It was May 1998, and comedian Phil Hartman and his wife, Brynn, were planning a party. Their son, Sean, was soon turning 10 and they wanted to make it special with a bash at Planet Hollywood. Brynn was inviting her son's friends, including some of his classmates from his school in Encino.
In mid-May she called Kathryn Alice, the mother of one of Sean's friends, to get her address. Sean and Calvin, Kathryn's son, played together and had visited each other's homes. Through their sons, the moms had gotten to know each other, too. They chatted on the phone, and Brynn confided that things were tough. "She said she was barely hanging on by a thread," Alice recalls. "I told her things will get better, but she said 'I don't know.'"
The invitation soon arrived in the mail, but the birthday party never happened. On May 28, at about 2:30 a.m., Brynn Hartman returned home from a night out with a female friend. As Sean and his sister, Birgen, slept in their rooms, Brynn entered the master bedroom and shot her sleeping husband three times. Four hours later, with police in the house and friends listening outside, Brynn lay down on the bed next to Phil's body and pulled the trigger once more, killing herself.
How could this happen? Why did a woman who was, by all accounts, a devoted and protective mother, deprive her children of their parents? In the days after the killings, the tabloids and mainstream press ruminated over the problems in the couple's often stormy relationship, speculating that Phil was preparing to leave her, or that she had relapsed into an old cocaine addiction. People magazine reported that she had recently started drinking again after 10 years of near-sobriety and had checked into an Arizona rehab clinic earlier in the year. Indeed, toxicology reports cited in press accounts indicate that at the time she died, Brynn Hartman had both cocaine and alcohol in her system.
But the couple's family and their lawyers have another answer: Zoloft made her do it.
In late May 1999, one year after the deaths, attorneys for the Hartmans' estate and children filed a lawsuit against Pfizer, the pharmaceutical giant that makes Zoloft, a new-generation antidepressant similar to Prozac. The suit contends that Brynn Hartman's violent outburst was caused by a rare but previously documented side effect of the medication that left her agitated, jittery and "out of touch with reality." It is one of more than 170 wrongful death lawsuits filed against the makers of these new antidepressants since Prozac first hit the market 12 years ago.
The Hartman suit also charges that Arthur Sorosky, the psychiatrist that supplied Brynn Hartman with Zoloft, was not really her doctor and never conducted an evaluation. Sorosky, the complaint alleges, was actually her son Sean's doctor and gave Brynn medication samples -- the kind doled out to physicians by drug company salesmen -- "without the benefit of a history and physical examination [or] diagnosis."
Sorosky's attorney, Joel Douglas, told Salon Health that his client and Brynn Hartman had "a doctor-patient relationship" and that Sorosky had prescribed the Zoloft in a proper and appropriate way. "From what I understand," he added, "with cocaine and alcohol in her system, you don't need to look for Zoloft to understand what happened."
But Zoloft and Prozac -- along with other similar antidepressants -- are being blamed for hundreds of violent deaths, including these:
- July 1997: Thirteen-year-old Matthew Miller of Overland Park, Kan., kills himself in his closet one week after he begins taking Zoloft. According to his father, Mark Miller, Matthew had been moody and withdrawn for about nine months -- the result, Miller believes, of the family moving to a new neighborhood and Matthew starting at a new school. In June, his parents took him to a psychiatrist. The doctor, accompanied by two medical students in training, talked with Matthew and his parents, but Matthew had little to say. When they met again three weeks later, one thing Matthew did tell him -- in response to a question -- was that he would never consider suicide. The doctor ruled out attention deficit disorder, but offered no other diagnosis to the Millers. But he did give them a three-week supply of Zoloft to try, and told them to check back in a week. Seven days later, members of Matthew's family noticed that he seemed agitated. That night, he took his own life.
- Feb. 19, 1997: Patricia Williamson, 60, of Beaumont, Texas, stabs and slashes herself more than 100 times in the bathtub while her husband eats breakfast in their kitchen. On the advice of a psychiatrist, she had begun taking Prozac six days earlier to help her through a depression that had arisen just a few months before. Her husband, hearing strange noises in the bathroom, pried open the door and found his wife of 20 years semi-conscious in a pool of her own blood. She died the next day in the hospital. Lawyers for Eli Lilly, the pharmaceutical giant that makes Prozac, recently reached an out-of-court settlement in the case.
