Antidepressants

Pills Don’t Kill People, Untreated Depression Does

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Recently, after every mass shooting (such as the July 4 shooting this past weekend), news organizations have pointed to mental illness as the cause of the mayhem. Fine. They go one step further, though, and indict the medications the shooter was taking at the time he opened fire. “The perpetrator was reportedly taking an antidepressant medication, which may have led to the mass shooting.” Whenever I hear this, I am reminded of the attack on guns.

Predictably, whenever someone with a gun kills someone else in the United States, all we hear is more calls for gun control, and uninformed attacks on firearms. “If only we had common-sense gun laws, this tragedy would not have happened.” We never heard calls for SUV control after the Waukesha murders last Christmas. Why? Guns and psychiatric medications have become scapegoats for societal problems caused by liberal and left-wing politicians, problems they refuse to take accountability for.

People kill because they are bad people, and because they can. Guns are irrelevant. In fact, the presence of armed citizens is a deterrent to both individual and mass shootings. One reason why schools are frequently targeted by those who wish to murder is that most schools are gun-free zones (except for the murderer, of course). Israeli learned this lesson in 1974, when three Palestinian terrorists murdered 22 children in the town of Ma’alot. After the massacre, Israeli fortified its schools and armed its teachers. There have been no school shootings in Israel since then. In the U.S. today, we have removing armed guards and prohibiting teachers from carrying concealed weapons, exactly the opposite of what Israel did. And yet we continue to blame guns as the cause of the problem.

We also blame anti-depressants. The Uvalde murderer was reportedly taking medication for depression, as was the July 4 parade murderer. Clearly, the anti-depressant is responsible for the killings, as much as the gun is. This is lunacy. And it all started in 2004 when the FDA issued a black-box warning on antidepressants.

A study at the time found that antidepressants were associated with a 4% risk of suicidal thinking or behavior, compared with a 2% risk of suicidal thinking or behavior in the placebo population. None of the suicide attempts in the study were fatal. Following the black box warning, though, prescriptions for antidepressants cratered. Primary care doctors, in particular, became concerned about liability and decided to simply stop treating depression in their patients. Predictably, deaths from suicide increased. Child suicide rates that had been declining for two decades began to rise again. By the time the FDA reversed its black box warning in 2007, over 600 children had died due to suicide. It turns out that the number one risk for suicide is untreated depression—not antidepressant use.

Just as the greatest risk of gun violence is in places where guns are banned, the greatest risk of suicide is in populations where antidepressant treatment is restricted or unavailable. As a child and adolescent psychiatrist, I certainly do not see medication treatment as a panacea for mental illness. All evidence shows that a combination of therapy and medication is the most effective treatment for severe depression. We have to live in the real world, though, where access to competent therapy—or any therapy at all—is hard to come by. Since the government began locking down the people over two years ago, the landscape for therapy has worsened considerably. Many therapists have either closed their doors, moved away, or began to refuse to see patients in-person. I believe that any therapist (or medical doctor) who refuses to see a patient in-person should have his or her license suspended as a consequence of failing to honor the ethical obligations of the profession. I have jettisoned at least 80% of my therapist referrals for this very reason. I am not only disappointed by the foolishness and cowardice of the majority of my colleagues: I hold them in contempt. I see them no differently than a police officer would see his partner, sworn to serve and protect, turn and run at the sound of gunfire. Just as the cowardice of the Uvalde police led to the deaths of 19 children and two teachers, the cowardice of therapists and physicians throughout the United States has led to the deaths of thousands, if not tens of thousands, of innocents. And I am disgusted by it.

Let’s stop attacking guns. Let’s stop attacking antidepressants. Neither is responsible for the deaths, the suicides, the loss of life. Guns and prescription medications are tools. When used properly, they save lives. Their misuse should not lead to their removal, no more than the misuse of an SUV, a knife, or an airplane flown into a skyscraper. If we truly want to go after “root causes” of murder and suicide, we must look no further than family breakdown, the proliferation of illegal drugs, and the attacks on legal gun ownership. These problems are nearly universally caused by one political party in this country. This November, we have an opportunity to remove every last one of them from office. I hope we succeed in that endeavor.

Mark McDonald, M.D.
Psychiatrist and author of United States of Fear: How America Fell Victim to a Mass Delusional Psychosis