Paxil: Aggression and Homicide

I really just did want to win, to say, OK, the drugs did do it — what's everyone going to do now? And of course, there's been nothing. I honestly believe until it's somebody of importance it will be very difficult to get any changes. Here I am, a simple man from Montana. I'm not exceptionally rich or famous or anything. Who's going to listen to me?

Tim Tobin
son-in-law of Donald Shell
'Four People Dead is Four Too Many'

In February 1998, Donald Schell, a 60 year old man, living in Gillette, Wyoming, became withdrawn and began to complain to his wife, Rita, that he had difficulty sleeping. Schell had first had nervous problems in the mid-1980s and between then and 1998 was to have approximately five nervous episodes, centered on work stressors or bereavements. Don and Rita appeared to most of those who knew them to be a close couple who were married for 37 years. They had two children, Michael and Deborah. Deborah married Tim Tobin in 1992 and in 1997 she gave birth to the Schell’s first grandchild, Alyssa. Deborah and Alyssa, now nine months old, came down from Billings, Montana to stay for a few days with Don and Rita in February 1998.

Don’s means of handling his nerves was to take time off work, as he could easily get someone to deputize for him. He went for walks with his wife, spent time talking with friends or Tim if he was around, in addition to taking care of his diet. Ever since he had had a good exposure to a Dr. Suhaney in 1990, if he remained low after a week or two, either Rita or Don himself would suggest going along to see a doctor. Dr. Suhaney had first put Schell on Prozac and noted that it made him tense, anxious and jittery, despite the fact that he was on several antidotes such as Inderal, Ativan and Desyrel. Dr. Suhaney stopped Prozac and put Don Schell on imipramine to which he responded rapidly. What Dr. Suhaney didn’t know was that Schell may have even been hallucinating while on Prozac. Having responded to imipramine in 1990, in two further brief episodes in the 1990s, Schell was put on tricyclic anti-depressants and responded rapidly.

In February of 1998, when he began to complain about his sleep, Don and Rita went to see a primary care physician, Dr. Patel. Dr. Patel did a thorough examination, which included administering rating scales that indicated Schell’s main problem was poor sleep and that he felt hopeful about the future and thought well of himself. Dr. Patel diagnosed an anxiety state and — unaware of the significance of a prior adverse response to Prozac — put Mr. Schell on Paxil, without any covering antidotes. Forty-eight hours later Mr. Schell put three bullets from two different guns through Rita’s head, as well as through Deborah’s head and through Alyssa’s head before shooting himself through the head.

GSK's "Do More, Feel Better, Live Longer" video
(Windows Media Player or RealOne Player required to view)

After more than a year in a mental wilderness, Tim Tobin sought out a Houston, Texas attorney, Andy Vickery, and took an action for wrongful death against SmithKline Beecham, which was then in the process of becoming GlaxoSmithKline, the worlds largest pharmaceutical company.

SmithKline Beecham (in a classic example of corporate hubris) risked it all by squaring off with the families of the deceased in a backwoods Wyoming courtroom. The company lost the suit, and in spectacular fashion.

According to Dr. Peter Breggin — one of the world's foremost and respected authorities on SSRIs — and similar class drugs: Paxil, Zoloft et al. can cause suicide, violence and other criminal acts through several mechanisms, including:

  • SSRI-induced mania, sometimes (but not always) with psychotic features, such as hallucinations or delusions ... Drug-induced mania can cause many expressions of disinhibited or out-of-control behavior, including sexual acting out, road rage, buying sprees and shoplifting. Drug-induced mania, even when seemingly not intense, can ruin marriages and destroy careers. All of the features of mania are not required in order to meet the diagnosis of Antidepressant-Induced Mood Disorder with Manic Features. If the individual's mood is "elevated, euphoric, or irritable," the necessary criteria are met.
  • SSRI-induced depression or worsening of depression. In a seemingly paradoxical effect, antidepressants can cause or worsen depression. In controlled clinical trials for Prozac that were conducted by the manufacturer, Eli Lilly and Company, depressed patients taking Prozac attempted suicide more frequently than depressed patients taking placebo (sugar pill) or older antidepressants.
  • SSRI-induced severe anxiety and agitation, especially in a patient already suffering from depression with anxiety and agitation;
  • SSRI-induced obsessions and compulsions that motivate violence toward oneself or others.
  • SSRI-induced akathisia, an internal sensation of agitation or discomfort that drives a person to move about, and also to lose impulse control. During akathisia, the inner experience of agitation includes many unusual physical feelings, such as electricity in the head or body. The person suffering from akathisia typically feels compelled to move the feet when sitting, to stand, or to pace. Akathisia is known to increase the risk of suicide and violence.
  • Severe Adverse Effects After One or Two Doses

    Dr. Breggin stated that physicians and patients are not aware that many severe adverse drug effects can surface after the first or second dose of any SSRI antidepressant. Because the "therapeutic effect" of any antidepressant usually takes several weeks or more to develop, some doctors fail to realize that toxic effects can develop beginning with the first dose. These doctors are not likely to warn patients and their families about adverse events occurring after one or two doses. Furthermore, these doctors may discount the patient's report when these early reactions occur. They may urge the patient to continue taking the drug so that the patient ends up developing an unnecessarily severe reaction.

    You might be surprised to learn that when someone gets into trouble with the law because of this type of drug-induced behavior and inquiries are made by the authorities to GlaxoSmithKline about Paxil, not only does GlaxoSmithKline deny that Paxil causes such behavior, but GlaxoSmithKline provides the authorities with a confidential document — a so-called “prosecutor’s manual.” The contents of this manual have been kept secret by GlaxoSmithKline, but the motivation behind its existence and use of the manual is to protect Paxil's “good” name. GlaxoSmithKline knows full well that people may not buy and take a drug that could cause them to end up in jail.

    Thousands of Americans are in jails throughout the United States today because GlaxoSmithKline and the other SSRI manufacturers have not only failed to tell the public that Paxil (and its feral siblings) can cause hostility and aggression, but have, behind their backs, participated in their prosecution. This is unconscionable.

    Excerpts From Paxil's June, 2005 Prescribing Information

    Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient’s prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient’s presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.

    There is a Risk of Suicidal Thoughts or Actions: Children and teenagers sometimes think about suicide, and many report trying to kill themselves. Antidepressants increase suicidal thoughts and actions in some children and teenagers.

    The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric.

    If you, or someone you know, has become violent, aggressive or hostile while on Paxil, please report it immediately to the United States Food and Drug Administration. This is one way consumer leverage can be applied to GlaxoSmithKline; eventually this official documentation will compel the company to fully disclose the "adverse side effects" of Paxil. You can report your side effects at: MedWatch.