Is there a link between antidepressants and violence?

The recent murder suicide of an elderly couple in Newton, Massachusetts brought to mind a horrific story I heard while attending the ICSSP conference in Syracuse a few weeks ago. In 2006, David Crespi, a former banking executive with no criminal record or history of violence, killed his twin five-year-old daughters, stabbing them multiple times with a kitchen knife. He then called the police and sat with his daughters, blood all over him, until they arrived. Crespi, who was living with his wife and family in Charlotte, North Carolina (they have three other children), pled guilty to avoid the death penalty and is now serving a life sentence for the murders.

What wasn't mentioned at the time is the fact that Crespi was taking Prozac when he killed his daughters, along with the sleeping pill Ambien. He was taking the drugs (and had previously taken Zoloft and Paxil) because he couldn't sleep and was very anxious about losing his job with Wachovia Bank. Crespi became agitated and delusional on Prozac, according to his wife, Kim. Seven days after starting the drug, he killed their twin daughters, Tess and Samantha.

In the 25 years since Prozac and the other SSRI antidepressants have been on the market, there has been a long litany of cases like Crespi's, where someone with no history of violence, became agitated and violent after taking these drugs, either killing themselves or their loved ones. Indeed, as I write in Side Effects, Dr. Martin Teicher and his colleagues at McLean Hospital in Belmont, first reported on the phenomenon of akathasia among several patients on Prozac in a seminal case study published in the American Journal of Psychiatry in 1990.

In 2001, a Wyoming jury ordered GlaxoSmithKline, the maker of Paxil, to pay $6.5 million to the relatives of Donald Schell, who two days after starting the drug, murdered his wife, daughter and granddaughter before killing himself. And just last week, a Kansas jury acquitted a prisoner of beating a corrections officer, essentially buying the prisoner's defense that high doses of Prozac made him go ballistic; for more on this case, read Furious Seasons.

Which brings me back to the murder suicide in Newton last week. I have no idea if William Wyman was on antidepressants -- family members and police aren't talking -- but that could explain why this 86-year-old man would take a knife with a three-inch blade to his wife (also 86), stabbing her repeatedly in the neck and then killing himself in the same brutal manner. According to The Boston Globe and the Newton Tab, Wyman and his wife had health issues. So he could have decided to end both their lives for that reason alone. But most elderly people who kill themselves because of poor health and an uncertain future don't do it quite so violently. They usually take an overdose of pills or they leave the car running and the garage door closed.

My heart goes out to the Wyman family, as it does to Kim Crespi and her three surviving children. Kim says she has filed an appeal based on the argument that the public attorneys who defended her husband were incompetent (they're the ones who convinced David Crespi to plead guilty and didn't raise the issue of his medication history).

While the FDA has insisted on black box warnings about the suicidal risks of these antidepressants, there has been no similar warnings about their link to violence, even though it is well-documented that these drugs cause some people to become agitated and unbalanced. So I just have one question: when is the FDA going to insist that the drug companies, who continue to earn billions from the sale of these antidepressants, do the kind of large-scale post-approval safety studies that can resolve this issue one way or the other?