A popular honors student who played on his varsity high school basketball and baseball teams in rural Washington state, Corey Baadsgaard nevertheless would come home complaining that no one liked him.
His family physician prescribed Paxil, a popular antidepressant. But Corey, then 16, sank deeper into depression. The doctor switched him to a different antidepressant, Effexor, and stepped up the dose over a three-week period from 40 milligrams to 300. The first morning Corey took 300 milligrams, he felt rotten and went back to bed.
Three years later, he says, he still has no memory of what happened next: no memory of taking a high-powered rifle into his third-period English class, of herding his classmates and teacher into a corner, of holding them at gunpoint for 45 minutes, of being talked by the principal into giving up his gun.
He spent 14 months in a juvenile detention center.
Baadsgaard and his father believe that the antidepressants made him suicidal at first, then violent. The Food and Drug Administration relying on such anecdotal evidence and the results of clinical trials is reconsidering its decision not to require that doctors and parents be warned about possible side effects of the drugs known as selective serotonin reuptake inhibitors.
Dr. Joseph Glenmullen, a Harvard Medical School psychiatrist who has studied such medications, said Baadsgaard’s story was plausible. And he wondered whether antidepressants could help explain the rash of school shootings and murder-suicides over the last decade.
People who take antidepressants, Glenmullen said, could “become very distraught. They feel like jumping out of their skin. The irritability and impulsivity can make people suicidal or homicidal.”
The pharmaceutical companies and many doctors dispute the suggestion that antidepressants play a role in violent or suicidal acts.
Dr. Alastair Benbow, the European medical director for GlaxoSmithKline, Paxil’s manufacturer, refused to comment on specific cases. But, he stressed,“I don’t believe there is any clear evidence that Paxil is linked with suicide, violence or aggression and certainly not homicide.”
The source of aggressive behavior, doctors and mental health groups said, may lie with the illness and not the treatment. And failing to treat depression, they explained, could have costs as grave as treating it.
Although only one antidepressant, Prozac, is explicitly approved by the FDA for children, doctors routinely prescribe others to their young patients. The National Mental Health Association estimates that depression affects one in 33 children and one in eight adolescents.
Most of the drugs carry no specific warnings about potentially increasing the risk of suicide or violence.
However, one company, Madison, N.J.-based Wyeth, warned doctors in a letter last summer that children taking Effexor in clinical trials had shown increased hostility and suicidal thoughts compared with children taking placebos. The company directed doctors not to prescribe Effexor to children.
And GlaxoSmithKline, during clinical tests on children with obsessive-compulsive disorder or depression, found that the percentage of children taking Paxil who became hostile which was defined as everything from angry thoughts to violent acts ranged from 6.3 percent to 9.2 percent. For those taking the placebo