Several years ago, we commented about the practice of some attorneys who exploit the misunderstanding that surrounds the putative “criminogenic” effects of antidepressants.1 Neither time nor science has given pause to the trend of condemning these widely used and beneficial medications. This legal strategy continues. Attorneys use “experts” to testify that these medications can produce all manner of illegal behaviors—from murderous rage to callous lack of empathy to manipulative criminal behaviors.
Here, we give a brief update on the research in this area, along with an illustrative criminal case that received international media attention—the case of Commonwealth v Michelle Carter—more popularly known as the “texting suicide case.”
Antidepressants as “criminogenic” agents
Approximately 13% of persons aged 12 and older take antidepressants, which makes them one of the top 3 most commonly used medications in the US.2,3 Four years ago, we reviewed the literature and found no statistically relevant evidence that antidepressant medications cause violence or criminal behavior.1
In contrast, we found reliable research that showed that antidepressants were associated with a significant decrease in lethal violence and a reduction in irritability and aggression.4-6
The relatively rare adverse effects of antidepressant-induced mania and serotonin syndrome are sometimes invoked by those who believe antidepressants are criminogenic. However, these adverse effects produce characteristic physical symptoms and mental status changes that are easily distinguishable from a criminal act committed in the absence of these phenomena. But what has the research found since our last review?
A Swedish study of medication adherence using a nationwide registry of dispensed prescriptions found that nonadherence to antidepressants appeared to elevate the risk of homicide offending, while adherence showed no association.7 Another Swedish study looked at psychotropic medications in offenders released from prison.8 The study included all released prisoners from 2005 to 2010, and rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. For this group at high risk to reoffend, antidepressants were not associated with violent reoffending.
Focusing specifically on the serotonin receptor, Crockett and colleagues9 enhanced serotonin in healthy volunteers with citalopram and contrasted its effects with both a pharmacological control treatment and a placebo on tests of moral judgment and behavior. Subjects who received citalopram were more likely to demonstrate an aversion to harming others, as well as greater prosocial behavior. Siegel and Crockett10 later analyzed serotonergic research and hypothesized that serotonin may shift social preferences in a prosocial direction.
Dr. Knoll is Professor of Psychiatry at the SUNY Upstate Medical Center in Syracuse, NY; he is Editor-in-Chief Emeritus of Psychiatric Times. Dr. Annas is Assistant Professor of Psychiatry and Behavioral Sciences at SUNY Upstate Medical Center.
1. Knoll Jl. Warning: antidepressants may cause bank robbery. Psychiatric Times. November 2013. Accessed August 17, 2017.
2. Pratt LA, Brody DJ, Gu Q. Antidepressant use among persons aged 12 and over: United States, 2011-2014. NCHS Data Brief, No 283. Hyattsville, MD: National Center for Health Statistics; 2017.
3. National Center for Health Statistics. Health, United States, 2015: With special feature on racial and ethnic health disparities. Table 80: Selected prescription drug classes used in the past 30 days, by sex and age: United States, selected years 1988-1994 through 2009-2012. Hyattsville, MD. 2016.
4. Bouvy PF, Liem M. Antidepressants and lethal violence in the Netherlands 1994-2008. Psychopharmacol (Berl). 2012;222:499-506.
5. Walsh M, Dinan T. Selective serotonin reuptake inhibitors and violence: a review of the available evidence. Acta Psychiatr Scand. 2001;104:84-91.
6. George DT, Phillips MJ, Lishitz M, et al. Fluoxetine treatment of alcoholic perpetrators of domestic violence: a 12-week, double-blind, randomized, placebo-controlled intervention study. J Clin Psychiatry. 2011;72:60-65.
7. Hedlund J, Forsman J, Sturup J, Masterman T. Psychotropic medications in Swedish homicide victims and offenders: a forensic-toxicological case-control study of adherence and recreational use. J Clin Psychiatry. 2017;pii:16m11244.
8. Chang Z, Lichtenstein P, Langstrom N, et al. Association between prescription of major psychotropic medications and violent reoffending after prison release. JAMA. 2016;316:1798-1807.
9. Crockett MJ, Clark L, Hauser MD, Robbins TW. Serotonin selectively influences moral judgment and behavior through effects on harm aversion. Proc Natl Acad Sci USA. 2010;107:17433-17438.
10. Siegel JZ, Crockett MJ. How serotonin shapes moral judgment and behavior. Ann NY Acad Sci. 2013;1299:42-51.
11. Molero Y, Lichtenstein P, Zetterqvist J, et al. Selective serotonin reuptake inhibitors and violent crime: a cohort study. PLoS Med. 2015;12:e1001875.
12. Pozzi M, Radice S, Clementi E, et al. Antidepressants and, suicide and self-injury: causal or casual association? Int J Psychiatry Clin Pract. 2016;20:47-51.
13. Knapton S. Antidepressants linked to murders and murderous thoughts. The Telegraph. July 26, 2017. http://www.telegraph.co.uk/science/2017/07/25/antidepressants-linked-murders-murderous-thoughts/. Accessed August 18, 2017.
14. BBC. The Batman Killer: A Prescription for Murder. http://www.bbc.co.uk/news/resources/idt-sh/aurora_shooting. Accessed August 17, 2017.
15. Adshead G. Antidepressants and murder: case not closed. BMJ. 2017;358:j3697.
• Piquero AR. Taking stock of developmental trajectories of criminal activity over the life course. In: Liberman A, ed. The Long View of Crime: A Synthesis of Longitudinal Research. New York, NY: Springer; 2008:23-78.
• Sweeten G, Piquero AR, Steinberg L. Age and the explanation of crime, revisited. J Youth Adolesc. 2013;42:921-938.
• Wilson M, Daly M. Competitiveness, risk taking, and violence: the young male syndrome. Ethol Sociobiol. 1985;6:59-73.