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Study shows significant association between SSRIs, violent crime in young adults

Study findings in PLoS Medicine indicate a significant association between selective serotonin reuptake inhibitors and violent crime convictions among individuals aged 15 to 24 years, however, the finding requires further research.

“Despite a number of legal cases linking SSRIs and violent behavior, empirical research on the association is limited and inconclusive. Ecological studies suggest that increased SSRI prescriptions have been associated with decreases in violent crimes in the U.S. and lethal violence in the Netherlands. In contrast, an expert review of clinical trials concluded that there was an excess of violence in both adults and children on SSRIs compared with placebo,” Yasmina Molero, PhD, of the Karolinska Institutet in Stockholm, and colleagues wrote. “Furthermore, drug safety (or pharmacovigilance) data have shown a disproportionate association between SSRIs and violent behaviors and serious violent acts, and an observational study found an association of work-related violence with antidepressant purchases.”

Researchers applied stratified Cox regression analyses to data from Swedish national registers for 856,493 individuals prescribed SSRIs, to compare the rate of violent crime from 2006 through 2009 while individuals were prescribed SSRIs.

Researchers found an overall association between SSRIs and violent crime convictions (HR = 1.19; 95% CI, 1.08-1.32).

When stratifying age, there was a significant association between SSRIs and violent crime convictions among individuals aged 15 to 24 years (HR = 1.43; 95% CI, 1.19-1.73). However, researchers did not find significant associations among individuals aged 25 to 34 years, 35 to 44 years or 45 years and older.

Researchers also found associations between SSRIs and violent crime arrests with preliminary investigations (HR = 1.28; 95% CI, 1.16-1.41), non-violent crime convictions (HR = 1.22; 95% CI, 1.1-1.34), non-violent crime arrests (HR = 1.13; 95% CI, 1.07-1.2), non-fatal injuries from accidents (HR = 1.29; 95% CI, 1.22-1.36) and emergency inpatient or outpatient treatment for alcohol intoxication or misuse (HR = 1.98; 95% CI, 1.75-2.21) among individuals aged 15 to 24 years.

When stratifying for sex and age, there was a significant association between SSRIs and violent crime convictions for males (HR = 1.4; 95% CI, 1.13-1.73) and females (HR = 1.75; 95% CI, 1.08-2.84) aged 15 to 24 years. There were no significant associations among individuals aged 25 years and older.

The researchers noted a significant limitation to the study in that they were unable to fully account for time-varying factors.

“There are two principal clinical implications arising from this study. First, no association between SSRIs and violent crime convictions was found for the majority of people who were prescribed these medications, including individuals aged 25 years and older. Second, the risk increase we report in young people is not insignificant, and hence warrants further examination,” Molero and colleagues wrote. “If our findings related to young people are validated in other designs, samples, and settings, warnings about an increased risk of violent behaviors while being treated with SSRIs may be needed.” – by Amanda Oldt

Disclosure: Molero reports no relevant financial disclosures. Please see the full study for a list of all researchers’ relevant financial disclosures.