|
By Kelly
Patricia O'Meara
Andrea Yates' crime shocked the nation. Did mind-altering
drugs prescribed to treat her depression actually drive this young
mother of five to drown the children she loved?
Only weeks ago, Houston wife and mother Andrea Pia Yates methodically
drowned each of her five children. One by one
Yates forced her children, ages 6 months to 7 years, into the family's
bathtub and held their struggling bodies under the water until each
fell limp.
Whatever possessed the 36-year-old mother to commit these unconscionable
acts remains murky. Depression and postpartum syndrome topped early
speculation, but there has been little discussion about the possible
effects of the powerful
mind-altering drugs she was taking.
Although Texas District Judge Belinda Hill issued a gag order concerning
the case, family members have released disturbing facts about Yates'
psychiatric treatment that specialists say may account for her state
of mind at the time of the murders.
During a two-year period, Yates was prescribed four
extremely potent mind-altering drugs intended
to help her through two episodes of severe depression that began
after the birth of her fourth child.
The first of these psychopharmacological cocktails included Haldol,
an antipsychotic most often used to treat schizophrenia; Effexor,
an antidepressant very similar to selective serotonin reuptake inhibitors
(SSRIs); and Wellbutrin, a unique
antidepressant that has amphetaminelike effects.
ccording to Yates' husband, Russell, his wife appeared to respond
well to this treatment regimen and, after a short time, became her
"old self."
At the onset of the second episode of depression following the
birth of her fifth child, and the subsequent death of her father,
Yates again was prescribed a psychopharmacological cocktail. This
one contained Effexor and, at
the end, Remeron.
While information about the Remeron dosage was not made public,
Yates' husband has said that his wife was given Effexor at
a dosage nearly twice the recommended maximum
limit. Just days before the murders, the Effexor
was for some reason reduced to just slightly more than the recommended
maximum dosage of 225 mg per day and the Remeron was added.
Psychiatrist Peter Breggin,
court-qualified medical expert and author of numerous books, including
Talking
Back to Prozac and the recently released The
Anti-Depressant Fact Book, tells Insight:
"The mixture of Remeron and Effexor would tend to be extremely
agitating and certainly could lead to behavioral disturbances. The
mixture of Haldol, Wellbutrin and Effexor is unpredictable
in its effects. Haldol actually can cause depression,
and putting the three drugs together is somewhat experimental."
Breggin continues: "Haldol is a very blunting drug. It's difficult
to come to any definitive conclusions with so little data about
her state of mind at the time. However, Haldol is a drug that produces
what can only be referred to as a chemical lobotomy that tends to
make a person more docile and robotic."
Many Americans who have read or heard reports about this case have
little doubt that Yates was "out of her mind" when she
killed her children. What appears to be developing, however, is
an argument within the medical community about whether the mother's
homicidal state of mind was triggered by the depth
of her depression or by the mind-altering drugs prescribed to her.
Were these the actions of a severely depressed woman who "lost
it," or did the mind-altering drugs push this emotionally distraught
woman over the edge? Should the latter be established in the criminal
court, it could raise an even greater issue: Who was responsible?
Was it a chemically poisoned mother who carried out the crazed act,
the physician who prescribed the mind-altering cocktails or the
pharmaceutical companies that manufactured and marketed the treatment?
Only recently have pharmaceutical companies been held responsible
for violent behavior associated with their product lines of mind-altering
drugs. A case in point is a June trial in which a jury in Cheyenne,
Wyo., found that the antidepressant Paxil,
one of the newer SSRIs distributed by GlaxoSmithKline PLC, "can
cause some individuals to commit suicide and/or homicide."
The jury said Paxil caused Donald Schell,
a retired oil-rig worker, to shoot and kill his wife, daughter and
granddaughter before turning the gun on himself. Schell
had been on the mind-altering drug only two days.
The jury awarded surviving family members $8 million in damages,
finding that 80 percent of the fault lay with the drugmaker. Andy
Vickery of the Houston law firm of Vickery & Waldner, lead attorney
in the Wyoming case, has taken dozens of similar cases seeking to
hold responsible those dispensing and manufacturing these drugs.
"The important thing," Vickery explains, "is to
lay the responsibility
and accountability at the doorstep of those who
ought to have it and those who could and should do something about
it. Whether it's criminal or civil responsibility, there isn't a
lot of difference."
As Vickery puts it, "Look, if I give you a loaded gun and
for whatever reason it's likely that you're going to shoot someone,
then I'm an accessory before the fact of murder. Shouldn't the drug
company that's encouraging doctors to prescribe a drug and is aware
that these drugs cause adverse reactions be held responsible?
