A Better Defense For Andrea Yates

errorShortly before Houston area mother Andrea Yates drowned her five children in a bath tub on June 20, she was prescribed the mind-altering psychiatric drug known as Remeron. Yates' Remeron prescription was an addition to her prescription for another mind-altering psychiatric drug known as Effexor. Yates' destructive acts were not the first an individual has committed while taking psychiatric drugs. The Yates' case comes at an important juncture in the history of psychiatric medicine.

On February 13, 1998 Donald Schell, 60, of Gillette, Wyoming took two tablets of the psychiatric drug known as Paxil before he killed three family members and himself. Sometime in the early morning hour on that fateful day Schell shot his wife, daughter and 9-month-old granddaughter with a .22 calibre pistol. He shot his already wounded family members again with a .357 magnum before he took his own life.

More than three years later Paxil manufacturer GlaxoSmithKline (GSK) was order by a jury in a federal court in Cheyenne, Wyoming to pay the family of Donald Schell $6.4 million. The Schell family sued the world's largest drug company claiming that their Prozac-like antidepressant drug was the primary cause of Donald's murderous actions. Company documents revealed during the trial that GSK was aware that Paxil could induce suicidal thoughts in healthy volunteers put on the drug (Guardian, June 8, 2001). GSK lost its request for a retrial in August and is appealing the jury verdict in federal court in Denver.

A month after the verdict in the Paxil trial British-based GSK agreed with the Medicines Control Agency, the British equivalent of the Food and Drug Administration, that patients who take Paxil (known as Seroxat in Britain) may be at an increased risk for suicide soon after starting the drug. GSK agreed with the MCA's request to provide doctors and patients with a suicide warning with packets of the drug. The MCA has been requesting a similar suicide warning for the entire Prozac-class of drugs (including Celexa, Luvox and Zoloft) for over a year now (Guardian, July 10, 2001). This class of drugs does not include Effexor or Remeron but each of these drugs have similar impairing affects on brain function in patients.

The expert witness in the Paxil trial was British psychiatrist Dr. David Healy. Dr. Healy is one of the few psychiatrists in the world who has not shied away from publicly stating his belief that Prozac and other mind-altering drugs like it can cause suicidal reactions in patients and subjects. Dr. Healy estimates that at least 250,000 people world wide have attempted suicide because of Prozac alone. He calculates that at least 25,000 have succeeded (Guardian, May 7, 2001).

Although the mass media in the United States hasn't paid much attention to these breaking developments in the history of psychiatric drugs, the defense attorney's and supporters of Andrea Yates might want to.

The late August announcement by the National Organization for Women that the feminist organization was starting a fund to aid Yates's court room defense in her case sparked a national debate about the merits of defending an individual who committed such reprehensible acts against her own children. Yates' now stands charged with three counts of capital murder and could face the death penalty if convicted.

NOW's defense of Yates is that she was experiencing insanity induced by post partum depression, or depression experienced by new mothers. The organization's resolution on post partum depression at its 2001 national conference does mention the fact that Yates had a long history of taking multiple psychiatric drugs. The resolution doesn't include a word about the possibility that these drugs may have contributed to Yates' violent acts against her children. Also, the resolution states that Yates would likely be receiving psychiatric care instead of being imprisoned while facing capital murder charges if she were a resident of England. The resolution contains no mention of the fact that the MCA is requesting suicide warnings for all the of the Prozac-class of psychiatric drugs.

One individual who isn't backing down from bringing up Yates' prescriptions for two psychiatric drugs is Dr. Ann Blake Tracy of the Coalition for Drug Awareness in West Jordan, Utah.

"The chances of a new mother going into full blown psychosis is about 1 to 2 in 1000 (Tracy's numbers are confirmed by information about post partum depression in new mothers obtained at www.obgyn.net)," said Dr. Tracy. "The odds of insanity being induced by two psychiatric drugs are much greater." Dr. Tracy is an opponent of psychiatric drugging who has worked as a consultant and expert witness in lawsuits and trials surrounding psychiatric drugs, like the recent Paxil trial mentioned above, for nearly a decade. She has been in contact with the Yates family and Andrea's attorneys since the tragedy happened. Dr. Tracy's organization provides information for patients who wish to withdraw from psychiatric drugs. She also documents the stories of adverse reactions experienced by patients on psychiatric drugs in her book Prozac: Panacea or Pandora? She is currently writing three more books on patient experiences.

"Psychiatric drugs are much more likely to induce psychosis in new mothers than post partum depression is," said Dr. Tracy. "Most drug company warnings on their psychiatric drug labels state that at least 1 in 100 patients will experience what they like to call 'adverse events.' I think this is a euphemism for potential psychosis, or insanity. This is already 5 to 10 times greater than the odds of a mother coming down with full blown psychosis due to post partum depression. Yet study after study conducted by the drug companies shows that their drugs induce insanity in patients and subjects at rates higher than 1 in 100. When another drug is added to a patient's prescription the odds of inducing insanity double. That's what happened to Andrea Yates after Remeron was added to her Effexor prescription. Her psychosis was drug induced. Nobody is paying any attention to this."

Meanwhile, Dr. Peter Breggin describes the case of man on Remeron who murdered his wife in front of several witnesses in his new book The Anti-Depressant Fact Book.

