Psychiatric prescribing of psychotropic medications may be contributory to mass public shootings (MPS).
- Increased use of psychotropic medications is associated with increased frequency of MPS.
- Non-psychiatric prescribing of these drugs is not strongly associated with overall MPS frequency.
- Psychotropic medications are associated with elevated rates of homicide, hence also associated with MPS.
- Perps receiving medications and psychiatric counseling are strongly associated, indicating mental health professionals are not catching warning signs.
- Over a quarter of a million at-risk and unmanaged adults are statistically likely to have “hostile” reactions from their drugs.
A note about data and correlations
Before going into a summary, much less the detailed data, know that this is not a one-problem-fits-all conclusion. There is no singular driver of MPS.
What is herein is an exploration of trends in how America is (mis)medicating the population and how it may well contribute to some/many MPS. The data is strong enough that we must incorporate how psychotropics are involved into any possible set of solutions.
The summary view
America takes a lot of brain meds. From the initial distribution of modern psychotropics (roughly speaking, 1980), we have gone from a largely unmedicated society to one where:
- 20% of adults are on such medications (23% of MPS perps used them).
- Over 6% of children and teens do, as well.
- 60% of those taking any, take two or more prescriptions.
This is not to decry these medications. There are certainly mental health disorders whereby the patient benefits from them. But they are not risk-free.
A Finnish study i of psychotropic medications and homicides shows that the former increases the latter. The rate of homicides committed by people rises 31% among antidepressant users, 45% with benzodiazepines (antianxiety). This pales in comparison to the 92% rise among opiate painkillers and folks swallowing extreme combinations. The fact, however unpleasant, is that fatal violence is a side effect of psychotropics medication.
But most people – about four in five ii – taking these drugs were not prescribed them by a psychiatrist. Most prescriptions for these drugs come from doctors untrained or undertrained in psychiatrics, who are not managing patients (and thus medical outcomes) in the way psychiatrists do. [ED: I once dated a lady whose general practitioner prescribed her Prozac to deal with PMS symptoms.]
The obvious outcome is that fewer and fewer people taking psychotropic medications, and suffering often violence-inducing side effects, are receiving routine therapy where medications and side effects are monitored.
One hypothesis we explore herein is that some fraction of the over-prescribed yet under-monitored psychotropic medication-taking population become mass public shooters.
Trends in Medicated Americans
Three interrelated factors are concerning:
- More people are taking these medications.
- More are doing so without monitoring by trained psychiatric professionals.
- More are talking multiple psychotropics without consistent precautions concerning interactions.
The reason this is concerning is that some categories of psychotropics have well-documented side effects of a violent nature. We previously documented the possible correlation between adverse reactions to medications and mass public shootings. Given a significant correlation between increases in MPS and perps who take psychotropics, the stronger (possible) correlation between adverse reactions of these medications and the rate of MPS, and the rise in the population taking these drugs without psychiatric monitoring, we may have cooked up a kettle of unrestrained violence.
Trends in Mass Public Shootings and Psychotropic Medications
The correlation between MPS perps on psychotropic medications is about 30%, which is statistically worrisome.
But the picture is more detailed than that.
Per the Violence Project MPS database, 33% of MPS perps on medications did not have prior counseling. Conversely, 67% of medicated perps did have counselling. Stated differently, medications without counselling appears to be less dangerous (though not danger-free) than actually getting hands-on therapy.
The obvious perspective is that people who had such significant mental health issues that they received counseling were also more likely to be disturbed enough to be a risk to the public. Taken a rhetorical step further, those who get drugs and therapy from psychiatric professionals may not be closely monitored enough by those pros. Psychiatrists appear to be missing signs or not referring patients to institutions aggressively enough.
Kids, Meds and School Shootings
It might be a different story for school shootings, but the data is too thin to state anything with certainty.
One cruel data point is that most K–12 school shooters are also young. The most active group for K–12 shootings is the age 13 through 18 bracket (mainly high school). This is also the group with the highest consumption of psychotropic meds.
This is not correlation. Why? Because there are too few of these events for reliable evaluation. The Violence Project’s MPS database has only 15 instances of K–12 shootings going back as early as 1992. We’ll avoid muddying the intellectual waters by trying to read trends into small and sporadic data.
But it is worth noting that children and teens are also getting psychotropic medications from non-psychiatry sources. Granted, the largest number of prescriptions are for ADHD and in the stimulant category, but even these are documented as having some violence-inducing side effects, though not at the same rate as antidepressants.
What to Make of Meds
- Psychotropic meds have potentially violent side effects.
- They are correlated with rates of MPS.
- The meds by themselves are less correlated than consumption of meds and receiving psychiatric therapy.
- Meds might be a driver of school shootings, but the data is too sparse.
The two weaknesses in the current medical industry in regard to MPS are that more people than necessary [yes, subjective] are taking the drugs, and psychiatric professionals are not managing their patients as well as they need to.
Let’s linger on that a bit.
