Citation

Fine EW. Am. J. Forensic Psychiatr. 2002; 23(3): 5-38.

Copyright

(Copyright © 2002, American College of Forensic Psychiatry, Publisher R. Shlensky)

DOI

unavailable

PMID

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Abstract

The drugs designated as SSRIs have become the psychopharmacological mainstay for the treatment of patients with major depression, and have also been found useful for the treatment of several other psychiatric disorders. Although they have not been demonstrated to be any more effective for the relief of depressive symptomatology than their predecessors, they have a significantly better adverse effect profile and are unquestionably better tolerated than the tricyclic and monoamine oxidase inhibitor antidepressants previously utilized. Since the introduction of Prozac (fluoxetine) in 1987, the SSRIs have been prescribed to millions of patients worldwide, and remain the most commonly utilized antidepressants in the psychiatrist's armamentarium. They are certainly not free from side-effects, and there have been reports in the literature of the occurrence of treatment-emergent violent behavior including homicide and suicide. This article discusses the frequency and nature of these incidents, and attempts to put them into a perspective that is important to clinical and forensic psychiatrists. Several landmark cases are described, and the role of expert witnesses in these cases is critiqued and discussed. It is concluded that while such cases are very unusual, and largely anecdotal, they cannot be ignored and each individual case requires careful and comprehensive evaluation on its merits.

Language: en

Keywords

adult; aged; alprazolam; behavior disorder; citalopram; depression; drug efficacy; drug induced disease; drug tolerability; fluoxetine; fluvoxamine maleate; homicide; human; incidence; male; monoamine oxidase inhibitor; paroxetine; reboxetine; review; serotonin uptake inhibitor; sertraline; suicidal behavior; symptomatology; tricyclic antidepressant agent; violence