So, I decided to drop 30 min or so doing a quick literature search on PubMed. Keywords: SSRIs + violence. Like, I said, quick and dirty. Annotated bibliography below of three relevant studies.

Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study. PLoS Med. 2015;12(9):e1001875. https://doi.org/10.1371/journal.pmed.1001875

A retrospective study of 850K Swedes prescribed SSRIs between 2006-09 showed correlation with violent crimes in patients from 15-24y, but not in those older than 25. More arrests and more convictions for violent crimes. True in males and females. More non-violent arrests and convictions. Higher rates of outpatient treatment and ER visits for alcohol abuse.

Hemminki E, Merikukka M, Gissler M, et al. Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort. J Epidemiol Community Health. 2017;71(1):12-18. https://doi.org/10.1136/jech-2016-207265

A retrospective study of a Finnish cohort of individuals born in 1987 and followed for 18 years showed higher rates of SSRI use among those convicted of crimes as teenagers.

Moore TJ, Glenmullen J, Furberg CD. Prescription Drugs Associated with Reports of Violence Towards Others. PLoS One. 2010;5(12):e15337. https://doi.org/10.1371/journal.pone.0015337

Of 1527 cases of violence reported as adverse drug effects to the FDA, associations were identified between violence and 31 drugs. Varenicline (Chantix) was highest. The SSRIs and several SNRIs (venlafaxine, desvenlafaxine, atomoxetine) all showed disproportionately high rates of ADEs of violent behavior.

Key thoughts:

• These are all retrospectives, meaning they cannot prove causality, only demonstrate correlation. Don't overinterpret.
• While the hazard ratios on all of these ended up being somewhere between 1-100% increased risk of violent behavior, the absolute risk increase was small, usually less than 3%. We're talking about a very small percentage of the overall number of people taking these drugs.
• None of these studies directly address gun violence or school shootings, which is what we're trying to assess. There may be such a study, but in my 30 min search, I didn't find it.

Conclusion:

• There may be something here. It's smaller than we think, more specific than we think. And we'd need much better evidence to say it conclusively. However, we're looking at some significant smoke, and where there's smoke, there's usually a fire. That's my thinking. It's worth what you paid for it. You should, of course, do your own thinking.

So, I decided to drop 30 min or so doing a quick literature search on PubMed. Keywords: SSRIs + violence. Like, I said, quick and dirty. Annotated bibliography below of three relevant studies.

Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study. PLoS Med. 2015;12(9):e1001875. https://doi.org/10.1371/journal.pmed.1001875

A retrospective study of 850K Swedes prescribed SSRIs between 2006-09 showed correlation with violent crimes in patients from 15-24y, but not in those older than 25. More arrests and more convictions for violent crimes. True in males and females. More non-violent arrests and convictions. Higher rates of outpatient treatment and ER visits for alcohol abuse.

Hemminki E, Merikukka M, Gissler M, et al. Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort. J Epidemiol Community Health. 2017;71(1):12-18. https://doi.org/10.1136/jech-2016-207265

A retrospective study of a Finnish cohort of individuals born in 1987 and followed for 18 years showed higher rates of SSRI use among those convicted of crimes as teenagers.

Moore TJ, Glenmullen J, Furberg CD. Prescription Drugs Associated with Reports of Violence Towards Others. PLoS One. 2010;5(12):e15337. https://doi.org/10.1371/journal.pone.0015337

Of 1527 cases of violence reported as adverse drug effects to the FDA, associations were identified between violence and 31 drugs. Varenicline (Chantix) was highest. The SSRIs and several SNRIs (venlafaxine, desvenlafaxine, atomoxetine) all showed disproportionately high rates of ADEs of violent behavior.

Key thoughts:

• These are all retrospectives, meaning they cannot prove causality, only demonstrate correlation. Don't overinterpret.
• While the hazard ratios on all of these ended up being somewhere between 1-100% increased risk of violent behavior, the absolute risk increase was small, usually less than 3%. We're talking about a very small percentage of the overall number of people taking these drugs.
• None of these studies directly address gun violence or school shootings, which is what we're trying to assess. There may be such a study, but in my 30 min search, I didn't find it.

Conclusion:

• There may be something here. It's smaller than we think, more specific than we think. And we'd need much better evidence to say it conclusively. However, we're looking at some significant smoke, and where there's smoke, there's usually a fire. That's my thinking. It's worth what you paid for it. You should, of course, do your own thinking.