The mental health issues hovering around the crash of Germanwings Flight 4U 9525 on March 24 ought not be a cause for the stigmatization of depressive disorders. There is, however, evidence that the pilot, Andreas Lubitz, was or had been on antidepressants. And this tragedy is an emphatic reminder that patients being treated with psychotropic drugs need to be aware of the possible side effects of these powerful medications and have easy access to mental health professionals.

Of course, these drugs can be lifesavers, but in a small segment of the population they can also be a wellspring of some very troubling ideas. One of the authors of this article can attest to this fact.

About a decade ago, I, Gordon Marino, sank into a serious funk. My family physician prescribed an antidepressant, the serotonin reuptake inhibitor (SSRI) Paxil. Within a couple of days, I began having repugnant thoughts and impulses. Having been in psychotherapy for a good part of my troubled life, I had developed enough introspective ability to realize these ideas were “not me,” but an adverse effect of the medication. I discontinued the drug and the horned ideas that were visiting me quickly vanished.

To be sure, we have heard people say that they never felt like themselves until they started taking an SSRI. But for some of us with different wiring, the same drugs can conjure demonic impulses.

As with other medications in this class, sertraline (Zoloft) comes with this warning:

“Call a physician right away if you or a person you know who is taking Zoloft has any of the following symptoms, especially if they are new, worse or worry you: thoughts about suicide or dying; attempts to commit suicide … acting aggressive or violent; acting on dangerous impulses …”

Suicide is a violent deed. It is self-murder, a form of homicide. If suicidal ideation bubbles up in a vulnerable segment of the population taking antidepressants, it is not too far-fetched to imagine that fantasies about hurting others might also arise.

Truth be told, whenever we hear about someone committing a seemingly random act of murder who is or was in therapy, we have to wonder: Were they on, or perhaps coming off, a regime of psychoactive medications? After all, we have no problem acknowledging that alcohol and street drugs can be a gateway to helter skelter. What about prescription pills?

Further complicating the matter, people suffering from anxiety and depression are often taking a veritable cocktail of potions. What percentage of those on powerful psychotropic drugs are being carefully followed? Today, the vast majority of meds are dispensed by general practitioners, who often lack an in-depth appreciation of the havoc some of these medications cause behind the brows.

Thoughts of suicide and violence are embarrassing; it is unlikely that young people, who are often shy to begin with, will volunteer that they are having impulses to hang themselves or use a gun. Instead, they might only confide, “I am feeling worse,” which can lead to an increase in the very medication that is the seed to their troubling thoughts.

Right now, all the palaver about mental health awareness, checklists, depression screening weeks, etc., is nothing but a Hollywood stage front. What good is awareness without resources? There are many locales in which it takes months to get in to see a psychiatrist. For instance, the small suburban college town in which we live has superb medical facilities — aside from the fact that it is well nigh impossible to get an appointment with a psychiatrist in a timely manner. And ironically enough, it is college-age people who, according to the black-box warnings, are most susceptible to these dangerous impulses.

All this is not to suggest that the antidepressants, which are highly efficacious in treating some forms of the blues, should be banned or further restricted. But we are too cavalier about these potent pills.

We need the means to monitor the inner lives of the 1 in 10 Americans who gulp antidepressants every morning with their orange juice as though they were as innocuous as a multivitamin. They are not.

 

Gordon Marino is a professor of philosophy at St. Olaf College in Northfield. Susan Marino is director of the Center for Clinical and Cognitive Neuropharmacology and assistant professor of experimental and clinical pharmacology at the University of Minnesota.