As we showed in previous work on deinstitutionalization and mass public shootings, we depend on outpatient management of troubled souls. These folks, even under psychiatric care, are often unmanaged on a daily basis, and have been known to do cold turkey withdrawals from the medications their doctors thought would keep them stable.
It is this combo – lack of full-time monitoring. and over-reliance on drugs documented to instigate violent actions – that statistically correlate with rates of mass public shootings.
True, the majority of mass shooters don’t take prescription medications (at least, not that we know of), but the medical community is not actively involved in their care and watching for aberrant behavioral changes. The medical community needs to prescribe less and care more.
The question then is, “How much of a problem is this?”
The answer: substantial.
Let’s just look at adults taking antidepressants, which for MPS is the big cluster of medicated incidents. According to one study,vii about 0.65% of people taking these psychotropic medications had “hostile” events. According to 2017 data, 19.1% of adults take antidepressants. That equates to over 49,000,000 adults. With a 0.65% rate of “hostile” side effects, we have almost 323,000 at-risk adults. Given that 80% of psychotropic medications are prescribed by non-psychiatrists, we have over a quarter of a million at-risk and unmanaged adults who are statistically likely to have “hostile” reactions from their drugs.
Disturbing numbers and text from the literature
Who is taking what and how it is increasing
|Adults Taking Psychotropics||28%|
|2+ Medications per Patient||40%|
|3+ Medications per Patient||96%|
|Youths on Psychotropics||181%|
|Taking Antidepressants and Receiving Psychotherapy||-39%|
|Increases in usage from the various studies|
Here are the rates of increase in psychotropic medication use from the sundry studies referenced in the endnotes.
Text from all the academic papers ingested for this review
- “Patients often receive psychotropic medications without being evaluated by a mental health professional, according to a study last year by the Centers for Disease Control and Prevention (CDC).” [ii]
- Mental Health Disorder: A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior.
- “Most antidepressants are prescribed by primary-care physicians who may have limited training in treating mental health disorders… Almost four out of five prescriptions for psychotropic drugs are written by physicians who aren’t psychiatrists…fewer of their patients receive psychotherapy than in the past.” ii
- “Many people with mild depression are prescribed antidepressants even though they aren’t likely to benefit from the drugs… Clinical trials for four SSRI antidepressants found that the drugs didn’t perform significantly better than placebos in treating mild or moderate depression, and the benefits of the drugs were “relatively small even for severely depressed patients.” ii
- “Antipsychotics nearly tripled from 1995 to 2008… More than half of those prescriptions in 2008 were for uses with uncertain scientific evidence.” ii
- “Foster children are up to four-and-a-half times more likely to receive psychotropic drugs than other children covered by Medicaid.” ii
- Stimulant ADHD medication side effects: [iii]
- Most common side effects mentioned… mood disturbances (21%), with 54% reporting symptoms to be bothersome to very bothersome (so roughly 10% have bothersome+ mood disturbances).
- Forty-eight percent of the approximately 325 patients surveyed reported having experienced a side effect.
- “While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.” (2+ medications from often non-psychiatric prescribers.) [iv]
- 2% of adults had a major depressive episode, but 13.2% took antidepressants (nearly 2X). [v]
- 31% elevated risk of homicide with antidepressants, 45% for benzodiazepines (depressants, Xanax, Librium, etc.; though not antipsychotics). +92% opiate painkillers.
- “Youth psychotropic treatment utilization during the 1990s nearly reached adult utilization rates… Total psychotropic medication prevalence for youths increased 2- to 3-fold and included most classes of medication.” [vi]
- “On therapy and during the 30-day drugfree phase after taper had finished, 0.65% of patients had hostile events.” [vii]
- “In healthy volunteer studies, hostile events occurred in 1.1% of volunteers compared with zero taking placebo.” vii
- “In data from… pediatric trials, aggression was the commonest cause for discontinuation from the two placebo-controlled trials in depressed children. … 4% discontinued for aggression, agitation, or hyperkinesis [a coding term for akathisia], compared with zero in patients on placebo.”
- “For any manifestation of treatment induced activation (suicidal ideation or attempts, aggression, agitation, hyperkinesis, or aggravated depression) 8% discontinuations compared with 1% on placebo.”
[i] Study analyzes link between psychotropic drugs, homicide risk, University of Eastern Finland, 2015. Science Daily.
[ii] Inappropriate Prescribing, American Psychological Association, 2012.
[iii] Real-World Data on Attention Deficit Hyperactivity Disorder Medication Side Effects, Cascade, Kalali, & Wigal, 2010.
[iv] National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry, Mojtabai & Olfson, 2010.
[v] Antidepressant Use Among Adults: United States, 2015–2018, Brody & Gu, 2018.
[vi] Psychotropic practice patterns for youth – a 10-year perspective, Zito, DosReis, Gardner, Magder, Soeken, Boles, Lynch, & Riddle, 2003.
[vii] Antidepressants and Violence: Problems at the Interface of Medicine and Law, Healy, Herxheimer, & Menkes, PLoS Medicine, 2006.