Dying to be Famous? Shooting Fuels Debate Over Safety of Prozac for Teens

Sun, 27 Mar 2005

An Op Ed in The New York Times by Lionel Shriver (from London), dismisses the notion promulgated by the mental health industry–which is under the influence of drug companies–that “early signs” in troubled adolescents are predictive of future mental disorders. He inadvertently but effectively undermines the premise underlying the recommendations of the President’s New Freedom Commission on Mental Health which calls for mass “screening for mental health.”

He notes that: “Screwed-up comes in as many flavors as ice cream, and the merest fraction of troubled boys go literally ballistic at their schools. If occasionally fatal, the combination of despair and grandiosity is as common – and American – as apple and pie.”

He suggests that more than anything else, the one thing that school shooters have in common is a yearning for recognition–celebrity: “Whether we care to admit it, the calculation these boys are making is culturally astute. You do not make headlines by getting an A on your report card. So long as we make a minimal distinction between fame and infamy – and consistently accord infamy a measure more fascination – any smart teenager is going to take the easier, more spectacular route to glory and opt for ignominy over achievement.”

All the more reason for the FDA to investigate whether widely prescribed antidepressants, such as Prozac (the drug that Jeff Weise was prescribed) do not extinguish the internal mechanism that controls impulsive behavior.

A Minneapolis PBS radio program acknowledges: “Some research seems to indicate a link between the medication and suicide attempts and violence.”

Publicly disclose evidence trumps Eli Lilly’s 16 years of denial: When confronted with the FDA warning about an increased risk of suicidal thinking (and actions) John M. Plewes, medical advisor at Eli Lilly, the maker of Prozac, claimed: “that doesn’t mean Prozac is at fault.”

Neither Lilly spokespersons, nor Dr. David Fassler, APA’s most ardent defender of the use of these drugs for children and adolescents–can make the genie go back into the bottle. Their oft-repeated arguments ring hollow when the evidence-based warnings outlined in the recently revised SSRI labels in the UK, in Canada, and the US are known. Though their wording is not consistent, all labels acknowledge that evidence exists showing drug-linked risks of violent and suicidal behavior in patients taking Prozac for psychiatric and non-psychiatric conditions. That leaves no room for doubt about the drug’s effect:

“Families and caregivers of pediatric patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality” See: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01283.html

“There are clinical trial and post-marketing reports with SSRIs and other newer anti-depressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others.” See: http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/prozac_e.html

Evaluating these life-threatening risks against the absence of evidence showing the drugs’ benefit for children, independent scientists who analyzed the unpublished and published data, concluded that “data from unpublished trials suggest that most SSRI antidepressant drugs unsuitable for children.” Whittington. Kendal, The Lancet 2004; 363: 1335, 1341-45

In light of the evidence, statements such as the following, by Lilly spokespersons have no credibility: “There is no credible scientific evidence that has established a causal connection between Prozac and either violent or suicidal behavior.”

PBS concluded: “Whether or not Prozac played a role in the Red Lake shootings, the incident is likely to fuel still more debate over the safety of treating children and adolescents with the medication, and others like it.”

Contact: Vera Hassner Sharav
212-595-8974

THE NEW YORK TIMES
March 27, 2005
OP-ED CONTRIBUTOR
Dying to Be Famous
By LIONEL SHRIVER
London

ADOLESCENTS don’t conceive the notion of strafing their classmates in a vacuum; they get the idea from cable TV. Bad news in itself, the 10-fatality reprise of the American school shooting last week at the Red Lake Indian Reservation in Minnesota bolsters the archetype. It makes a trend that had seemed to subside since Columbine in 1999 seem current again, and prospectively gives more boys big ideas.

The lessons we’ve been meant to learn from school shootings have been legion. We need better gun control. We need to be more understanding of misfits. We need to stop bullying. We need to curtail violent films and video games. So far, the suicide of 16-year-old Jeff Weise and his murder of nine people, including his grandfather, has fostered another familiar homily: We need to recognize the “warning signs.” Jeff Weise’s “warning signs” have been widely publicized. He drew ghoulish cartoons and wrote gory short stories. He aped his predecessors in Colorado by wearing a black trench coat. On the Internet, heartbreakingly, he admired Hitler and flirted with eugenics – although the Nazis would hardly have championed the pure genetic line of Mr. Weise’s Chippewa tribe. Predictably, all this dark ideation took place against the backdrop of a broken family and a forlorn personal life.