- March 1996: Daryl Dempsay, 35, stabs his wife and two children at their home in Burlington, Kan., then shoots and kills himself with a .22-caliber rifle. His wife and children survive, and have charged in a recently filed suit against Pfizer that Dempsay's violent outburst was caused by an adverse reaction to Zoloft, which he had been taking for several weeks.
What would cause these people to become so violent or suicidal? The surviving family members and their lawyers -- along with some experts and anti-psychiatry activists -- contend that this volatile behavior is an extreme manifestation of a rare side effect of the new antidepressants.
The side effect, called akathisia, creates a feeling of distress, agitation and restlessness that leaves people jittery and unable to sit still or to stop shaking their legs. "In its milder form," wrote Pfizer scientist Roger Lane in a journal article published last year, "it is experienced as a vague feeling of apprehension, irritability, dysphoria, impatience or general unease."
"Akathisia is like being tortured from within," says Peter Breggin, a Maryland psychiatrist and prominent critic of Prozac and other psychiatric medications. "It's like the screeching of chalk down a board, only it's going down your spinal column.
"This agitation or akathisia drives a person into extreme states of irritability, anger, and frustration," Breggin continues. "People can become more depressed and more despairing; their impulse control loosens and they do stupid things. So the violent impulses that an ordinary person would control come pouring out or even appear for the first time."
In his article, Pfizer's researcher Lane described the suicide risk of SSRIs -- selective serotonin reuptake inhibitors, the class of drug to which Prozac and Zoloft belong -- in this way: "It may be less of a question of patients experiencing ... suicidal ideation, than patients feeling that 'death is a welcome result' when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders."
Lane's article focused specifically on akathisia and other similar side effects caused by SSRIs. Yet the word "akathisia" never appears in the package insert for Zoloft that is supposed to inform doctors about the risks and side effects of medication. And while akathisia is mentioned as a rare side-effect in the Prozac insert, both companies continue to publicly underplay the risks.
"This is an old story, it's gone around and around," says Jeff Newton, a spokesman for Eli Lilly. "But there's ample evidence that Prozac is in no way linked to these kinds of violent behavior." In fact, he added, Prozac reduces aggressive behavior and may lower the risk of suicide.
Pfizer representative Celeste Torello rejected the notion that Zoloft had any role in causing suicides or violence. "There's no scientific or medical evidence that Zoloft causes violent or suicidal behavior," she told Salon Health. "At this point, there have been over 90 million prescriptions written and there hasn't been any evidence that it causes anything close to what Brynn Hartman did." (When asked why Roger Lane, her own company's scientist, discussed akathisia in his journal article but the company included no similar information in their package inserts, she declined to comment due to the pending lawsuit.)
To Andy Vickery, the lead attorney in the Hartman case and the other cases mentioned above, the failure of Pfizer and Eli Lilly to adequately warn doctors and patients about the possible risks constitutes gross negligence. "They withhold critical information from prescribing physicians, the public and the patients," he says -- information that would help doctors and patients recognize the symptoms of akathisia in time to do something about them.
Eli Lilly's contention that Prozac is safe is bolstered by two jury verdicts in the company's favor -- one several years ago in a Louisville, Ky., case and the other earlier this year in Hawaii. In the Hawaii case, a jury cleared the drug maker in the death of a Hawaii man who killed himself and his wife 10 days after he began taking Prozac. (However, a motion for a new trial was heard on July 1, due to complaints by two jurors that they did not actually concur with the supposedly unanimous verdict. A ruling is expected shortly.)
"Litigation [against Lilly] has never worked," Newton claims, though he acknowledges that Lilly has settled some lawsuits out of court. Newton claims the number is "very small" and they were made strictly as a business decision to avoid tying up company scientists and lawyers. Vickery says he settled nine Lilly cases last year alone, and has several more pending or waiting to be filed.
The idea that SSRIs can trigger suicidal or homicidal behavior is far from new. Indeed, the issue first exploded into public consciousness 10 years ago, when a former employee of a Louisville printing plant, Joseph Wesbecker, strolled into the plant with an AK-47 and started shooting. He killed eight people, wounded 12 and then turned the gun on himself.
