They told me the 80 year old man who’d had a stroke must be depressed – he wasn’t rehabilitating properly. Could I see him and look at whether the citalopram he’d been started on a week before needed tweaking?
Jeff was solidly middle class, professional. He had never been ill before his stroke and never ever been mentally ill. He had a large loving close-knit family who came to see him every day. He didn’t seem depressed to me. I stopped his SSRI and said I would come back in a week to see how things looked – perhaps his depression would be more obvious then.
A week later, Jeff seemed much better than he had been on citalopram. He clearly didn’t need an antidepressant – if he wasn’t rehabilitating it was because of where his stroke had struck.
‘While on those pills I had a terrible urge to get up and strangle him. I’ve never seen him before.’
I got up to leave just as his family came in. He grabbed my arm. ‘I’ve something to tell you before you go. You see the man across the room’. There was another older man confined to his bed.
‘Well while on those pills you know I had a terrible urge to get up from my bed in the night and go over and strangle him. I don’t know why. I’ve never seen him before. Those feelings have gone since you stopped my pills.’
This makes it about as Evident as you can get that SSRIs cause violence. The only thing possibly more convincing would be data from healthy volunteer studies where aggressive episodes have been relatively common (see Mystery in Leeds).