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Antidepressants, benzodiazepines increase risk for committing homicide

Use of painkillers and benzodiazepines significantly increased risk for committing homicide among individuals convicted of homicide, while antidepressant use moderately increased risk, according to a prospective cohort study.

“It has been repeatedly claimed that it was the antidepressants used by the persons who committed [school massacres] that triggered their violent behavior,” study researcher Jari Tiihonen, MD, PhD, a professor at the Karolinska Institutet in Stockholm, Sweden, said in a press release. “It is possible that the massive publicity around the subject has already affected drug prescription practices.”

To determine if antidepressant use increased risk of committing homicide, Tihhonen and colleagues assessed medication use among 959 individuals convicted of homicide between 2003 and 2011, using data from the nationwide Finnish Prescription Register. Researchers matched 10 population controls to each offender.

Adjusted analysis showed an adjusted relative risk for homicide of 1.31 (95% CI, 1.04-1.65; P = .022) when comparing current use of antidepressants vs. non-current use. For benzodiazepines, the adjusted relative risk was 1.45 (95% CI, 1.17-1.81; P = .001) for current use vs. non-current use. The adjusted relative risk for antipsychotics was 1.1 (95% CI, 0.82-1.47; P = .54) for current vs. non-current use of antipsychotics.

Current use of opioid (RR = 1.92; 95% CI, 1.36-2.72; P < .001) and non-opioid (RR = 3.06; 95% CI, 1.78-5.24; P < .001) analgesics increased risk for committing homicide, according to adjusted analysis.

A case-control analysis indicated current use of antidepressants had an adjusted overall risk of 1.3 (95% CI, 0.97-1.75) vs. 2.52 (95% CI, 1.9-3.35) for benzodiazepines, 0.62 (95% CI, 0.41-0.93) for antipsychotics and 2.16 (95% CI, 1.41-3.3) for opioid analgesics.

“These results … imply that the use of antidepressants should not be denied to either adults or adolescents due to a presumed risk of homicidal behavior. The surprisingly high risk associated with opioid and non-opioid analgesics deserves further attention in the treatment of pain among individuals with criminal history,” Tiihonen and colleagues wrote in World Psychiatry. – by Amanda Oldt

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