Stopping treatment for mental illness can be dangerous

The shooter at NIU had recently discontinued using his medication.

.CHICAGO (AP) – Psychiatrists say it’s a common scenario – troubled patients stop taking their medicine, because of cost, side effects, the stigma, or delusions that they don’t need it. The consequences can be tragic, though rarely as horrific as the Valentine’s Day suicide-slaughter at Northern Illinois University.

No one knows what triggered Steven Kazmierczak’s campus rampage, yet one of the clues to an emerging psychiatric profile is this: His girlfriend says he recently stopped taking Prozac.

Prozac is a drug generally prescribed for major depression. It and similar antidepressants carry warning labels about risks for suicidal behavior in patients younger than Kazmierczak, who was 27.

Still, stopping these drugs can also lead to suicidal thoughts and behavior. And taking them may increase the risk for other violence if they’re mistakenly prescribed as the only treatment for patients in a depressive phase of bipolar disorder, psychiatrists say. In that case, the drugs may trigger a manic phase that could include aggressive behavior toward others.

In court cases, attorneys have sometimes tried to blame violent behavior on Prozac. However, scientific evidence to support that is lacking, and psychiatrists and the drug’s maker, Eli Lilly and Co., say the underlying mental illness is the most likely culprit.

Kazmierczak, a graduate student in social work at the University of Illinois, was a worrier with obsessive-compulsive tendencies, his girlfriend told CNN, but it is not known if he’d been diagnosed with depression or bipolar disorder. She said he’d stopped taking Prozac three weeks before last week’s tragedy.

Two days before the Feb. 14 shootings, a New York man who’d been treated for psychiatric problems and who had also stopped taking medication is accused of fatally stabbing a therapist.

“Can stopping medications be an important contributory factor to deterioration of behavior … where violence ends up being committed? Yes, absolutely,” said Dr. Paul Ragan, an associate professor of psychiatry at Vanderbilt University.

Ragan said he has had patients attempt suicide after stopping antidepressants because their insurance ran out, although violence against others is rare in depression.

On or off medication, the vast majority of people with schizophrenia, depression and bipolar disorder “do not engage in violent behavior,” said Dr. David Fassler, a University of Vermont psychiatry professor.

Still, compliance with medication is a significant problem, he said.

“Research demonstrates that about 25 percent of patients stop taking antidepressant medication within three months. By six months, some studies suggest that the overall compliance rate is less than 50 percent,” Fassler said.

For about one-third of patients, side effects are the main reason they stop taking psychiatric drugs, Fassler said.

Dr. Lynne Tan, a psychiatrist at Montefiore Medical Center in New York, said many patients complain that antidepressants cause restlessness, agitation and racing thoughts. Sweating, sexual dysfunction and headaches are other common side effects. Sometimes they subside over time, and if not, patients can be switched to other medications, she said.