Wesbecker had been taking Prozac for about a month, a fact seized upon by attorneys for the shooting victims and trumpeted on TV talk shows. Wesbecker's sons did Larry King Live; one of the surviving victims went on the Donahue show for a program called "Prozac: the medication that makes you kill." They claimed that Wesbecker had never been violent prior to taking Prozac.
But that claim was disputed by accounts in the local newspapers, which portrayed Wesbecker as a man with a deeply troubled past who had been hospitalized for mental disorders on three occasions, had made numerous suicide attempts and had reportedly told his wife a year before his rampage that he'd like to go to the plant "and shoot a bunch of people."
About the time of the Louisville shooting, Harvard psychiatrists were finishing up an article for the American Journal of Psychiatry about six patients who "developed intense violent suicidal preoccupation" after taking Prozac for two to seven weeks. While three of the patients had attempted suicide in the past as a result of their depression, none were suicidal at the time they started on Prozac, the authors reported, and none had experienced suicidal urges on other psychiatric drugs. For all of them, their fixation with dying abated after they stopped taking the drug.
The article, coauthored by a leading expert on psychiatric drugs, sparked great interest and controversy within the psychiatric and pharmaceutical world. Other clinicians soon weighed in. A series of journal articles reported on cases in which patients on Prozac developed akathisia. When they stopped taking the medications, the researchers reported, the violent or suicidal urges abated.
Eli Lilly itself disputed the validity of case reports involving individual patients, criticizing them as inferior to the randomized clinical trials the firm had sponsored involving thousands of patients. Those studies, the company claimed, showed no evidence of suicidal impulses emerging among patients taking Prozac. Other researchers agreed with Eli Lilly, and submitted their own studies that found no increased suicide risk from Prozac.
In 1991, the FDA joined the fray, assembling a panel of experts to study the issue of Prozac and suicide and report back. The panel's conclusion: There was no credible evidence linking the drug to acts of suicide or violence.
Though critics complained that the panel had been stacked with paid consultants to Eli Lilly, its opinion -- coupled with Eli Lilly's success in dismissing or settling out of court scores of lawsuits -- seemed to settle the issue and remove it from the public spotlight. Until now.
Now the Hartman case and two violent school shootings committed by teenagers on antidepressants have pushed the issue back into the headlines. Eric Harris, one of the teenage gunmen at Columbine High in Littleton, Colo., was taking the antidepressant Luvox to treat obsessive-compulsive disorder. Kip Kinkle, the 15-year-old Illinois boy who killed his parents and two classmates last year before trying to take his own life, was reportedly on Prozac.
These two sensational cases, trotted out by critics of psychiatry like Breggin and columnist Arianna Huffington may, in fact, be poor examples. Kip Kinkle was reportedly obsessed with guns long before he started taking Prozac nearly two years before his rampage. And Eric Harris' carnage, far from an act of drug-addled rage, had been meticulously planned for months.
And then there was Brynn Hartman. Given the cocaine and alcohol in her system, could any jury be made to believe that Zoloft was responsible, rather than the booze or the drugs? Perhaps there was a terrible interacion between all three substances -- the Zoloft package label does warn that the drug should not be taken in conjunction with alcohol. It does not specifically mention cocaine, though common sense suggests that combining the drugs would not be the smartest idea.
The lawyers for the Hartman family will try to make the case that Brynn's behavior changed during the two weeks or so during which she took the Zoloft, immediately prior to the killings. They argue in the complaint that her symptoms started several days before the shootings. She was having trouble sleeping, the suit claims, and complained that she felt "weird," telling her nanny that she was having adverse effects from the drug. She told one friend that she was "going to jump out of her skin" and the friend advised her to talk to Sorosky. The lawsuit claims that on May 24, four days before her death, she called him and told him about her reaction the drug. His advice, according to the complaint: Cut the dosage in half.
When Kathryn Alice turned on her TV and learned of the Hartman deaths, she was stunned. "I never saw a sign of her being that off-balance," she says. "She had a real strong instinct to protect her children. She was very involved with her kids and very concerned -- constantly setting up play dates and picking them up and dropping them off. She was a really good mother."
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