Boy's Murder Case Entangled in Fight Over Antidepressants

Boy's Murder Case Entangled in Fight Over Antidepressants

By BARRY MEIER
http://www.nytimes.com/2004/08/23/business/23drug.html

Christopher Pittman said he remembered everything about that night in
late 2001 when he killed his grandparents: the blood, the shotgun
blasts, the voices urging him on, even the smoke detectors that
screamed as he drove away from their rural South Carolina home after
setting it on fire.

"Something kept telling me to do it," he later told a forensic
psychiatrist.

Now, Christopher, who was 12 years old at the time of the killings,
faces charges of first-degree murder. The decision by a local
prosecutor to try him as an adult could send him to prison for life.
While prosecutors portray him as a troubled killer, his defenders say
the killings occurred for a reason beyond the boy's control - a
reaction to the antidepressant Zoloft, a drug he had started taking
for depression not long before the slayings.

Such defenses, which have been used before, have rarely succeeded.
And most medical experts do not believe there is a link between
antidepressants and acts of extreme violence.

But the Pittman case has attracted special attention because it is
among the first to arise amid a national debate over the safety of
antidepressant use in children and teenagers. Depression is a complex
condition, and antidepressants like Zoloft have helped countless
children and adults.

In recent months, however, the federal Food and Drug Administration
has been examining data from clinical trials indicating that some
depressed children and adolescents taking antidepressants think more
about suicide and attempt it more often than patients given placebos.
The findings varied between drugs. The F.D.A. is scheduled to hold an
advisory committee meeting on the issue next month.

Against that backdrop, the case of Christopher Pittman - an otherwise
obscure small-town murder case that may go to trial this fall - has
become a battleground, where the scientific threads of the F.D.A.
debate have become entangled with courtroom arguments and a family's
tragedy.

Pfizer
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the maker of Zoloft, has helped the county solicitor who is
prosecuting Christopher Pittman. Plaintiffs' lawyers from Houston and
Los Angeles, who between them have brought numerous civil lawsuits
against Pfizer and other antidepressant makers, have signed onto the
defense team. Groups opposed to pediatric antidepressant use have
also championed the boy's case, which is being played out in Chester,
S.C., a small town near the North Carolina border.

Locally, some people involved in the Pittman case said they have been
stunned by the rush of outsiders. Even a forensic psychiatrist, who
testified at a hearing that she believed that Christopher committed
the murders while in a psychotic state induced by Zoloft, said she
worried that the publicity may frighten parents whose children could
benefit from Zoloft and similar drugs.

"I wished it could be staying in Chester, S.C., with this one kid,"
said the psychiatrist, Dr. Lanette Atkins of nearby Columbia, S.C.,
who has been retained by Christopher's public defender.

While the pediatric antidepressant debate has focused on potential
suicide risks, aggressive behavior can be a side effect of
antidepressants. There have also been case reports of adults and
children on antidepressants acting violently. But only a handful of
psychiatrists have ever argued that such medications can unleash
rages so uncontrollable as to overwhelm a person's ability to
distinguish between right and wrong and commit murder.

With the Pittman case pending, Pfizer, based in New York, declined to
make company executives or lawyers available to be interviewed for
this article. The company has previously said that no regulatory
agency has ever found a connection between Zoloft and suicidal or
homicidal behavior.

Zoloft belongs to a class of medications known as selective serotonin
reuptake inhibitors, or S.S.R.I.'s, which also includes other popular
drugs like Paxil and Prozac. In the last year, federal drug
regulators have issued cautionary statements about most S.S.R.I.'s
and similar medications prescribed for the treatment of pediatric
depression. The one exception has been Prozac, the only S.S.R.I.
formally approved for pediatric use after it was shown to be
effective in tests with children and adolescents.

Regulators issued their advisories after a re-examination of drug
makers' test data, much of which had not been publicly released. The
disclosure of the test results has spurred demands by doctors' groups
and others that drug companies be required to list all drug tests
publicly, and a few producers have announced plans to do so.

If for some doctors such controversies seemed to have sprung up
suddenly, the issues behind them were already stirring about three
years ago - right around the time that Christopher Pittman fired four
shotgun blasts into his grandparents as they slept.

