SSRI Stories note: The Physicians Desk Reference states that Paxil can cause psychosis, both while taking it and during withdrawal.
May 24, 2010, Law and Crime
Ambien, delusions, and violence: Is there a link?
Can Ambien use lead to violence?
Published on May 24, 2010
There is nothing more welcome than a good night sleep-and no one knows this better than the millions of Americans who struggle with insomnia. Many turn to prescription medications, especially Ambien, one of the most popular sleep aids. Some users know about the rare side effects associated with Ambien use-sleep-walking, sleep-driving and sleep-eating-but few are aware of the more dangerous side effects.
On April 27, 2010, 26-year-old Air Force veteran Derek Stansberry boarded Delta Flight 273 from Paris to Atlanta. According to press reports, he passed a note to flight attendants that said, " Forgive me, I fu***d up, I am sorry… My passports and identity are fake… Please let my family know the truth." He wrote he had brought dynamite aboard in his boots and laptop (CNN.com, 4/28/10).
Mr. Stansberry was overpowered by air marshals and the plane was diverted to the Bangor International Airport in Maine. No explosives were found on the plane. Mr. Stansberry was arrested and charged with knowingly giving false information and interfering with a flight crew.
Mr. Stansberry had no history of violence or mental illness and his behavior that day was apparently out of character. He had served in Afghanistan and Iraq from 2005 to 2009 as a senior airman and an intelligence specialist and was honorably discharged. At the time of this strange incident he was working for a contractor in Africa.
Newspaper reports indicate that Mr. Stansberry was acutely psychotic when he was taken into custody. He told FBI agents that he believed that the passengers were talking about him and that he was being followed. He also told the agents that he had taken Ambien.
These events sounded almost too far-fetched to believe. But as a forensic psychologist, I never doubted that the press reports were genuine. I once evaluated a defendant who took Ambien and behaved in a bizarre and unexpected way. While no one was injured by Mr. Stansberry's apparently Ambien-induced psychotic episode, the defendant I evaluated had, in fact, acted violently.
The defendant, whom I will refer to as Mr. Abrams for the sake of protecting his identity, was arrested for killing his wife. Mr. Abrams and his wife were living with his parents at the time of the offense. His mother called the police after he stumbled downstairs, mumbling incoherently, "Something's wrong, Ma." When the police entered the downstairs living room, they found a dazed-looking Mr. Abrams slumped in a chair. The officers climbed the stairs to the bedroom, where they found his wife dead on the floor. She had been stabbed over twenty times. There was no sign of forced entry and the killer's identity was never in doubt.
I was hired by Mr. Abrams's attorney to conduct an evaluation of his mental state at the time of the offense. I was to determine whether he was insane, or "not responsible." By law, a defendant lacks criminal responsibility if at the time of the offense, "as a result of mental disease or defect, he lacked substantial capacity to know or appreciate either: 1. The nature and consequences of such conduct; or 2. That such conduct was wrong." (Criminal Law Handbook of New York, 2008, 18-19).
Mr. Abrams claimed to have no memory of the crime. In my 25-year career as a forensic psychologist I have found it very unusual for a defendant to genuinely be unable to recall committing a violent crime. Most of the defendants who tell me "I can't remember" are lying. Research indicates that genuine amnesia usually occurs only in the event of a brain damage, severe head trauma, sedative drug use or alcohol abuse. Emotional trauma has been linked to a different type of amnesia. Individuals may be psychologically unable to recall an overwhelmingly traumatic event. Freudian theory explains how individuals use the defense mechanism of repression to protect themselves against posttraumatic stress. This kind of psychological amnesia usually last for a few hours or days.
I interviewed Mr. Abrams many times and administered a battery of psychological tests. I never uncovered a rational motive for his violent attack on his wife. He had no criminal history. He did, however, have a long history of psychiatric treatment for depression. On two occasions he was admitted for treatment with electroconvulsive therapy (ECT). He had fallen into his third deep depression about six months before his arrest for murder. His psychiatrist prescribed Paxil, an antidepressant, and Ambien. The medications were ineffective and his depression worsened. He had one ECT treatment only three days before he allegedly killed his wife.
I spoke with Mr. Abrams' family to get a picture of what he was like in the days and weeks before he killed his wife. His sister's memories were the most distinct. She was convinced that her brother's mental state was deteriorating and that he was psychotic. "He asked me the strangest question," she said. "He asked me whether I was afraid of his ex-wife. Then he went off rambling about her voodoo books. He told me he was afraid of those books." She also believed her brother was hearing voices.
After completing the forensic evaluation, I became convinced that Mr. Abrams was severely depressed and psychotic at the time he killed his wife. Although I could not explain his amnesia, I believed his story. I concluded that he was insane or "not responsible." Then I recommended to his defense attorney that he retain a forensic psychiatrist.
To be continued next week. This case is included in my book The Measure of Madness: Inside the Disturbed and Disturbing Mind.