No one can believe that a mother would do such a thing. It's too
horrible. But the fact is these people get completely
out of touch with reality because
of these drugs. Unfortunately, in most of the cases that I get involved
with, we never know if the people committing the violence knew what
they were doing when they did it because they also killed themselves."
Although alcoholic-beverage distillers have yet to be held responsible
for the overwhelming number of fatalities resulting from alcohol
abuse, in many states bartenders are held civilly and criminally
liable when customers get drunk and cause automobile fatalities.
With the growing number of physicians and psychiatrists prescribing
mind-altering drugs and the alarming data filtering out about adverse
reactions to them, tort lawyers are asking if medically trained
dispensers of psychotropic drugs shouldn't also be held liable.
For example, Yates' psychiatrist, Muhammad Saaed, reportedly prescribed
at least one mind-altering drug (Effexor) at almost twice the maximum
recommended dose as part of a cocktail of mind-altering drugs that
also included Haldol and Wellbutrin during her first bout with severe
depression.
A cautionary note in the Physicians Desk Reference says Effexor
negatively interacts with Haldol. Apparently, Effexor hinders Haldol's
drug clearance by a factor of more than 40 percent and can cause
Haldol concentration levels to increase by nearly 90 percent, creating
toxicity.
Did Saaed know the contraindications associated with the cocktail
he prescribed? If the psychiatrist was unaware of the toxic mix,
would ignorance of
the potential poisoning make him any less liable
than if he had known and prescribed the mind-altering drugs anyway?
These are just a few of the questions Saaed may be asked should
he have to defend his treatment under oath.
According to Ann Blake Tracy, executive director of the International
Coalition for Drug Awareness and author of the recently updated
book Prozac:
Panacea or Pandora?, there is little doubt about Saaed's culpability.
Tracy, a doctor of health sciences specializing in adverse reactions
to serotonergic medications, tells Insight that "when doctors
start prescribing 'off label' outside the FDA [Food and Drug Administration]
guidelines, they run the risk of being sued for malpractice.
In the case of Yates, her psychiatrist already had her on superhigh
doses, and on the Monday before the tragedy he dropped the Effexor
back to almost the maximum dosage, then added Remeron.
It's well-documented that when doses are increased or decreased,
patients experience negative reactions. A great many of the court
cases, but certainly not all of them, are a result of the drastic
change in the medication."
According to Tracy, "There's a lot of science to demonstrate
that depression is
the result of an inability to metabolize serotonin,
but somehow the drug companies have got the world believing that
an increase in serotonin, rather than an increase in serotonin metabolism,
is what the depressed person needs. This is the exact opposite of
what research on depression shows and, if you look at the research
over the last 50 years it is clear that there has been a horrible
mistake.
There is such a wanton disregard for life. Why can't these doctors
at least read the package inserts so they know how to prescribe
the drugs properly? They're not supposed to prescribe over the maximum
doses, and they know that they are at toxic levels at that point.
That's why they have maximum-dose information; that's why the Food
and Drug Administration puts a maximum dose on the packaging. They
do it to show that over the allowable dose level, a person becomes
toxic and it's extremely dangerous."
When asked what questions she might have for Yates' psychiatrist,
Tracy tells Insight: "I'd want to know how he could have
ignored so many warnings and contraindications
in [reportedly] giving this poor woman this dangerous drug cocktail.
I'd also like to know which sleeping pill he uses to knock himself
out at night when those five children's faces run over and over
again through his mind?"
Harsh words? It appears this is just the beginning. Many who follow
such matters say that because of the high profile of the likely
trial of Yates for capital murder, it may turn into a landmark case
pitting the pharmaceutical giants against the medical practitioners
and vice versa, perhaps even dragging in the American Psychiatric
Association.
George Parnham, Yates' attorney, has reported that he will enter
a not-guilty plea on behalf of his client for reasons of insanity.
After meeting with Yates and speaking with psychiatrists that had
examined her, Parnham told reporters, "I've accumulated evidence
in the last 24 hours that strongly suggests that the mental status
of my client will be the issue."
Just what Parnham has discerned is anyone's guess, including whether
he'll defend his client by challenging the pharmaceutical companies
and his client's psychiatrist. In the meantime, sources close to
the case report that Yates still is being medicated. Saaed has turned
his files on Yates over to the court and has, to date, made no public
statement.
Insight
Magazine July 2001
| 