But isn’t Lubitz an exception of a person running amok who has planned his insane act in advance while being heavily sedated with medication with considerable side-effects such as SSRI-antidepressants?
David Healy: Many public shootings bear witness to it. In the final report about Adam Lanza, for example, who shot on December 14, 2012, in Newtown, Connecticut, his mother, 20 children and 6 adult staff members and finally himself, it says that the evidence clearly shows that the shooter planned his actions, including the taking of his own life.
Or let’s take David Carmichael who reports about the killing of his own son that a few days after he started taking the antidepressant Paxil again, he was having suicidal thoughts. Three days later, he planned his suicide. But then he went from planning his suicide to planning a murder-suicide to planning a murder. On July 31, 2004, he finally killed his 11-year-old son Ian.
Does this also hold for the spree killer James Holmes who was sentenced to life in prison on August 7 this year without the possibility of parole?
David Healy: The information compiled from multiple sources about Holmes who became known as "Batman" shooter, because he killed 12 people and injured 70 others at a Century movie theater in Aurora, Colorado, on July 20, 2012, at the premiere of the Batman movie "The Dark Night Rises", shows the planning for his rampage was methodical, went back months.
But the picture about Holmes is not the way it happened. He had no plans to kill anyone until he went on the SSRI-antidepressant Zoloft which his doctor prescribed on March 21, 2012 - four months before he committed the mass shooting. In this period his dose of Zoloft was being increased in steps from 50mg to 100mg to 150mg per day. And Holmes not only got worse every time he changed dose. It also appears that specific plans of harming others began to crystallize out as the dose of Zoloft was increased.
How did James Holmes deal with the situation?
David Healy: While being on drugs such as Zoloft, he attempted to alert others about his specific plans of harming others in so far as he could - but no-one registered the changes in him. He describes himself as developing a state of Manic Dysphoria3 which is a good description of Zoloft induced akathisia. He also describes clear emotional blunting - that endured after he stopped the treatment - which is a well-recognized phenomenon.
When did he stop taking Zoloft?
David Healy: Somewhere around June 30, 2012, about 3 weeks before his killing. And when he stopped Zoloft, he did so abruptly from quite a high dose of 150mg. And he was unaware Zoloft could produce dependence and a withdrawal syndrome.
He became confused on withdrawal - being both more and less depressed. He became emotionally labile - dysphoric mania as he described it.
The reduction in fear he experienced while on Zoloft continued after he had stopped. Lots of people have continued emotional blunting or depersonalization - detachment from your thoughts or feelings - for months after stopping treatment with SSRIs.
But in an Associated Press article from August 8 it is being claimed that "Holmes told one [psychiatrist] that he had been secretly obsessed with thoughts of killing since he was 10." This conveys the impression that the potential to be a "killer machine" was already part of him at an early age.
David Healy: It is not true that Holmes was "obsessed" with thoughts of killing when he was 10. He didn’t have a nervous disorder till shortly before he went to the clinic in March 2012, a few months before he committed his mass killing at the age of 24 in Aurora, Colorado.
It was only when he was put on Zoloft in March 2012, he developed new thoughts centering on the possibility of specific homicidal acts - and these were not the same as his former vague ideas of killing people, as I also outline in my comment "The Man who thinks he is a Monster: Sertraline [= Zoloft] and Violence", published on August 15, 2015.
Against this background one may ask why the attorney team of James Holmes didn’t use the Zoloft/medication argument during the court case, especially as there are court cases in which a certain psychotropic drug such as an antidepressant has been named "guilty" for suicide or murder (see here, here and here).
But Brian N. Connors, Chief Deputy State Public Defender at the Office of the State Public Defender in Denver, Colorado, said upon request that "Neither Mr. Holmes nor any of his lawyers will be speaking with journalists concerning the case."4 What do you think may be the reason why the attorney team of James Holmes didn’t use the Zoloft/medication argument?
David Healy: The law is not clear on drug related issues - and lawyers are even more uncertain. They find it difficult to distinguish between mental illness and medication related issues and don’t know how to explain these things to juries.
The attorney team insisted that James Holmes' crimes were caused by his psychotic breakdown of a mentally ill person. With the final result that Holmes escaped the death penalty and was sentenced to life imprisonment. Do you think the attorney team could have reached more for James Holmes if they had argued that the SSRI-antidepressant Zoloft did play a vital or important role in the formation of his insane act?
David Healy: James Holmes had a good medication defense but neither the law not the legal system are comfortable with these issues.
In the mentioned Associated Press article it also says, "As in previous proceedings, Holmes who is on anti-psychotic medication that dulls his responses, showed no reaction." How could it be that Holmes has been given antipsychotics that have a brain damaging effect (also here) and that "dulls his responses," though one should assume that an accused person shouldn’t have an additionally "befogged" mind being able to speak in a manner that helps elucidating the circumstances of the massacre?
David Healy: The problem here is it’s the doctor treating him who decides on this one - the lawyers have little input. I saw no clinical reason for continuing treatment with these meds.
But if medication such as SSRI-antidepressants can bring people to commit suicide or even a massacre, why has anyone noticed something in advance?
David Healy: In contrast to alcohol or street drugs such as LSD, with antidepressants you do not become necessarily "maladjusted." In fact, many of the people being given antidepressants can seem essentially normal. They will show up as "normal" on profiling. Let’s take the example of Tim Kretschmer who killed 15 people and finally himself in 2009 in Winnenden near Stuttgart.