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September 30, 2015
Do SSRIs Increase Violent Crime by Teens and Young Adults?
Oxford, UK—A new study raises questions about whether the use of selective serotonin reuptake inhibitors (SSRIs) is associated with more violent crime in teens and young adults. A subgroup analysis of the cohort study, published online by PLOS Medicine, found an association in participants aged 15 to 24, but nothing significant for adults 25 or older. For the study, Oxford University researchers used matched data from the Swedish Prescribed Drug Register and the Swedish national crime register to compare the rate of violent crime by patients on SSRIs with the rate of violent crime in the same individuals while not receiving medication. Over the 4-year study period, they found that about 10.8% of the Swedish population—representing about 850,000 patients—was prescribed SSRIs; 1% of these individuals were convicted of a violent crime. Results indicate an overall association between SSRI use and violent convictions, with a hazard ratio of 1.19. In age-stratified analysis, meanwhile, associations between SSRI use and convictions for violent crimes were significant for individuals aged 15 to 24 years, with a hazard ratio of 1.43, but not for older patients. In addition, study subjects 15 to 24 years had higher rates of violent arrests, nonviolent convictions and arrests, nonfatal accidental injuries, and emergency contacts for alcohol problems while taking the depression medications. “These findings show an association between SSRIs and violent crime that varies by age group. They cannot, however, prove that taking SSRIs actually causes an increase in violent crime among young people because the analytical approach used does not fully account for time-varying risk factors such as symptom severity or alcohol misuse that might affect an individual’s risk of committing a violent crime (residual confounding). In addition, some people who committed a violent crime might have subsequently taken SSRIs to cope with the anxiety and stress of arrest (reverse causation),” according to an editor’s summary with the study. “The lack of a significant association between SSRIs and violent crime among most people taking SSRIs is reassuring; the association between violent crimes and SSRIs among individuals younger than 25 years is worrying,” the summary notes. Study authors call for validation of their findings but suggest that SSRIs’ risks and benefits be weighed before prescribing, adding, “From a public health perspective, this worsening of overall morbidity and mortality might argue against restrictions on the primary care prescribing of SSRIs as long as potential risks are disclosed.”
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