Reports of Gunman’s Use of Antidepressant Renew Debate Over Side Effects

Fuente: New York Times 

Steven P. Kazmierczak stopped taking Prozac before he shot to death five Northern Illinois University students and himself, his girlfriend said Sunday in a remark likely to fuel the debate over the risks and benefits of drug treatment for emotional problems.

.Over the years, the antidepressant Prozac and its cousins, including Paxil and Zoloft, have been linked to suicide and violence in hundreds of patients. Tens of millions of people have taken them, and doctors say it is almost impossible to tell whether the spasms of violence stem in part from drug reactions or the underlying illnesses.

“It’s a real chicken-and-egg sort of situation,” said Dr. Jane E. Garland, director of the Mood and Anxiety Disorders Clinic at BC Children’s Hospital in Vancouver, British Columbia.

Dr. Garland said some people could and did become agitated and unpredictable in response to the drugs, usually just after starting to take them or soon after stopping.

“But it’s hard to make a case for a withdrawal reaction here, because Prozac comes out of the system gradually,” she said.

The girlfriend, Jessica Baty, said in an interview on CNN that Mr. Kazmierczak took Prozac to battle anxiety and compulsive behavior but that it “made him feel like a zombie and lazy.”

She said that in the days leading up to the shooting he was not behaving erratically, as university officials had suggested.

Much of the debate over the side effects of antidepressants focuses on erratic behavior like the cautious college student who stabs herself or the good husband and father who buys a gun and shoots himself.

The drug labels warn about agitation and severe restlessness, and display a prominent caution that the medications increase the risk of suicidal thinking and behavior in some children and young adults.

Psychiatrists said Monday that stopping an antidepressant could cause effects like lightheadedness, nausea and agitation as the brain adjusted. Among the most commonly prescribed drugs, Prozac is the least likely to cause withdrawal effects because it stays in the system longest, the doctors said.

“A small dose of Prozac is what you might use to block withdrawal symptoms when you take a patient off one of the other drugs,” said Dr. Donald Klein, an emeritus professor of psychiatry at Columbia who has consulted with drug companies.

Sara Bostock, of Atherton, Calif., whose daughter committed suicide shortly after taking Paxil, acknowledged that the interaction between drug effects and underlying emotional distress was hard to untangle.

Ms. Bostock wrote in an e-mail message, “As an observer and suicide survivor, my main wish is that medical professionals, regulatory authorities and other scientists will examine closely the entire medical and treatment history of the perpetrators of these violent incidents in which innocent people are victims.”

She is a founder of, a Web site that has tallied 2,000 news reports of violent acts in which people were thought to be taking antidepressants or had recently stopped them.

“If it weren’t for us, many of these stories would be lost to oblivion forever,” Ms. Bostock said.

Psychiatrists say the debate on such side effects, particularly suicide in the last four years, has driven many patients from drugs that could help save their lives. The psychiatrists emphasize that patients should be closely monitored for changes in behavior when starting or tapering off a medication.

Advocates on both sides agree that catalogs of violent acts are not enough and that news reports are incomplete. Only more thorough investigation and careful tracking of drug side effects, they say, will clarify the links between drug treatment and violent behavior.

Dr. Michael Stone, a professor of clinical psychiatry at Columbia, maintains a database of 1,000 violent crimes, including mass murders, going back decades. In many cases the accused had stopped taking drugs for schizophrenia, Dr. Stone said.

“I only have a handful of cases,” he added, “where the person was on an antidepressant.”

Los antidepresivos son efectivos en el dolor neuropático

Pregunta Clínica: ¿Son los antidepresivos efectivos en el dolor neuropático?

Respuesta: Los antidepresivos triciclicos y la venlafaxina proporcionan alivio del dolor neuropático (NNT*= 3.6 y 3.1 respectivamente). Este efecto es independiente de cualquier efecto en la depresión. Hay evidencia limitada de la eficacia de los inhibidores de la recaptación de serotonina(IRS), podrían ser eficaces pero el numero de participantes fue insuficiente para calcular NNT sólidos.

*NNT= numero necesario a tratar para beneficiar a un individuo

Advertencia: El NNH* para los efectos adversos importantes, definidos como un evento que lleva a la retirada del ensayo, fue de 28 para la amitriptilina y 16,2 para la velanfaxina. El NNH para efectos adversos menores como somnolencia, mareos, boca seca y estreñimiento fue 6 para la amitriptilina y 9.6 para la venlafaxina.

*NNH = número necesario a tratap ra causar daño en un individuo.

Contexto: El dolor neuropático puede ser muy discapacitante, grave e intratable, causando angustia y sufrimiento en las personas, incluyendo disestesias y parestesias parestesias. Durante muchos años los antidepresivos se han utilizado para el tratamiento del dolor neuropático, y son a menudos el tratamiento de primera elección. No esta claro sin embargo, cual antidepresivo es mas efectivo, cual es el papel que pueden jugar los nuevos antidepresivos como los IRS o la velanfaxina en el tratamiento del dolor neuropático y que efectos adversos experimentan los pacientes.

Referencia: Saarto T and Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Reviews 2007, Issue 4. Esta revisión incluye 61 ensayos que involucraban 3,293 participantes

Versión española (previa) : Antidepresivos para el dolor neuropático (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4. Oxford: Update Software Ltd. Disponible en: (Traducida de The Cochrane Library, 2007 Issue 4. Chichester, UK: John Wiley & Sons, Ltd.).

PERLA No. 29, Febrero 2008 Autor Brian R McAvoy, Trad. Rafael Bravo