A Last Chance Goes Wrong

When Christopher Pittman arrived in Chester in October 2001 to live
with his paternal grandparents, Joe and Joy Pittman, the move seemed
like his last, best chance to find stability.

He felt abandoned by his mother, according to medical reports. And
his relationship with his father, who raised him in Florida, was
troubled.
"I haven't had that good a life; my real mom left when I was 2,"
Christopher Pittman told a forensic psychiatrist with the South
Carolina Department of Juvenile Justice.

Psychiatric reports suggest that Christopher's tailspin began when
his parents revived their relationship in 2001, only to end it yet
again.
After his mother left this time, he threatened to kill himself and
was hospitalized. His diagnosis, records show, was mild chronic
depression accompanied by defiant and negative behavior. He was put
on Paxil.

But after about a week, his father, also named Joe, decided to remove
him from the hospital and send him to live with his grandparents.
There, a doctor put Christopher on Zoloft, the most widely prescribed
S.S.R.I. antidepressant for pediatric patients and adults alike.

Initially, Christopher Pittman appeared to thrive. After a few weeks
in Chester, though, he got into a dispute on a school bus and his
grandparents threatened to send him back to his father. By the next
morning, they were dead.

Dr. Pamela M. Crawford, a forensic psychiatrist who was asked by the
case's prosecutor to examine the boy, concluded in her report that
Christopher knew what he was doing when he took his grandparents'
lives.

He provided "nonpsychotic reasons" for killing his grandparents,
setting fire to the house, taking money from his grandparents and
then stealing their car, Dr. Crawford's report states. "Following his
detention by police, Christopher made self-protective statements to
avoid arrest prior to admitting his actions."

Citing the continuing case, both Dr. Crawford and Dr. Atkins, the
other forensic psychiatrist, declined to answer questions about their
reports or court testimony.

At the time of the murders, questions about the safety of
antidepressants were focused on adults, not youngsters. Just a few
months earlier, a plaintiff's lawyer, Arnold Vickery, who is known as
Andy, had convinced a federal jury hearing a lawsuit in Cheyenne,
Wyo., that Paxil had caused a man to go on a murderous rampage.

In June 2001, that jury ordered GlaxoSmithKline
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the maker of Paxil, to pay $6.5 million to the relatives of Donald
Schell, who, two days after starting on the drug, murdered his wife,
his daughter and his granddaughter before killing himself. The
company appealed, before settling the case, for undisclosed terms.

It is hard to draw comparisons between civil lawsuits and criminal
cases like the one involving Christopher Pittman. Still, the Wyoming
verdict was significant because it was the first time, after more
than a decade of litigation, that a jury had concluded that an
S.S.R.I.-type antidepressant could make users so agitated and
unbalanced that they could kill others or themselves.

The Wyoming award has not led to similar verdicts, and drug makers
like Pfizer take the position that antidepressants do not cause
suicide or homicide.

Contradictory Reports

Little is known about Christopher Pittman's response to Paxil,
because he took the drug for only a few days. And reports about his
reactions to Zoloft vary sharply.

He later told a psychiatrist that his mood changed on the medication,
to the extent that he "didn't have any feelings."

The notes of the local doctor who prescribed the medication for
Christopher paint a different picture, according to court records.

That physician, who saw Christopher just a few days before the
killings, described him this way: "Lots of energy. No plans to harm
self. Not flying off the handle."

Psychiatrists have long known that adult patients might experience
increased suicidal thinking or agitation during the first weeks of
treatment with S.S.R.I.-type antidepressants. But in May 2003
GlaxoSmithKline made a disclosure related to pediatric use of the
drug, which would set off a cascade of events that are still in
motion.

That month, the drug maker told the federal Food and Drug
Administration and its British counterpart agency that its re-
examination of published and unpublished test data showed that
adolescents who took Paxil during clinical trials had more suicidal
thoughts or attempted suicide more often than those who received a
placebo. About six months earlier, a curious F.D.A. analyst had
contacted the company seeking more safety information.

Within weeks, British drug regulators told doctors not to prescribe
Paxil to new patients younger than 18. In June 2003, the F.D.A
followed suit, and a month later the agency asked all antidepressant
makers for more safety data about their pediatric tests. In the weeks
leading up to an emotionally charged F.D.A. hearing this past
February on antidepressant safety, doctors learned that the drug
industry had not published all the data gathered during pediatric
trials of the medications.

