SSRIs Linked to Raised Violent Crime in Some Patients

Selective serotonin reuptake inhibitor users have a greater tendency to commit violent crime. The effect could last up to 12 weeks after stopping the treatment. This work is published in the peer-reviewed journal European Neuropsychopharmacology.

First author Tyra Lagerberg at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, said:

‘Identifying individual characteristics might give someone a higher risk of committing violent crimes during SSRI treatment.’
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“This work shows that SSRI (selective serotonin reuptake inhibitor) treatment appears to be associated with an increased risk for violent criminality in adults as well as adolescents, though the risk appears restricted to a small group of individuals. We don’t claim that SSRIs cause the increased risk we see in our data. It is possible that the disorders that SSRIs are prescribed to treat, such as depression, are driving the association.

In that case our findings may mean that SSRIs are unable to fully remove this tendency towards violent crime, which is also a potentially important insight. Previous work has found an association between SSRI use and violence in young individuals, but not in adults. Ours is a much bigger study which allows us to confirm that there is an association in adults as well”.

The study was done after analyzing the records of 785,337 people between 15 to 60 years who were prescribed an SSRI in Sweden in 2006 till 2013. The patients were followed up for around 7 years. Subjects in the study were found to have committed 6306 violent crimes while taking SSRIs, and 25,897 when not taking SSRIs.

The risk of committing a violent crime was around 26% higher during periods when individuals took SSRIs compared to periods when they did not, though only a small proportion of individuals went on to commit violent crimes regardless of treatment (<3% in the study sample).

Due to the rarity of violent crimes, periods of SSRI medication are expected to coincide with only a small increase in the rate of this event. When the researchers subdivided the study follow-up according to time since start and end of SSRI treatment, they found that the risk for violent crime was higher throughout treated periods.

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The increased risk also persisted for up to 12 weeks after the estimated end of SSRI treatment, after which the risk returned to levels before start of SSRI treatment. The researchers showed that the association between SSRI treatment and violent crime existed in young adults as well as in adults aged up to 60 years (the study did not investigate the association in adults older than 60 years). However, only 2.7% of individuals in the study committed violent crimes during the study period, meaning the increased risk applied to a small subgroup of SSRI users.

Tyra Lagerberg commented:

“Previous studies have shown that depression itself is associated with a 3-fold increase in the risk for violent crime, and of course many SSRIs are prescribed for depression; so it may be the underlying depression that causes the association with violent crime, rather than any effect of the SSRI. More work is needed to uncover the causes of this association.

Our results suggest there may be a need for clinical awareness of the risk for violence during and possibly after SSRI treatment across age groups. However, a large majority of SSRI-users, around 97% in our sample, will not experience the outcome of violent crime, so our work needs to be understood in this context.

Our findings do not affect the vast majority of people taking antidepressants and should not be used as basis for individuals to stop their SSRI treatment, nor for prescribers to withhold treatment from individuals who might benefit from it.

Nevertheless, clinicians should be attentive when prescribing SSRIs to individuals with aggressive tendencies. More work is necessary to identify what further individual characteristics might give someone a higher risk of committing violent crimes during SSRI treatment, regardless of whether the risk is increased because of the SSRI or because of the underlying disorder that indicates an individual for treatment with these medications".

An associated commentary, explores possible explanations for the increase. Lead author, Professor Eduard Vieta (University of Barcelona) said:

“This observational study presents a firm basis for further investigations on SSRI use and criminality. However, as the authors themselves say, we need to emphasise that the study shows an association between violent crime and SSRI use in a small subset of patients, it doesn’t show that one causes the other.

The study also shows that past offenders were more likely to commit a violent crime during SSRI treatment: this in itself is an interesting finding, which could be the main focus of future research on the topic”.

Source-Medindia