more drugs that some government officials and company personnel know cause suicide but about which they keep quiet.

How common is violence as a side effect of SSRI-antidepressants?

David Healy: It is more or less the same as for suicidality: Up to 1 in 10 may have suicidal thoughts and up to 1 in 20 have violent thoughts they would not have had if they had not been taking an antidepressant. But the rate of completed suicide and violent acts is much lower - 1 in 500 or more.

In June, Brice Robin, the state’s attorney from Marseille, reported that Lubitz in the weeks before the crash was under the influence of an overmedication of anti-anxiety drugs, Valium and other psychotropic drugs and, concretely, that he was taking Mirtazapine, an antidepressant, and had even doubled the dosage from 15 to 30 milligrams.

But in the product description of Mirtazapine it says "short term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond the age of 24 years", and Lubitz was 27 when doing his "kamikaze" crash.

David Healy: There is convincing evidence that Mirtazapine increases the risk of suicidality in clinical trials, compared to Placebo. This is not age-specific evidence, it is across-the-board evidence with the date for people in their 40s, 50s and early 60s, for instance, looking identical to the data in under 25s.

And how is the product description of Mirtazapine then to explain?

David Healy: Companies take great care in their product descriptions to word things in a manner that deflects attention for their product. This rather than informing doctors or patients often appears to be their primary aim. Companies will often claim there is no need to enter data unless the data is statistically significant but this means they leave out figures showing a very clear increase in the risk of suicide - as the figures for mirtazapine show.

An objection against the thesis that antidepressants such as SSRIs or drugs with similar side effects may cause acts of violence is that they cannot be made responsible for insane acts such as the one of Lubitz because these drugs only cause acts of violence "on impulse" and not ones that have been planned long(er) beforehand, as Lubitz did it.

David Healy: SSRIs are by far not only linked to impulsive acts, but to planned acts of violence or harm. It is generally accepted that they cause emotional blunting and this makes it possible to contemplate things like homicide that someone would normally be too anxious to consider.