"Vance was convicted of murder without his defense attorney bringing up the adverse affects of Remeron as a defense or even as a mitigating circumstance," writes Dr. Breggin. "Attorney's in criminals cases often have no idea that psychiatric drugs can contribute to abnormal, irrational, bizarre and destructive behavior." Dr. Breggin has written a report on Vance's behalf in the hope of convincing the judge in his case to reduce his sentence. Dr. Breggin has helped other criminal defendants who were on psychiatric drugs at the time they committed their crimes get lighter sentences, or what is known also a "Prozac Defense."

What about all of these drug company funded clinical studies Drs. Breggin and Tracy have cited throughout the Prozac era of the '90s and are still citing today? These studies demonstrate that the drug companies are fully aware of the harm their psychiatric drugs can cause, argues both Drs. Breggin and Tracy. More specifically, what do the published clinical studies have to say about the affects of Effexor and Remeron on patients and subjects, the two drugs Andrea Yates was using at the time she killed her five children?

The August 2001 Journal of Clinical Pharmacology published a study comparing patient response to treatment with either Effexor or Remeron. A total of 78 patients were put on Remeron and 79 were put on Effexor. One of the patients in the Effexor group committed suicide on the fifth day of the study. Other serious psychiatric symptoms included 13.2 percent in the Remeron group and 10.8 percent in the Effexor group experiencing failing memories. Emotional indifference was experienced by 19.7 percent of patients in the Remeron group and 18.9 percent in the Effexor group. Decreased duration of sleep, or insomnia, was experience by 10.5 percent of Remeron patients and 14.9 percent of Effexor patients. Increased duration of sleep was experienced by 19.7 percent of patients on Remeron and 16.2 percent of patients on Effexor. Sleepiness was experienced by 21.1 percent of patients on Remeron and 16.2 percent of patients on Effexor. Increased dream activity was experienced by 25 percent of patients in the Remeron group
and 16.2 percent of patients in the Effexor group. The above mentioned categories include many apparent sleep disturbances, all telltale signs for patients to get off drugs like Effexor and Remeron, argues Dr. Tracy. She believes sleep disturbances are the primary cause for insanity in patients.

Also, a letter published by a group of German doctors in the same issue of the Journal of Clinical Psychopharmacology describes an obese female patient who began experiencing hallucinations they believed were Effexor-induced. The group describes the woman as developing "complex, colored, moving, visual hallucinations (i.e. a fair-haired man with a dog, running ponies, a ghost, but also colored balls and other geometric figures) in the evening hours when she was alone in her room." Dr. Tracy believes that these doctors are describing a sleep disturbance brought about by Effexor.

A study published in the June 2001 Journal of Clinical Psychiatry involved switching depressed patients who had experienced treatment failure with either Prozac, Paxil or Zoloft to treatment with Remeron. Of the 101 subjects treated with Remeron in the study 43 did not finish the study, 26 due to adverse events and 17 for other reasons. Two experienced mania, or abnormal and potentially violent behavior, and three experienced aggravated depression. Also, 20 subjects reported nervousness and 11 reported insomnia. Dr. Tracy believes the nervousness category really means akathisia, or extreme restless agitation, which can lead to violence and suicide.

A study published in the September 1994 issue of the International Journal of Clinical Psychopharmacology describes a group of 34 patients put on Effexor. One patient experienced anxiety, one experienced convulsions and another committed an act of intentional injury, or possibly attempted suicide.

The studies the author has observed so far (and there are plenty of them out there, including 47 matches for clinical studies for Remeron and 129 for Effexor found in searches conducted at the University of Washington Health Sciences Library search engine) appear to confirm Dr. Tracy's argument that the psychiatric drugs Andrea Yates was on at the time she killed her children were more likely to have driven her insane than mere post partum depression. However, the main limitation of the published studies mentioned above and others is that they only provide the reader with an outline of what actually happened during the study. The published results of studies alone can never be enough to make a case in a court of law. It is difficult to figure out what is happening because each study uses different terminology to describe various side effects experienced by subjects. Also, many patients who drop out of these studies are not accounted for and are categorized using vague terminology like "lost to follow-up" or "failed to return." There is a reason for this.

"Pharmaceutical companies fund almost all of the drug research that gets published and they usually retain the right to withhold the information their researchers find that they don't want the public to see," said Keith Hoeller, a community college psychology instructor in Seattle. He edits the peer-reviewed journal Review of Existential of Psychology and Psychiatry. "These kinds of contractual stipulations also provide researchers with incentives to find the kind of results drug companies are looking for in the studies they fund."

The only way to find out what Effexor manufacturer Wyeth-Ayerst Laboratories and Remeron manufacturer Organon really know about the potential for their drugs to induce insanity in patients like Andrea Yates is to force them to reveal all of their documents on these drugs in court, says Dr. Tracy. Her position was vindicated in the Paxil trial in the Wyoming. Paxil manufacturer GlaxoSmithKline's own internal documents proved to be the decisive factor in the jury verdict and award in favor of the plaintiffs.

Perhaps it's time for Andrea Yates' defense attorneys and supporters to start paying attention to the arguments about the dangerous side effects of psychiatric drugs being made by Drs. Breggin, Healy and Tracy. They may find their chances of successfully defending Yates enhanced. If a prescription for one psychiatric drug could be found to be the primary cause of a multiple murder-suicide in a civil trial, then why couldn't it work as a defense in a criminal trial with a defendant who had been prescribed two psychiatric drugs?