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« To do: Listen to Talk of the Nation | Main | New hot drug for depression: NS2359 »

We'll stop talking about this soon, I promise

I did, though, want to run this excerpt from WebMD. I think there's some interesting points made.

Mental Illness, Antidepressants, and Violence

Could the antidepressants that Cho was said to have been taking made him violent? No, [Robert] Irvin, MD, [medical director of a long-term residential treatment program that is part of the Bipolar and Psychotic Disorders Program at Harvard's McLean Hospital in Belmont, Mass] says.

It's not known whether Cho was taking antidepressants under a doctor's supervision, whether he was taking the medications properly, and whether he was taking some drug other than antidepressants.

"Certainly just being on an antidepressant does not increase your risk of engaging in violence," Irvin says. "Antidepressants causing increased risk of self-harm have been talked about, but there is much more evidence to support that they are effective in treating depression. The risk of self-harm is much greater when patients are left untreated."

Might underlying depression be to blame? Probably not.

"People who are hopeless, who don't experience any joy or happiness, their thoughts are far more likely to tend toward self-harm than harm to anyone else," Irvin says. "If they are moved to violence, they are far and away more frequently the victims."

There is a form of depression -- some think it a form of psychosis -- which doctors call "major depression with psychotic features." People with this kind of depression have delusional thinking -- such as believing everybody at their workplace is very clearly out to get them, perhaps by putting bugs in their offices in order to control them.

"If you are paranoid, perceiving you are threatened when you are not, you might be prone to violence," Irvin says. "But these are people who, if given a choice, would hurt themselves or flee before acting in an aggressive way toward others."

Victoroff agrees that paranoid individuals are more prone than others to commit violence.

"Someone who has a grossly distorted threat-perception system is more likely to commit violent acts," he says. "Humans respond to threat by flight or by fight. Those predisposed to respond with fight, who regard innocent people all around them as terribly threatening to them, will be prone to harm those innocent people."

Even so, Victoroff says, the majority of people suffering paranoia do not commit violent acts, so it's impossible to say whether a particular paranoid man or woman will become violent.

We tend to think that only mentally ill people would commit horrific crimes. But this may be false reassurance, Irvin says.

"One of the reasons we try to understand this aberrant behavior in terms of an illness is that it gives us a sense we can identify these people ahead of time. But just because the act is crazy does not mean the person suffered from a defined psychiatric illness," he says. "It is an ongoing debate whether these people need to be dealt with in the criminal justice system or the mental health system."

That's because there are two basic forms of violence: sudden, impulsive acts of aggression and premeditated violent acts.

"Premeditated aggression enters the realm of pathologic sociopathy -- and there is no good known treatment for sociopaths," Irvin says.

Sorry to make you link to Fox

Comments

I read a blog yesterday that said that the situation had we (the United States) not allowed someone with psychosis to be allowed a green card! I had a a bit of a rant on the subject in his comment section, I usually don't rant at people. Basically my point was how do you distinguish between violent people with psychosis or non-threating people with psychosis?

Ugh..my head is spinning again, that's why I don't blog about serious things usually, but I stay up to date my reading your blog.. you mix just enough good info with a few other things to keep my entertained and not get pissed off

What about violence that comes from unresolvable frustration? Unresolvable frustration leads to hopelessness, and when one can't stand the feelings anymore, what then?

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About

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Liz Spikol is senior contributing editor of Philadelphia Weekly. She writes the award-winning column The Trouble With Spikol, which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop. She also writes the paper's book review column, Lit Gloss. This blog -- named one of the Top 10 Bipolar Blogs of 2007 by PsychCentral -- is about mental illness policy, news, personal journeys and more.