Did a drug lead to killing?

 

Shane Clancy’s mother and stepfather alleged on ‘The Late Late Show’ that antidepressants caused him to stab three people, and then himself. However, no medical research has ever linked these drugs to homicide

ON AUGUST 16th, 22-year-old Sebastian Creane from Bray, Co Wicklow, was fatally stabbed by Shane Clancy, who also injured Sebastian’s brother Dylan and Jennifer Hannigan, Clancy’s ex-girlfriend. On October 2nd, Shane Clancy’s mother and stepfather, also from Bray, appeared on The Late Late Showto argue that in their view Shane’s behaviour was so uncharacteristic that it could only be explained by the fact that he had been taking antidepressants.

“The conversation gave the impression that antidepressants increase the risk for homicide. There is absolutely no link between taking antidepressants and homicidal behaviour,” says Dr Jogin Thakore, clinical director of psychiatry in the HSE’s Dublin North Central district.

Dr Justin Brophy, a consultant psychiatrist in Co Wicklow agrees, adding: “I would be extremely concerned that following The Late Late Show, people who have been prescribed antidepressants would stop taking them, and that people who need to take them in order to function in their lives will feel stigmatised, and may even hide the fact that they are taking them. The stakes are very high here because people’s lives and people’s health will be seriously compromised and endangered by misleading and imbalanced advice.”

After hundreds of scientific studies and independent evaluation by the US Food and Drug Administration (FDA), the EU and the Irish Medicines Board (IMB), antidepressants have probably come under more scrutiny than most drugs on the market. The worst you can say of them is that in the under-25 age group they are linked to increased “suicidal ideation” – as in thoughts of suicide – but they have not yet been shown to cause suicides.

Yet there are many people who refuse to accept the evidence. Just type “antidepressants violence” into your web browser, and you will find hundreds of sites with anecdotal claims that troubled adolescents (keep in mind that the mind is adolescent until the age of 25 or even 30) became violent after taking antidepressants.

The College of Psychiatrists in Ireland refused an invitation to participate in the The Late Late Showon October 2nd.

“Making antidepressants the focus of this tragic situation was a serious hijacking of two families’ grief and of the facts, while the facts of the case have yet to be established. We thought it was unethical to parade the issue of antidepressants in front of a bereaved family who had been hijacked for the sake of the argument. We also had misgivings that another brave family was not represented,” says Dr Brophy.

Dr Brophy believes the “sensationalistic” misinformation peddled by media and special interest groups about antidepressants amounts to “scientific bullying”. He says, “A small group of people with a particular agenda aim to completely decimate the facts, manipulating methodologies for their own ends. The legal industry is also heavily invested. Those interests are not declared and expressed in websites and sensationalist media reports. It represents a form of scientific bullying.”

Dr Michael Corry stated on The Late Late Showthat he had seen Shane Clancy’s parents twice as their psychiatrist and was in the green room with them beforehand, he then said of antidepressants that: “The side effects which are recognised can tip somebody into suicidal behaviour and homicidal behaviour. This is well documented.” Two other doctors, both GPs, were also in the studio audience and did not say on air that there is no scientific proof of Dr Corry’s view.

When asked whether the item was intended by Clancy’s parents to be a warning on antidepressants, based on their own beliefs, RTÉ responded that: “As a policy, RTÉ Television doesn’t discuss the motivations of guests in participating in any of our shows – that is for them to elucidate. These discussions are private to the parties involved. However, we can clarify that Ms Fennell’s concerns about the possible effects antidepressant drugs had on her son had already been publicly aired – in a letter to the Gerry Ryan Show(Wednesday 16 September).

“We felt that the Clancy’s beliefs and comments would lead to a wider discussion on the approaches to treating depression in Ireland. The item included mental health experts in the audience who could contribute expert opinion on antidepressants in particular and mental health care provision in general. Two expert opinions were offered which differed from Leonie Fennell and Tony Donnelly’s position and one supported their thesis. Advice was offered to any viewers currently on antidepressant medication to seek medical advice before changing any aspect of their treatment. The Aware helpline number was also put up on screen at the conclusion of the item during The Late Late Showon Friday night, for any viewers affected by the discussion.”

IN IRELAND, a reliable source of information is the IMB, which has the role of evaluating every drug that companies seek to put on the market here. Evidence presented by the pharmaceutical industry is only one of the research sources reviewed by the board. Epidemiological studies and “surveillance” – alerts from doctors prescribing the drug – are also taken into account. The IMB doesn’t approve anything that the EU and the FDA haven’t thoroughly investigated first, and it then reviews these investigations with an objective eye.

In 2006, the IMB reviewed all the current evidence and wrote a warning that comes on a leaflet inside antidepressant prescription boxes. It states: “If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.” It adds that “if you are a young adult, information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who are treated with an antidepressant.”

The warning refers to suicidal behavour, not actual suicides. In August, the British Medical Journalpublished a study showing that the risk of suicide in under-25s on antidepressants was about one in 12,000 – but there was absolutely no risk of homicidal behaviour. It hasn’t turned up in a single study.

Some people believe doctors and the pharmaceutical companies work hand-in-glove to suppress the evidence. Says Dr Brophy: “If there was any implication of concealment of the truth, the IMB would know it. The facts are very open and accessible. No one is trying to conceal anything. . . . To imply [we] are beholden to the pharmaceutical industry is a misrepresentation. We don’t prescribe based on any information from the pharmaceutical industry – we get it from the IMB.”

AN ESTIMATED400,000 people in Ireland suffer with depression. The WHO has estimated that by 2030, depression will overtake heart disease as the illness causing the most distress both in terms of individual suffering and human productivity. Stigmatising depression, by linking its pharmacological treatment to violent behaviour, can only prevent people from seeking help, Dr Thakore warns.

How many Irish people take antidepressants? It’s a difficult figure to come by. More than 1.1 million prescriptions annually for new-generation antidepressants are paid for by the general medical scheme (GMS), and another 100,000 under the direct payment (DP) scheme.

Dr Harry Barry, a GP and cognitive behavioural therapist, who was in The Late Late Showaudience that night, says prescription drugs are an important part, but not all, of the solution for depression. Teenagers, especially, need someone to listen to them with empathy so that they can tell the truth about how they feel. Many young people with depression, he says, are fearful of their parents and friends knowing that they are not the wonderful, sociable person they think they are; this fear of letting people down can lead to suicide.

Lifestyle changes are also important – avoiding alcohol and illegal drugs, improving diet and exercising. The focus should not be on antidepressants, but on the services, Dr Barry believes. According to a recent report, only 12 per cent of adolescents with mental health problems have access to a specialist service.