After two decades of contentious denials about the suicidal risk posed by certain psychoactive prescription drugs, numerous drugs now carry label warnings about suicidal behavior.

Now, a new study in PLoS One , identifies 31 drugs in FDA’s MedWatch adverse drug reports that are disproportionately linked to 1,527 acts of violence–defined as "Homicide," "Physical assault," "Physical abuse," "Homicidal ideation" or "Violence-related symptom."

The violence events in these widely prescribed drugs–for diverse patient populations–were reported to the FDA between 2004 and Sept. 2009.

The authors, Thomas J. Moore, Joseph Glenmullen, MD Curt D. Furberg, MD, identified 1,937 reports of violence submitted to FDA’s MedWatch that met a restrictive criteria:

The violence cases included 387 reports of homicide, 404 physical assaults, 27 cases indicating physical abuse, 896 homicidal ideation reports, and 223 cases described as violence-related symptoms. The patients were 41% female and 59% male with a mean age of 36 years (SD=17.9)

Of all currently marketed prescription drugs, those linked to most of the violent events reported to the FDA are drugs that increase dopamine and /or serotonin in the brain– irrespective of the patient population.

The worst offender with the strongest association to uncontrollable, murderous violence–within days of ingesting the drug–is the smoking cessation drug, Chantix (varenicline), which increases dopamine: it ranks 18.0 in the proportional reporting ratio (PRR) with 408 cases of violence–including murder.  There are two other smoking cessation drugs that do NOT pose serious risks of violence.

The next drugs most often linked to unprovoked violent outbursts–some resulting in murder–are 11 of 13 SSRI antidepressants. These not so, "magic bullets," whose mode of action (reuptake inhibition) increases serotonin, were involved in 578 cases of violence.

Two drugs within the SSRI class–Prozac and Paxil--have been linked to the greatest number of reported cases of violence toward others: Prozac ranks 10.9 in the PRR, with 72 reported cases of violence, and Paxil (Paroxetine) ranks 10.2 in PRR, with 177 reported cases of violence.

The authors note that there was no signal for violence linked to mood stabilizers such as valproic acid, carbamazepine, and phenytoin, even though these drugs are commonly used in bipolar patients who may experience psychosis in the acute manic phase and therefore be more prone to violence. On the other hand, SSRI’s, which are clearly linked to violent actions in patients with no history of violent behavior, are being prescribed for patients with bipolar disorder. That is a prescription for disaster.

The other class of drugs that are demonstrably linked to violence are 3 drugs prescribed for ADHD–amphetamines, atomoxetine and methylphenidate–and 5 hypnotic /sedatives.

Only 0.25% of all serious adverse drug events met the PLoS study’s restrictive criteria of violence. Thus, it is likely that the number of cases included in the analysis is understated.

Not only does the FDA disregard the precautionary principle of medicine–"First, do no harm"– the agency is unleashing drugs whose mode of action–accelerating dopamine and or serotonin in the brain–poses serious threats of violence to bystanders in the community!  Think of the school shootings….the postal shootings…the troop "friendly fire" deaths…

The list of brain-altering drugs (mostly psychotropics) statistically related to violence (listed in decreasing order of likelihood of correlation in FDA’s AERS reportage [the number behind the name of the drug is the relative risk of drug-induced violence, including homicidality and suicidality]:

Chantix (Varenicline) _________18.0

Prozac (fluoxetine) __________10.9

Paxil (paroxetine) ____________10.3

Amphetamines _______________9.6

Mefoquine (Lariam) ___________9.5

Strattera (atomoxetine) ________9.0 

Halcion (triazolam) ____________8.7

Luvox (fluvoxamine)__________ 8.4 

Effexor (venlafaxine) __________8.3

Pristiq (desvenlafaxine) ________7.9

Zoloft (sertraline) _____________6.7 

Ambien (zolpidem) ____________6.7 

Lexapro (escitalopram) ________5.0

Celexa (citalopam) ____________4.3  

Abilify (aripiprazole) ___________4.2

OxyContin (oxycodone) ________4.1

Wellbutrin/Zyban (bupropion)____ 3.9

Geodon (ziprasidone)__________ 3.8

Ritalin/Concerta (methylphenidate) 3.6

Remeron (mirtazapine) _________3.4

Neurontin (gabapentin) _________3.3

Keppra (levetiracetam) _________3.3

Valium (diazepam) _____________3.1

Xanaz (alprazolam) ____________3.0

Cymbalta (duloxetine) __________2.8

Klonopin(clonazepam) __________2.8

Risperdal (risperidone) _________2.2

Read the complete article at PLoS One , "an interactive, open-access journal for the communication of all peer-reviewed scientific and medical research,"  

 Vera Hassner Sharav