Dr. David G. Fassler, a child and adolescent psychiatrist in
Burlington, Vt., who attended the meeting, recalled being struck by
the number of pediatric studies he had never known about although he
followed medical journals.

"This was a lot more data than I knew existed," said Dr. Fassler, who
is an official of the American Academy of Child and Adolescent
Psychiatry, a professional group. That hearing also served as a
public forum for grieving parents to testify about children who had
committed suicide soon after they had started on antidepressants. Joe
Pittman, Christopher's father, was there, reading a letter written by
his son in prison, in which he blamed Zoloft for his grandparents'
deaths.

"Through the whole thing, it was like watching your favorite TV
show," wrote Christopher, who is now 15. "You know what is going to
happen but you can't do anything to stop it." A Gathering of Lawyers

By then, his case had become the center of a pitched legal struggle.
Mr. Vickery, the plaintiffs' lawyer who had won the Wyoming trial,
was contacted about the Pittman case by the International Coalition
for Drug Awareness, a group based in Utah opposed to antidepressant
use.

Over the past decade, the group's director, Ann Blake Tracy, has
become involved in several murder cases in which a defendant has been
on antidepressants or other drugs. Ms. Tracy maintains that
antidepressants "overstimulate the brain stem and cause you to go
into a sleep-walk state where you can act out the nightmares you
have." Mr. Vickery, who has been suing antidepressant makers since
the mid-1990's, soon joined the defense team, offering his services
for free. So did another plaintiffs' lawyer who has filed similar
lawsuits, Karen Barth Menzies of Los Angeles.

Lawyers for Pfizer have also gotten involved. The case's prosecutor,
Chester County Solicitor John R. Justice, was recently hospitalized
with a serious illness and has not been available to comment. But he
stated at a court hearing that Pfizer had provided information to him
last year to help him prepare for the trial, according to a published
report in The Herald, a newspaper in Rock Hill, S.C.

Christopher Taylor, an assistant country solicitor, said he thought
that Pfizer had contacted Mr. Justice. The material provided by
Pfizer, the article reported, included F.D.A. reports about Zoloft
and previous court testimony by a psychiatrist, Dr. Peter R. Breggin,
who is scheduled to testify on Christopher Pittman's behalf. Dr.
Breggin, who has campaigned against the use of psychotropic drugs in
children, has testified in numerous lawsuits and criminal trials that
a link exists between S.S.R.I.-type antidepressants and both suicide
and violence -positions rejected by drug makers like Pfizer and by
many other experts.

"I have been given advice on how to cross Breggin," Mr. Justice was
quoted as saying, adding that he had "been schooled on how these
drugs are supposed to work."

The involvement of a drug company like Pfizer in a criminal
proceeding is not unusual. Jennifer Yoder, a spokeswoman for Eli
Lilly & Company, the maker of Prozac, said that over the years,
a "Prozac defense" had been raised about 75 times in criminal cases
and that the company had worked with prosecutors at times. She said
she was unaware of any case in which the Prozac defense succeeded.

Not long ago, Mr. Vickery and Ms. Menzies asked the case's presiding
judge to order the release of scores of Pfizer company documents
about pediatric trials of Zoloft, claiming they were critical to
their client's case. Those records were reviewed in the past by Ms.
Menzies, the plaintiffs' lawyer, as part of a 2002 civil lawsuit
filed in a Los Angeles federal court against Pfizer by the widow of a
man who committed suicide a week after starting on Zoloft. The case
was dismissed before trial.

According to court filings, the documents include early drafts of a
published positive pediatric report about Zoloft that was later
criticized by researchers for its methodology. F.D.A. officials also
did not find that the study provided convincing evidence of Zoloft's
efficacy in children and adolescents. Both Mr. Vickery and Ms.
Menzies said they were barred from speaking specifically about the
Pfizer documents because they were covered by confidentially
agreements they had signed during civil proceedings. But with the
Pittman defense, "I am hopeful that this case is the one that all of
Pfizer's dirty laundry comes out," Mr. Vickery said.