But Monday-morning quarterbacking has a reputation as cheap for good reason. A host of teenagers have morbid inclinations that they express through art and schoolwork. The very fact that the style that Mr. Weise adopted has a name – Goth – implies that thousands of other youths don the same dour garb. Many adolescents try on outrageous, painfully incoherent ideologies to set themselves apart. In her book “Rampage,” Katherine S. Newman cites factors like access to “cultural scripts” from violent media, victimization from bullying and social marginalization. But such broad characteristics apply to half the children in the country.

I, too, researched school shootings for my seventh novel, about a fictional version of same. But the more I read, the more disparate these stories appeared. The boys had in common what they did, but not who they were or why they did it. If another school is shot up again, rest assured that the culprit will have exhibited his own eccentric set of “warning signs,” like Mr. Weise’s constantly changing hairstyles, that if plugged into a computer would finger 10,000 other innocents as murderous time-bombs.

But I did identify one universal. The genre is now sufficiently entrenched that any adolescent who guns down his classmates aims to join a specific elect. Like Red Lake’s, the public shootings are often a cover for suicide, or for the private settling of scores with a parent or guardian. But a school shooting is reliably a bid for celebrity. As for murder-suicides like Jeff Weise’s, even posthumous notoriety must seem enthralling to someone who feels sufficiently miserable and neglected.

Whether we care to admit it, the calculation these boys are making is culturally astute. You do not make headlines by getting an A on your report card. So long as we make a minimal distinction between fame and infamy – and consistently accord infamy a measure more fascination – any smart teenager is going to take the easier, more spectacular route to glory and opt for ignominy over achievement. Far more Americans now know the name Jeff Weise than the winner of last year’s Nobel Peace Prize. Only two days after the shooting, a Google search of “Jeff Weise” and “Red Lake” scored more than 8,000 hits. If our boy wanted attention, he got it.

Am I the only one to find those thousands of hits shocking? Am I the only one to feel queasy over the painstaking examination of this boy’s psyche – perhaps including this very article?

The Star Tribune of Minneapolis: “Jeff Weise: A Mystery in a Life Full of Hardship.” Minnesota Public Radio: “Who Was Jeff Weise?” There’s hardly a teenage boy who wouldn’t covet those headlines for himself. Are we not dangling a prize of outsized pity for boys with the guts to compete for it? Are we in danger of being too sympathetic?

Surely no single factor explains the perniciousness of school shootings more than the intense news media focus they draw. Too late, we are now combing Mr. Weise’s reactionary Internet postings, grisly drawings and gruesome short stories. We are rightly wrenched by his fractured family life – his mother’s brain damage, his father’s suicide.

But I grew up in North Carolina alongside any number of anguished young men, a few of whom likewise chose to leave the building with a shot in the head. Most humble suicides, however, don’t take nine unwilling people with them on the way out the door. Sympathy, of course, is not zero-sum. We can afford to lavish it unsparingly on all parties in tragedies like this one. But one might make a case for ordinal sympathy.

That list should be topped by nine dead people who should have been eating breakfast this morning. Next, their grieving families. The seven wounded. Jeff Weise’s extended family, living with shame and perplexity hereon. The Red Lake reservation, now receiving the kind of attention it doesn’t want. The nation at large, in which extravagant media response to this killing has once more raised the likelihood that it will happen again. Jeff Weise – overweight, politically confused lonely guy, but also a killer – belongs on the list, but last.

Otherwise, reserve a special compassion for any folks in Mr. Weise’s orbit, like the doctor said to have dismissed the boy’s cutting himself as “a fad,” implicitly being made to feel that by not reading the “warning signs” they are in some way at fault. The hurling of blame constitutes a secondary wave of violence that leaves a second set of scars. Still coping with gratuitous murder, counselors and teachers, parents or guardians, friends and neighbors of the gunman grapple with an equally gratuitous guilt.