Pfizer's lawyers have argued in court papers in the Pittman case that
the documents being sought have nothing to do with the boy's
situation, also noting that a Florida judge struck down a request for
company records in a similar case. In addition, they have effectively
accused Mr. Vickery and Ms. Menzies of using the case to make a
cynical end run in order to obtain documents they want for other
Zoloft-related lawsuits they are pursuing.

A Case in Limbo

A Pfizer spokeswoman, Mariann Caprino, said in an e-mail message that
Mr. Vickery had made a business out of suing antidepressant
makers. "In his three cases against Pfizer that were decided by the
court in which he claimed Zoloft caused suicide, each case was
decided in Pfizer's favor and dismissed by the court," she stated.

The case's presiding judge has yet to rule on the document disclosure
issue.

Christopher Pittman's trial, scheduled to begin this fall, may be
delayed because of the illness of Mr. Justice, the prosecutor. The
teenager's lawyers are trying to move his case to juvenile court,
where if convicted, he would be released by age 21 from a juvenile
facility.

Meanwhile, lawyers like Mr. Vickery have continued to file lawsuits.
Although Mr. Vickery failed earlier this year in his first attempt
use an S.S.R.I. defense to win an acquittal in a murder case, at a
trial in Detroit, the calculus of such cases may be changing.

In April, a time of intense media publicity about the issue, a man
was acquitted of attempted murder after a state jury in Santa Cruz,
Calif., found that he was not liable for his actions because of a
reaction to Zoloft.

The case's prosecutor, Barbara Rizzieri, an assistant district
attorney for Santa Cruz County, said the growing debate about
antidepressants had played a role in the outcome. "If this had
happened a year ago," she said "it truly would have been different."

Christopher Pittman and his grandfather Joe in a family photo that
was charred in the fire Christopher is accused of setting.

Jim Stratakos/The Herald
Christopher Pittman entering a courtroom in Chester County, S.C. He
faces charges of first-degree murder.
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Little known in cases like this where Christopher killed his grandparents is
the fact (as I know it) is possibly that one or more of his parents or
grandparents were on an anti-depressant or some other stimulant. That is a
question that should be investigated by the defense. The emphasis is on the
fact that Christopher was on an anti-depressant when his parents or
grandparents could also have been on anti-depressants.
That would make all the difference in the world. His parents or grandparents
taking anti-depressants could have affected Christopher is such a negative and
harmful way as to alter his physical condition or mental condition. I have
seen the most gentle people attack another not because they were taking an
anti-depressant, but some other person they were in mental contact with was
taking an anti-depressant.
Before jumping to conclusions that this cannot be so, I will state that crohns
illness is caused by such a factor and it is the sole cause of crohns and UC,
Strange and illogical tho it may appear, it begs researching to verify its
truth.
Too many innocent people are regarded as killers when they have no control over
their body or emotions when under the mind/body connection that is literally
gotten from a friend or relative on a stimulant whether in the same room or
miles apart. Many times a child will die under the care of someone who is
held liable, and actually it was the parent on a stimulant causing the childs
death.
Too many variances under the influence of stimulants for a fair evaluation of
innocence or guilt.
The pharmaceutical companies should be sued for their ignorance of what
anti-depressants can do and will not do to research this aspect of stimulants.
Include Xanax, Buspar, Depakote, Flexeril, natural herbs with natural
stimulants, kava kava, st johns wort in the harmful category of causing out of
control illness and behavior.
More infomation on my website on the layman's theory of the cause of crohns.
http://ascc.healingwell.com/info/gailfaq.htm
TRUE, TRUE, TRUE, TRUE.
whatever science says. Their explanation for crohns and a myriad of other
unrecognized symptoms of crohns does not address the clear fact that they are
not on a course of finding the cause no matter what is spent or said that the
cure is imminent.
Simply justifying chasing a rainbow that doesn't exist.
Again, the question to ask is "Were or are the parents or grandparents taking
anti-depressants or any stimulants. That should be ruled out as a first step.
The child taking anti-depressants then can be dealt within more certainty that
perhaps the anti-depressant he was taking was responsible or not.

Gail Michael

Many children on anti-depressants have friends or parents on anti-depressants
is a fact that should be investigated.