For no one should have seen this coming. Screwed-up comes in as many flavors as ice cream, and the merest fraction of troubled boys go literally ballistic at their schools. If occasionally fatal, the combination of despair and grandiosity is as common – and American – as apple and pie.

Lionel Shriver is the author of “We Need to Talk About Kevin,” a novel.

http://news.minnesota.publicradio.org/features/2005/03/25_helmsm_prozacfolo/

Shooting fuels debate over safety of Prozac for teens
by Marisa Helms, Minnesota Public Radio
March 25, 2005

Jeff Weise, the assailant in the Red Lake shootings, was reportedly taking Prozac, a popular antidepressant. Some research seems to indicate a link between the medication and suicide attempts and violence. (Photo by Stephen Chernin/Getty Images)

Family members of Jeff Weise say they have questions about the medication he was taking up until the day of the shootings in Red Lake. Authorities say Weise shot and killed nine people before turning the gun on himself. Weise was taking the antidepressant Prozac. The shootings are likely to renew the controversy over the use of antidepressants in children and adolescents. St. Paul, Minn. — Jeff Weise’s aunts, Shauna and Tammy Lussier, say they had no idea he would carry out the grisly shootings in Red Lake. He had been living with them for the past seven or eight years. The two aunts spoke recently to Fred de Sam Lazaro of PBS’s NewsHour with Jim Lehrer and Twin Cities Public Television.

They told him they took Jeff to get help for problems he was having with police and at school. They say his treatment included the antidepressant Prozac. “Actually, they had just recently upped his dosage. He was taking two pills a night, they upped it to three. We think that was too much for him, too much medication for him,” they said.

Prozac is the only antidepressant approved by the U.S. Food and Drug Administration for use with adolescents.

In October, the FDA ordered that all antidepressants carry prominent warnings about an increased risk of suicidal thinking and behavior in children.

And now, groups opposed to the use of antidepresseants in children are calling on the FDA to investigate the possible relationship between Prozac and the Red Lake shootings.

Critic Vera Sharav is president of the Alliance for Human Research Protection, a New York-based nonprofit, promoting openness and accountability in medical research. Her group has been calling attention to the potential dangers of giving children and adolescents Prozac.

Sharav points out that Eric Harris, one of the killers in the 1999 Columbine shootings, reportedly was prescribed Prozac. Sharav says Prozac and other antidepressants in the class of drugs known as SSRIs interfere with a person’s inhibitions. “Lots of us have violent thoughts. ‘I would like to take this man by the throat, he’s bothering me.’ But we don’t do it. The drug removes that inhibition to act out and that is why you have these explosive situations,” says Sharev.

“That’s just not a correct scientific statement,” counters John M. Plewes, medical advisor at Eli Lilly, the maker of Prozac.

Though the FDA warning points out an increased risk of suicidal thinking, Plewes says that doesn’t mean Prozac is at fault. “There is no credible scientific evidence that has established a causal connection between Prozac and either violent or suicidal behavior,” Plewes says. “This kind of behavior sometimes is a part of a serious, life-threatening illness — that illness can be depression or some other illnesses — but it’s characterized by a variety of symptoms. And suicidal acts and thinking are symptoms of depression.”

Despite the controversy over Prozac, an official with the American Psychiatric Association says 1.5 million kids are taking Prozac and other SSRI medications.

David Fassler is a trustee of the APA, and a child and adolescent psychiatrist in Burlington, Vermont. He says about half his adolescent patients are on SSRIs, and says they are very effective. But he says medication is best used with a comprehensive treatment plan that includes talk therapy.

Fassler says daily dosage ranges from 10 to 60 milligrams, based on body size and other factors. The severity of a child’s depression is not a factor in determining dosage, he says. Fassler says he makes sure patients and their parents understand the FDA warnings about SSRIs. He says parents need to advocate for their children to find the best treatment.

“There’s no right answer for every family. They need to learn as much as they can about the risks and benefits of all treatment options, and the risk associated with not treating problems like depression,” says Fassler. “Over half of the kids with depression will eventually attempt suicide. And between 2 and 5 percent will ultimately die as a result.”

Whether or not Prozac played a role in the Red Lake shootings, the incident is likely to fuel still more debate over the safety of treating children and adolescents with the medication, and others like it.

(The Associated Press contributed to this report)

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